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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING/PERMITS <br /> The following is application for use of liquors, including non-toxieating malt <br /> liquor (3. 2 Beer) in City parks. <br /> FULL NAME OF APPLICANT <br /> ADDRESS <'lr:h� �;1- }1 � 7cY - 'Vvo <br /> AGE :� ;S Q,u� • �� -- ���. Grit-�� <br /> / Q�3 <br /> I certify that I am a resident of St. Anthony/or work in City of St. Anthony. <br /> I am responsible for conduct of his/her group. <br /> - X <br /> Sign ure of applicant <br /> NAME OF GROUP <br /> $50.00 <br /> Cleanup Deposit <br /> PARK LOCATION <br /> Received by; C ��►uy t c� <br /> � �3 <br />