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Minnesota Department of Public Safety Attachment C <br />Alcohol and Gambling Enforcement Division <br />i► G 445 Minnesota Street, Suite 1600, St. Paul, MN 55101 <br />651-201-7507 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 of organization Tax exempt number <br />Organization Address (No PO Boxes) City State Zip Code <br />MN <br />Name of person making application <br />Business phone Home phone <br />Date(s) of event <br />Type of organization ❑ Microdistillery ❑ Small Brewer <br />❑ Club ❑ Charitable ❑ Religious ❑ Other non-profit <br />Organization officer's name <br />City State Zip Code <br />MN <br />Organization officer's name <br />City State Zip Code <br />MN <br />Organization officer's name <br />City State Zip Code <br />MN <br />Location where permit will be used. 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 />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City or County approving the license <br />Fee Amount <br />Event in conjunction with a community festival ❑ Yes ❑ No <br />Current population of city <br />Date Approved <br />Permit Date <br />City or County E-mail Address <br />Please Print Name of City Clerk or County Official Signature City Clerk or County Official <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event <br />No Temp Applications faxed or mailed. Only emailed. <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. TEMPORARYAPPLICA TION@STA TE.MN. US <br />