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Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />445 Minnesota Street, Suite 1600, St. Paul, MN 55101 <br />651-201-7507 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 />Name of organization Date organized Tax exempt number '-4-1 llij,____,_·· =-D .......... l""--J o=--=-t1-=s__,,C-=..ote....=-'ul:Jc....=_ ______ I ..--I /�q....-:",:7---==5::------.I I 5 / -01 't' 5o I 3 <br />Address City State Zip Code ,_,_[¥--=.D=--·-X> ........ ��a'-=--�-'--'--, _____ �11 UKjo I '---I ..e....:...,_m_lU _ ____,l l55o3B <br />�ame of person making application Business phone Home phone <br />1=SJL.>..J.JA_._,,s�cn"'-'--'•-....£�=-< . ....::........c, 1:....__.e'--1--J-""-'-t,t<..,c.=,.__ ______ I � o);?t 7-9Vo� .__ ___ ___, <br />Date(s) of event Type of organization D Microdistillery D Small Brewer �lo-, -.e-'-'-p-+-�-m-betl.. ___ '9_</_�--a-0-d---�------,, �lub □ Charitable □ Religious □ Other non-profit <br />Organization officer's name City State Zip Code ���N�on�J�-�--_-_1c:3----..{,�f..�---�' IVO-drJai5 He:,h·M 07(\.)I l.f5J�r:J <br />Organization officer's name City State Zip Code <br />'---------------------' �------�------' �' ---� <br />Organization officer's name City State Zip Code <br />'-------------------� '-------� '-----------'' '--------' <br />Location where permit will be used. If an outdoor area, describe. )-/o.,nl--PI 1ielda ,03;;__ ;317� 5..i-_ Hu.JD 1 rnr0 5:503� <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. --:5 :S. � "-j \ �. f<.. 'I>-s-t-, ·1 o \ r;; n�1& 8 f v £)_ N , z: , N'l pl5i ¥1' t0 5S 9, � <br />•i<re0-).�-Jhru-:Be-� (___{c;_J'(_ If ri<e applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City or County approving the license Date Approved <br />Fee Amount Permit Date <br />Date Fee Paid City or County E-mail Address <br />City or County Phone Number <br />Signature City Clerk or County Official Please Print Name of City Clerk or County Official <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 <br />PERMIT APPROVALS WILL BE SENT BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY <br />CITY /COUNTY TO AGE.TEMPORARYAPPLICATION@STATE.MN.US <br />$25 <br />7-21-22