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Minnesota Department of Public Safety <br />-� pa y <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 <br />Date organized Tax exempt number <br />H uc\o Li ovts C U6 <br />1 G7s .5 F0(4S-013 <br />Address <br />City State Zip Code <br />Pb Qwr ,--1 <br />u' v Minnesota <br />Name of person making application <br />Business phone Home phone <br />A k- ei o <br />6�1- q 2Q <br />Date(s) of event <br />Type of organization <br />J.r,,e_ SPf'` <br />[] Club ErCharitable ❑ Religious Othernon-profit <br />Organization officer's name <br />City State Zip Code <br />L/AA l9^% ,hzrvt­ <br />iL Minnesota I I�Sc3�4 <br />Organization officer's name <br />City State Zip Code <br />Il 11-1110uvv-s <br />H nr C, Minnesota s, 63& <br />Organization officer's name <br />City State Zip Code <br />C_t Q-Zpe <br />{jt-1t13, �k� Minnesota <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 />Lcb^S RA t`2�_-_ ; l40%a vPPIpR 1 4I60c`' S _ <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />I 16A s C I LF 'as L +� � c �'�'t-t'� c��-� 1 1 '� oo 0� o a0 <br />uj eST iQ$ nck 1- L", s C° e,, i j 000" 000 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City or County ap oving the license Date Approved <br />Fee Amount Permit Date <br />4`.3--1? <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 />