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<br />JUL 08 2005 14:08 FR ARTESYN ENGINEERING <br /> <br />612 392 6740 TO 96514298629 , ~;'/03 <br />.<<' D / )1'1 <br />y)LY~\\:o \)'.00 Jf' <br />rOD }. \ ,,}) <br />D' ~or' \v <br /> <br />. / 0"J <br />/..t' ,00 ,00 I <br />'Y ,0' ~. <br /> <br /> <br />ervilfe <br />'Esta<<isfiet{ MS7 <br /> <br />1880 Mairt Stn:et . c."teTTJi{k. M'J{. 5,038 <br />1651) 429-3232 .70>( (651) 429-8629 <br /> <br />CITY OF CENTERVlLLE <br />APPUCATION FOR A 1 TO 4 DAY TEMPORARY/EVENT ON SAlE UQUOR UCENSE <br />(OIganizalion or Ioca\ion limited to 3 permits in 0 12 month periOd) <br /> <br />Type or Prinllnfonnatlon <br /> <br /> <br />Name of organization <br />~<r;24I"''-oL L-l~ 7 <br />StreetAlIdl9SS <br />/1".7'7 ..,.\ ri< ~ <br />Name of PelSOn Completing ApplicaIion <br />~t> (j~ <br />Dates liquor WIll Be Sold (1 to 4 daYS) <br />~C:-l? <br />sNe e <br />-a~ ~l1'~ ~ <br />Organizatlon Office!'s Nom <br />"'-D\II<\ Wl..... ~~ <br />OrgonlzatlOn 0flIceI's Name <br /> <br />Date organized <br />~'~7- 4- <br />City <br /> <br />Tax Exempt Number <br />Z; ...., ~l? cI7 <br />St8le Zip COde <br />\'l'I,..J <?'70313 <br />Home Phone <br />~';'l-i,.7:30-le33 <br /> <br /> <br />a,j2..lp.j..l ~\I"- <br /> <br />~.J~~t~ <br /> <br />ffl LA"'''' >2.\1, <br /> <br /> <br />(C <br /> <br /> <br />WiIIlfIe applicant contract for intlllCie8ling liquot seNi_? If 80, gtve \he nsme and address of the <br />uor license ro . tile selVice. <br /> <br />Win the applICant cany rlquer liability insurance? If so, tile canie(s name and amouR! of <br />cove . ./ ~7~of'" \ Po.-Q ~ -'C2-- <br /> <br />APPROVAL <br />APPUCAlIClN MUST E APPROV!D BY' CITY' COIJNCIL FRIClR TO S'8Ml&SION TO IJQIIOR CON11tCll. <br />CITY OF CENTERVlLLE DATE APPROVED <br />FEE AMOUNT $ LICENSE DATES <br />DATE FEE PAID <br /> <br /> <br /> <br /> <br />Signature of ApplIcant: <br /> <br />* ~ wAlliE' \'"'1f~ A? <br /> <br /> <br />53); <br /> <br />..... <br />