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• CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: i5`AAlt <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT:\—Lc-)(L,vv <br /> (Must work in St. Anthony or We in St. Anthony) �„� <br /> ADDRESS: <br /> AGE: _ <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am res siblefor conduc of his/her group. <br /> • ignature of Applicant <br /> NAME OF GROUP: .=�- <br /> # IN GROUP: So'—� <br /> LOCATION: <br /> DATE: La4, ao kcicik HOURS: —ti 30 <br /> TELEPHO E#• 7- -5sceG <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: <br /> RETURNED: <br />