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<br /> <br />'Esta6(ish.ec! 1857 <br /> <br />1880 :Main Street . Centervi[[e, :M'J{ 55038 <br /> <br />(651) 429-3232 .!Fa;c (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 Plint Information <br /> <br />Name of Organization <br />...- <br />. I R-' . <br />street Address <br />o 2. vI <br />Name of Person Completing Application <br />~ ( <br />Dates Liq or "'Jill Be Sold (1 to 4 days) <br />g -,;;!$-()Lj U <br />O~nization Officer's Name <br />r a.u.. D . <br />Organization Officer's Name <br /> <br /> <br />Date Organized . <br />'i{-28- l004 <br />City <br />eeV\-tevv~ Ie <br />Business Phone <br />-;; '!:J-tp <br />Type of Organization <br />o CLUB 0 CHARITABLE 0 REUGIOU <br />Address <br />bS\D Ce.ti <br />Address <br /> <br /> <br />Tax Exempt Number <br />YH <br />State <br />MN <br /> <br /> <br /> <br />~ <br /> <br />6' <br /> <br />Organization Officer's Name <br /> <br />Address <br /> <br /> <br />If an ouWoor area, desclibe: <br />~()..f\<.\ LD. 0 t; 'T1fI-\D <br /> <br /> <br />Will the applicant carry liquor liability insurance? If so, th~rrier's name and amount of <br />coverage. S "Bu.ms-\>J\ l)<. ~ 300 ODO <br /> <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY COUNCIL PRIOR TO SUBMISSION TO LIQUOR CONTROL <br />CITY OF CENTERVILLE DATE APPROVED <br />FEE AMOUNT $~~-?:'{P LICENSE DATES <br />DATE FEE PAID <br /> <br />Cit Clerk <br />NOTE: Submit to the City of Centerville at least thirty (30) days plior to event. <br /> <br />"'".~ of -""1/111liJJt (awL <br />