Laserfiche WebLink
FA <br />AM <br />MWNN MUTA DEPARTMENTOF PUBLIC SAFETY <br />Name of organization <br />Hugo Lions Club <br />Address <br />PO Box 321 <br />Name of per: <br />Mark Heifort <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 />Date organized Tax exempt number <br />Jan 1, 1975 5423375 <br />City State Zip Code <br />Hugo Minnesota 55038 <br />Business phone <br />61249-1449 <br />Home phone <br />1651-429-1745 <br />Date(s) of event <br />Type of organization <br />L41M J ,j1,1 11-1 — I -C-- l6 AQ l % <br />Q Club 0 Charitable <br />Q Religious Other non-profit <br />Organization officer's name <br />City <br />State <br />Zip Code <br />Dan Balthazor <br />Hugo <br />_ <br />Minnesota <br />55038 <br />Organization officer's name <br />City <br />State <br />Zip Code <br />Tracy Thomas <br />Hugo <br />Minnesota <br />55038 <br />Organization officer's name <br />City <br />State <br />Zip Code <br />Craig Tracy <br />White Bear Lake <br />Minnesota <br />55110 <br />Organization officer's name <br />City <br />State <br />Zip Code <br />Mark Heifort <br />I Hugo <br />Minnesota <br />55038 <br />Location where permit will be used. If an outdoor area, describe. <br />Wild Wings Game Farm field <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 />Lions Clubs Intn. $1,000,000 <br />West Bend Mutual $1,000,000 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BYCITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City or County approving the license <br />/ Fee Amount <br />Date Fee Paid <br />Date Approved <br />Permit Date <br />City or County E-mail Address <br />City or County Phone Number <br />Signature City Clerk or County Official 'A—pp- <br />pproved 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 />