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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 />LAj its Bem, -L"s Ce, v00/0(Do <br />APPROVAL <br />� <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />6T 4L, -&r G - - <br />City or County approving the license Date Approved <br />�rs <br />Fee Amount Permit Date <br />J V 2 -Z01- <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 />Minnesota Department of Public Safety <br />nGamblring 6 <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 a Enforcement <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 <br />number <br />"Uyo 'Lkov's CWCD <br />5-1--oiys-of3 <br />Address <br />City State <br />Zip Code <br />�? o sc,;>, 3-A1 <br />Ip Minnesota I <br />Name of person making application <br />Business phone Home phone <br />p AAaK t4 e►­Qcsz--t- <br />6s1 -Yom{ <br />Date(s) of event <br />Type of organization <br />Au,, 2 26 17 <br />❑ Club Ej Charitable ❑ Religious ❑ Other <br />non-profit <br />Organization officer's name <br />City State <br />Zip Code <br />,q V,, Gp, iT"-z,�� <br />L i V� p <br />I Minnesota <br />Organization officer's name <br />City State_ <br />Zip Code <br />`T PAC -It w\. /A S <br />H Uc)a Minnesota <br />Organization officer's name <br />City State <br />Zip Code <br />T"<Z <br />; Q• L�k� Minnesota <br />ISS -116 <br />Organization officer's name <br />City State <br />Zip Code <br />rnAa_Y- �'E�► OFZ� <br />� C L),Minnesota <br />!eo 3 g <br />Location where permit1 twill be used. <br />If an outdoor area, describe. <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 />LAj its Bem, -L"s Ce, v00/0(Do <br />APPROVAL <br />� <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />6T 4L, -&r G - - <br />City or County approving the license Date Approved <br />�rs <br />Fee Amount Permit Date <br />J V 2 -Z01- <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 />