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• CITY OF ST &NTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: 9 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT:- -Lie- <br /> (Must <br /> PPLICANT: S�-- e-_ <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: 3 b� -' ' �d C�yl D4. <br /> AGE: 3's� <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 Appl cant <br /> 1 <br /> NAME OF GROUP: <br /> # IN GROUP: /D0 l "A'04e l <br /> LOCATIO U ' i'oh 2r1 GC�Y�G <br /> DATE: 9 JR2 HOURS: 2— ' <br /> TELEPH NE#: 71�S- <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 />