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• CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date•)?d4'f <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT:- <br /> (Must work in St. Anthony or live in St. Anthony)-, <br /> ADDRESS-31/4 <br /> AGE: <br /> I certify that I am a esident of St. Anthony or ork in the City. <br /> responsible for condu of his/her group. <br /> Signature of Applicant <br /> NAME OF GROUP: <br /> # IN GROUP: 9r- <br /> LOC AON: <br /> DATE- OURS: .zd o�adz <br /> TELONE#: <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:;4,—y/—/ <br /> RETURNED: <br />