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6,►c) <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 />Alcohol & Gambling Enforcement APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization Date organized Tax exempt number <br />Huv o L(oc.3 C u �3 IF l� 7s Y'V2337s <br />Address <br />City <br />State <br />Zip Code <br />14 v e\cD <br />Minnesota <br />Name of person making application <br />Business phone Home phone <br />MAw-, <br />I 6(2 -Ss cj-146s-/—q-2q—(Tj <br />Date(s) of event <br />Type of organization <br />13 2,o(6 <br />RClub ❑ Charitable <br />❑ Religious ❑ Other <br />non-profit <br />Organization officer's name <br />City <br />State <br />Zip Code <br />m(C�Ret Skfq-,(1 <br />I <br />Minnesota <br />�S(�Q <br />Organization officer's name <br />Ciity1 <br />State <br />Zip Code <br />lR �A(.�Zo� <br />' > <br />(S( V P <br />l`"iU0 U <br />Minnesota <br />Organization officer's name <br />City <br />State <br />Zip Code <br />8 V\ e- 1-Iru2-Y <br />�c22'iAfZ <br />C, <br />Minnesota <br />__yo <br />Organization officer's name <br />City <br />State <br />Zip Code <br />VhACL14 -e( - 02:t <br />Av. O <br />Minnesota <br />5-5038 <br />Location where permit will be used. If an outdoor area, describe. j � �i (� Too( <br />"'� _moi llv <br />HAo4l- Fr -t45- "'S' <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />/V/� <br />If the applicant will carry liq�yluor liability insurance please provide the carrier's name and amount of coverage. <br />[,rvc1S Gl,.la .L h"}�26'Lh-'FrorvtC (� pGc>�OOU <br />6J2-S"T Qer"Ck jr-.9, <br />tf 000�c�00 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />04 a-1-1,4 6 <br />City or County apprbvingthelicense Date Approved <br />1� <br />Fee Amount Permit Date <br />Date Fee Paid City or County E-mail Address <br />/ n City or County Phone Number <br />Sig a Ure, rty Clerk or County 0 iva Approved Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days priorto 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(o)STATE.MN.US <br />