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• CITY OF ST kNTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: Y C-21 <br /> The following is an application for us of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: <br /> (Must work in St. Anthony or live in St. Anthon ) <br /> �( n <br /> ADDRESS: 3 T� LLD MEk <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I esponsibl for co uct of his/her group. <br /> • Sigtu <br /> nare o p icant <br /> NAME OF GROUT?: �C- <br /> # IN GROUP- <br /> LOCATION: X L PiW — [Z� <br /> DATE: O RS:4 — <br /> TELEPHONE#: '7$'v`2- 9 5-CL <br /> $50.00 CLEAN-UP DEPOSIT: <br /> (You are responsible for Park Clean-up, the deposit will be returned after inspection of the <br /> Park) <br /> RECEIVED BY: <br /> RETURNED: <br /> • <br />