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CITY OF ST ANTHONY <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: ��M4& 2. ' ` 44�s <br /> (Must work in St Anthony or live in St. Anthony) <br /> ADDRESS: <br /> AGE: <br /> I certify that I am a resident of St Anthony or work in the City. <br /> V4kVof <br /> for conduct of his/her group. <br /> licant <br /> NAME OF GROUP: l /� �i�'�1�J/�. �C, <br /> # IN GROUP: 3 <br /> LOCAT ION: C <br /> DATE: / HOURS: J-20 <br /> TELEPHO E#: ,q rl-- 3�7� ��• �! <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 />