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Attachment A <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />444 Cedar Street, Suite 222, St. Paul, MN 55101 <br />651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br />�'< �° �� �� APPLICATION AND PERMIT FOR A 1 DAY <br />Alcohol &Gambling Enforcement' TO 4 DAY TEMPORARY UN-SALE LIQUOR LICENSE <br />Name of organization Date organized Tax exempt number <br />Rotary Club of Roseville May 7, 1970 � 23-7068538 �� <br />Address City State Zip Code <br />233 Hamline Avenue North, Suite 620 ', Roseville � Minnesota 55113 .� <br />Name of person making application Business phone Home phone <br />David Kray 763 792-3621 � 651-489-1734 ����� <br />Date(s) of event Type of organization <br />June 26, 2014 <br />Organization officer's name <br />� Club � Charitable � Religious 0 Other non-profit <br />City <br />Location where permit will be used. If an outdoor area, describe. <br />Roseville Centra) Park Arboretum <br />State Zip <br />Minnesota 55113 <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />Cellar's Wine, 2701 Lincoln Drive, Roseville, MN 55113 <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />C..,t t �f c�� i�a���.�.� � �.��.�. <br />C�County Date Approved <br />� � L <br />City Fee Amount Permit Date <br />`°�12� l�C� i �l <br />Date Fee Paid <br />Signature �ity Clerk or County OfFicial Approved Director Alcohol and Gambling Enforcement <br />NOTE: SuEamit this f�rm to the city or county 30 days prior to event. Forward application signed by city andtor county to the address <br />above. If the application Es appraved the Alcohol and Gambling Et�forcement Division will return this applicatiot� to be used as the <br />permit for the event. <br />Page 1 of 1 <br />