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• CITY OF ST A.NTH01'Y <br /> DEPAMIENT OF LICENSING <br /> Date: Iq T <br /> The following is an application for u ebf 3.2 beer in Ci Parks. <br /> FULL ;NAME OF APPLICANT: �f) <br /> (Must work in St. Anthony or ve in . Anthony) <br /> ADDRESS: f-t L(-D 1= A <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I e onsible for con <br /> o of his/her group. <br /> a72 �� <br /> • Signature o ppli t <br /> NAME OF GROUP: M-v k;f I U)C= L L <br /> # IN GROUP: /o v - /-1_�) <br /> LOCATIOCc—::A <br /> DATE: HOURS: 5 — <br /> TELEPHONE#: ,?K�j �=iZC <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: n <br /> RETURNED: <br />