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CITY OF ST A,'�THONY <br /> DEPARTMENT OF LICENSING <br /> Date: "I <br /> Cts LFA <br /> The following is an application for use of 3.2 beer/in City Parks. <br /> FULL NAME OF APPLICANT: V <br /> (Must work in St. Anthony or lie in St. Anthony) <br /> ADDRESS: r� ' /�'�C V�V P46&, <br /> AGE: <br /> - <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I arl responsible for con t of his/her group. <br /> Signature df ApOicant <br /> NAME OF GROUT.. <br /> # IN GROUP: <br /> LOCATI N: <br /> DATE: HOURS: <br /> TELEPHONE#: <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 />