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OF PU <br />tno <br />Minnesota Department of Public Safety <br />41 <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 133, St., Plaul MN 55101-5133 <br />(651) 201-7507 Fax (651) 2917-51259, TTY (651) 282-6535 <br />WWW.DP-S.1STATE.MN.US <br />APPLICATION AN�Di PERMIT <br />FOR A I TO 4 DAY TEMPORARYON-SALE LIQUOR LICENSE <br />I <br />DATf.3SLIQU1OR WILL BE SOLD <br />September 20. 208 <br />ORGANIZATION OFFICER'S NAME <br />WX#01 i H VAW � I � 100 a KS1 a a IN; I IN a uAl � 8V I <br />DiRGANIZATION OFFICER'S AAlTiE <br />LIC —4 1 r ni A r n r-A q (i,- C r- r; he <br />W <br />DAU, ORGANIZED <br />1939 <br />CITY <br />Roil ev:Lalle <br />BUSINESS PHONE <br />6511.) 35,7-1204 <br />M ff ur M969, <br />A- <br />STATE ZIP CODE <br />TYPE OF ORGANIZATION <br />ADRESS <br />Is I <br />HOME PHONE <br />Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. <br />NO <br />will the applicant carry liquor liability insurance? If so, plea-se provide the carrier's niarne and amount of coverage. <br />We, have ingqyXan <br />coverage through our insurer - Catholic Mutual Insurance. <br />APR OVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING <br />ENFORCEMENT <br />CITY/COUNTY <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />DATE APPROVED <br />SIGNATURE CITY CLERK OR COUNTN"OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT <br />NOTE: Submit this form to the city or coun(y 30 days prior to event. F-om,ard application signed by city and/or county to the address <br />above. If the application is approved the, Alcohol and Gambling Enforcement Division will return this application to be used as the License for the event <br />M <br />