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Minnesota Department of Public Safety- � <br /> P - � <br /> LIQUOR CONTROL DIVISION f� �° � <br /> tilti�rz pS <br /> •Lr*, O �•r e• tii <br /> = '•. =.. 444 Cedar t./Suite IDOL <br /> - = t. Paul, MIS 55101-2156 <br /> r = 1 - 3 TIED (612)"282-6555 <br /> r <br /> f <br /> APPLICATION AND PERMIT <br /> FOR A I TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br /> ff E OR PST INFORMATION <br /> E GF ORGANIZATION DATE ORGANIZED TAX E FMPT NITM ER <br /> ur eh of St. Rose of Lima 1239 ES 32148 <br /> STREET ADDRESS CITY STATE ZIP CODE <br /> 48 N. aamline Ayenue Roseville <br /> NAME OF PERSON MAKING APPLICATION BUSINESS PRONE HOME PHONE <br /> Susan Galush Reinart, Bus. Admin.'strata (61 645-9389 6,12 642-9276 <br /> DATES LI{ t JGR WILL BE SOLD(I to 4 days) TYPE OF ORGANIZATION <br /> 1998 M GIIH;R PR f f l- <br /> ~A r 1 I CL�F <br /> ORGANUATIGN OFFICER'S DAME A.DDRE S S <br /> Rear. falter L. So � e i 2048 N. Hamline Aven ` <br /> ORGANIZATION OFFICER'S INANE ADDRESS <br /> ORGANIZATION OFFICER'S NAME ADDRESS <br /> Location where license wdt be used. If an outdoor area,describe <br /> A bar will be set u iu the school oaf eteria_lief ore and of to� dinner w'11 b e <br /> served with dinner in the school- gyn. <br /> Will the applicant contract for intoxicating liquor services? If so,give the tame and address of the Liquor lipase providing thesienice. <br /> Prom Catering Service, 190 N. Smith Avenue, St. Paul, ITT 55102 <br /> Will the applicant carry liquor liability insurance? if so,the carrier's name and amount of coverage. <br /> (NOTE: Insurance is not mandatary) Yes, we are insured through Catholic u to-al Insurance <br /> APPROVAL <br /> "PUCATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING To LIQUOR CONTROL <br /> IT1 DATE APPROVED .- . ._ <br /> CITY FEE AMOUNT" LICENSE DATES <br /> DATE FEE PAID 8 <br /> SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED LIQUOR CONTROL DIRECTOR <br /> 4 <br /> NOTE: Igo not separate these two parts,send both parts to the address above and the original signed by this di lilon <br /> will be returned as the Heense. Submit to the Cam* or County at least 30 days before the event. <br /> PS-09079(5 <br />