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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: ma /8 A <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: nd L4l"1 G Ct S G/L_ <br /> (Must work in St. Anthonyor liv in St. Anthony) <br /> ADDRESS: �J O $ aKL Cr o4 •.-n 1A b y <br /> o <br /> AGE: 3 5 <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 /> • J Signature o Applicant <br /> NAME OF GROUP: LLAII Pow <br /> # IN GROUP: <br /> LOCATIO : a—V 't � " _ 9L-r <br /> DATE: 57.7-? HOURS: b rl i fe, <br /> TELEPHONE#: <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: 6? <br /> RETURNED: <br />