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<br /> <br />tervi{{e <br />'Esta6(isfied 1857 <br /> <br />-...... <br /> <br />1880 'Main Street . Centervif[e, 'M'J{ 55038 <br />(651) 429-3232 .:J1l;t (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 />Name of Organization <br />tem~. L.a ~ <br />Street Address f"";' <br />/"9":> mai/? ST. ~;z.ol <br />Name of Pe n Completing Application <br />iW-h <br />Dates Li uor Will Be Sold (1 to 4 days) <br />-r 2.-4 Zoo2- <br />~nizatio9, Of!icer's Name <br />70/YI /k4/ <br />Organization Officer's Name <br />i?rt 11/;, e.- <br />O'Wlnization Officer's Name <br />C/t!W9 ~..e- <br />Location where license will be used. <br /> <br /> <br />/e- <br /> <br />Date Orqapized <br />~/,/ 80 /97 <br />City <br />~(/,/k <br />Business Phone <br />1- 70+- <br />Type of Organization <br />o CLUB CHARITABLE 0 RELlGIOU <br />Address <br />/J1~9 - 73../<7 ~. <br />Address . <br />/9:57 ,e~i/O/~ =:>I, <br />Address <br />7399 04' /J1.ffI ~ <br />If an outdoor area, describe: <br /> <br />o <br /> <br />Tax Exempt Number <br />tl Z-3 <br />State Zip Code <br />/"'?.AI ~7> 3 e. <br />Home Phone <br />(,,5/. .tfz.<:J- 774- <br /> <br />o OTHER NON- <br /> <br /> <br />Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of <br />covera e. C-or.. . ~78'P; <br /> <br />APPROVAL <br />APPLICATION MUST BE APPROYED BY CITY COUNCIL PRIOR TO SUBMISSION TO LIQUOR CONTROL <br />CITY OF CENTERVILLE J DATE APPROVED <br />FEE AMOUNT $' LICENSE DATES <br />DATE FEE PAID <br /> <br /> <br /> <br />~ <br /> <br /> <br />Ci Clerk <br /> <br />NOTE: Submit to the City of Cen~iIIe at least t' 30) days prior to event. <br />'" --:::/~ - <br /> <br />Signature of Applicant: ~" . <br /> <br />