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Alcohol & Gambling Enforcement <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />445 Minnesota Street, Suite 222, St. Paul, MN 55101 <br />651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization <br />Date organized Tax exempt number <br />[4L o L) <br />E ms- I 1,54/`)337S_ <br />Address <br />City State Zip Code <br />(BCS (1bh 2`)U <br />I-� p Minnesota <br />Name of person making application <br />Business phone Home phone <br />MAO -V, <br />24-17 <br />6(2-RT?-(`FCf 1 I s/-4�/S' <br />Date(s) of event <br />Type of organization <br />7-16 - ) 6 —7-1-7 -16 <br />❑ Club 0 Charitable Ej Religious F1 Other non-profit <br />Organization officer's name <br />City State Zip Code <br />m t e S h et+rz,+({�_� <br />Minnesota <br />SSd3 <br />Organization officer's name <br />City State Zip Code <br />0,4h (3 :� ITIAA -2Q iZ <br />HuAci <br />Minnesota S303g <br />Organization officer's name <br />City State Zip Code <br />(\(\A \A MV— tj ei -Qovcr <br />t- Lj Minnesota ,5'c5�Q3� <br />Organization officer's name <br />City State Zip Code <br />Minnesota <br />Location where permit will be used. If an outdoor area, describe. <br />%,IA W+hS Game PMe-SCCzve - <br />lAIJe).o +mv\. <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />in N <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />West Bey\c;, ` ir.S C6 tj©oof000 <br />LtoinS C(u6S Zh-kMVWyowl\ Ir000.(006 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City or County approving the license Date Approved <br />�3O <br />Fee Amount Permit Date <br />Date Fee Paid City or County E-mail Address <br />City or County Phone Number <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event. <br />ONE SUBMISSION PER EMAIL, APPLICATION ONLY. <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITY/COUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITY/COUNTY TO AGE.TEMPORARYAPPLICATION@STATE MN US <br />