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• CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> `i <br /> Date• G' 2 •�� <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT:a'/AW(9a VA-- 'ICcU ' (�C/��'� <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: �3 ,due, 13 .6'• <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 /> Signature.of Applicant Terms( <br /> NAME OF GROUP: , ?t c n t C,1- <br /> # IN GROUP: <br /> LOCATION: <br /> DATE: '61•I957•61L HOURS: <br /> TELEPHONE#: - Z9�l 2-2-1-Ke or 1 a l• 35 . <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 />