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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING TODAY.�S DATE; <br /> 'Clue following is application for us of 3.2 leer. 3.n City Parks. <br /> GI/.� . - -- (MUST WORK IN ST: ANTIIONY OR <br /> FULL NAME OF APPLICANT: LIVE IN ST. ANTHONY) <br /> ADDRESS: <br /> AGC:_ <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 /> NAME OF GROUP: G /✓u <br /> Sign re o App scant -� <br /> # =n Group <br /> LOCATION: <br /> DATE OF EVENT._ r_ �•�~J <br /> $50.00 Clean-up Deposit: 7 .lJ�C I'W- //%77 <br /> Received By <br />