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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: 1,2 7 19.5" <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: a�� �Sr q�i-rya•y�/ ��' <br /> AGE: <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 /> ignature of Applicant <br /> NAME OF GROUP: To 4- Ife v A�' <br /> # IN GROUP: <br /> LOCATION: C'��r.�,a/ /t`Rr <br /> DATE: '71-0-19S_ HOURS: /— <br /> TELEPHONE#: 7,5V- .9 7611 <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: ZL <br /> RETURNED: <br />