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CITY OF ST ANTHO N-Y <br /> DEPARTINIENT OF LICEtiSI\G <br /> Date: <br /> The folloAing is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT. ���ES'4P (S`- M l ey C''lv Iv <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: o�ZJ 0 h0b t✓� <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I responsible for conduct of his/her group. <br /> a . <br /> • ignature of Applicant <br /> NAME OF GROUP: -:-KO-)( <br /> # IN GROUP: 1 o o <br /> LOCATION: C e Y�7V g a L 17ca-Q K <br /> DATE: `T --Q HOURS: /:R Ncxcli — %U 0�? <br /> TELEPHONE#: U) - -1P.9--721 <br /> 7 L dC� �`� ✓ <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 />