Laserfiche WebLink
-,� <br />/ ?�M�:,,�; <br />! <br />MINNESOTq DEPARTMENT OF PUI3LIC $APETY ' <br />� � � � � � <br />Name of oraanization <br />Address <br />Minnesota Department of Pubiic Safety <br />Alcohol and Gambling Enforcement Division <br />444 Cedar Street, Suite 222, St. Paul, MN 55101 <br />651-201-7500 Fax 651-297-5259 Ti�Y 651-282-6555 <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />Ci <br />Name of person making application <br />�. - • - - <br />���,.rr.�"'w,w�' , <br />.�.� ' � �r �.�. ���� <br />��.'�.G.n�:�:iir`�+_.a�" <br />Organization officer's name <br />� cw�.."a.�,a G�-v✓`',�� ' <br />w Officer _' __ _'; <br />Date or anized Tax exempt number <br />� a � � �!- A3l �38(� <br />y State Zip Code <br />' V/ � Minnesota ���3 <br />Business phone Home phone <br />� � I � ~ Sq�_ 3����� <br />Type of organization Jr. --D�� <br />�� ��� <br />� Club 0 Charitable � Religious Other non-profrt <br />City State zip <br />�sy' Minnesota y. 1 �3 <br />Location where permit will be used. If an outdoor area, describe. ��^�� <br />p� !o �� 1./ �L .�0.$�G A GL'e , l�,'i l J �,� <br />� � �� <br />If the applicant will contract for intoxicating liquor service e the name and address of the liquor license providing the service. <br />If the applicant will carry liquor liabflity insurance please provide the carrier's name and amount of coverage. <br />� e S h �.u� �L�� 1� � !� <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY QTY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />�t'� t{. a �' �C�. V 11.eL�,. <br />City/County Date Approved <br />� �� <br />City Fee Amount <br />J� !�'"� 1'�I <br />Date Fee Paid <br />Permit Date <br />5ignature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />NQTE: Submit this form ta the eity or county 30 days prior to event. Forward applicatiar� signed by city ar7d/or county to the address <br />above. If th� a�aplicatian is approved tl7e Aleahol and Gambiing Enforcemenfi I�ivision will return this application to be used as thc <br />p�rmit for the evenfi. <br />Page 1 of 1 <br />