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<br /> <br />tervi{{e <br />'EstaNisfted 1857 <br /> <br />1880 'Main Street . Centeroi[fe, 'M9I[55038 <br />(651] 429.3232 .:Fa7\. (651) 429.8629 <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR A 1 TO 4 DAY TEMPORARY/EVENT ON SALE LIQUOR LICENSE <br />(Organization or location limited to 3 permits in a 12 month period) <br /> <br />Type or Print Information <br /> <br /> <br />Dat Organized <br />;e:L- 0 dJ"I <br />i,/, ' <br />U,Jf",ri,((" <br />Business Phone <br />':'5/-,653- ))1/ <br />Type of Organization <br />o CLUB 0 CHARITABLE 0 RELlGIOU <br />Address ,," <br />/'55;7 - (J)3 - .>'/ <br />Address , <br />/83).. l!c 10"'2- <br />Address <br />I) p$ - aiel <br />If an outdoor area, describe: <br /> <br />Tax Exempt Number <br />OZ:;3 <br />St~lj Zip Code <br />/11 rtI p 3 <br />Home Phone <br />.. ~z. - {l~56 <br /> <br /> <br />o OTHER NON- <br /> <br />Ji /.I <br /> <br />,eK <br /> <br />~; <br /> <br /> <br />Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of <br />covera e. &/' N4-li ; J::>- / pc) t:J ,~, t:fc"",,;>g ':5^Z <br /> <br />r. fr~ e ~.APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY COUNCIL PRIOR TO SUBMISSION TO LIQUOR CONTROL <br />CITY OF CENTERVILLE DATE APPROVED <br />FEE AMOUNT $ LICENSE DATES <br />DATE FEE PAID <br /> <br /> <br />Ci Clerk <br />NOTE: Submit to the ~ <br /> <br />Signature of Applicant: <br /> <br /> <br />L___ __ _H <br />