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CITY OF ST kNTHO.NY <br /> DEPARTMENT OF LICENSING <br /> Date: <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: <br /> AGE: 77 <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 /> Signature of Applicant <br /> NAME OF GROUP: �iLz o n. -�—N -� <br /> # IN GROUP: cLc7 <br /> LOCATION: <br /> DATE: _4 r HOURS: <br /> TELEPHONE#: 7 c'/— :2 2 1/2 <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 />