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CITY Or ST. ANTHONY c <br /> DEPARTMENT OF LICENSING TODAY!,S DATE; - 7 <br /> Tlic following is application for use of 3. 2 beMe.r. \i in City Parks. <br /> PULL NAME OF APPLICANT: d) ► S I ` ` �1 (t9UST WORK IN ST. ANTIIONY OR <br /> LIVE IN ST. ANTHONY) <br /> n � n <br /> ADDRESS: 3 f <br /> ACE: V <br /> I certify I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am re ns' e r conduct of his/her group. <br /> S gna ure o AI � scant <br /> NAME OIL' GROUP. <br /> # ;n Group: SO <br /> LOCATION:— Cl iw-lL <br /> ~ DATE OP' EVENT: <br /> $50.00 Clean-up Deposit: <br /> Received Dy Q�A <br />