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Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />445 Minnesota Street, Suite 222, St Paul, MN 55101 <br />6S 1-201·7500 Fax 651-297-5259 'ITY 651-282-6555 <br />APPLICATION AND PERMIT FOR A , DAY <br />........~ TEMPORARY CONSUMPTION AND DISPLAY PERMIT <br />(Cll)' Of c.ounty m,}}' not 1~ue more ttI~1) 10 permits in any IJnO! VNr) <br />Name of organization Date organized Tax exempt number <br />IHugo Uons Club = = I ~an l 1975 II....--.JS4_2_3_37_5 <br />Address City State Zip Code <br />§ Box 321 I [HUgO I [~innewta 11_55_03_8__--...J <br />Nam€ of person making appllcatton 8uslness phone Home phone <br />lOan Balthazor J los 1-777·6924 llr'""6-12.-.-91..:.0--0-9-94-------, <br />D.,te(s) of evenl Type of organizationIi10-22 thru ~ 12·202 2 181 Club 0 Cha ritab~e 0 Religious 0 Other non ·profit <br />Organjz;jtion officer's name City Slale Zip <br />["'Xl 0," B.kh"nr ~9n IIMione",.. II SS038 JOddNew Officer <br />Location where pe rmn 'NiB be used. If an outdoo r <:Ire~, de5cribe.<br /> <br />Hanifl Fields 7032 137th St. Hugo, MN. 55038<br /> <br />APPROVAL<br /> <br />APPUCAnoN MUST BE APPROVED B.Y an'Oil COUNTY ElEFORE SU8Mlmttffi TO ALCOHOL AND c.AMflLtNG ENFORCEMENT<br /> <br />City or Cou nty "pproving the license Date Approved <br />tee Amount Permit Date <br />Date Fee Paid ("ity or Cau nty Email Address <br />City or County phone number <br />Signature City Clerk O( County Offidal AppfOVOO Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE: Submil this form to Akohol and Gambling Entore m t Division 30 days prior to evellt. <br />'ONE SUBMISS O,N PER EMAIL, APiPLICATION ONLY.<br /> <br />PLEASE PROVIDE A VA, 10 E-MA.IL ADDRESS FOR THE C'ITYICOUNTY AS ALL TEMPORARY ,PEIRMIT APPROVALS Wi lL BE SENT<br /> <br />B.ACKV A EMA'll. E-MAIL HEAPPLCATtONSGNEDBYCtTY/COUNTYTOAGE.TEMPORA!RYAPPUCATION@STATiE.MN.US: <br />Sheet of