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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: �; /` �' 3 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLIC V\TT: h11 C1g to EL kGB AP-C A <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: a 6/ 7 3,;k <br /> AGE: 3 <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am responsible for conduct of his/her group. <br /> Signature of Applicant <br /> f <br /> NAME OF GROUP: NT 5 y S <br /> # IN GROU;Az!Lj LOCAT ION: <DATE: _2 r HOURS: 9z _30 TELEPHONE#: / <br /> ;? - 93�O � / �3-� X0/9 <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) J <br /> RECEIVED BY: <br /> RETURNED: <br />