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M& <br />innesota Department of Public Safety <br />Alcohol and Gambling Enforcement Daivision <br />Cedar Street, Suite 222,,.St, Paul,, MN 55101 <br />651-201-7500 Fax 651-297-5259 TTY 651-282-6550, <br />APPLICATION AND PERMIT FOR A I DAY <br />TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />Attachment A <br />Date set ups will be sold <br />I . ..I <br />jWrch 2, 2012 <br />Type of organization <br />El Club Z Charitable D Religious E]Other non-profit <br />Location where permit will be used. If an outdoor area, describe. <br />Ramsey County Library in Roseville,, 2180 N. Hamline Avenue <br />If the applicant will contract for intoxicatin§ liquor service give the name and address of the liquor license providing the service. <br />Fairview Liquors <br />V�vt "Iry ew 4)"r Yll?- 41 VyljV 1p 31 <br />K I'V <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />We have general liability insurance. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITrING TO ALCOHOL AND GAMBLING ENFORCEMEV-1 <br />City/County ------ <br />- ---------------------------------------- - - <br />City Fee Amount <br />Date Fee Paid <br />----------- <br />Signature City Clerk or County Official <br />---------- <br />Date Approved <br />Permit Date <br />Approved Director Alcohol and Gambling Enforcement <br />NOTE: Submit this form to the city or county 30 days prior to event. Forward 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 <br />i t fort he event. <br />perm <br />