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I <br />� <br />MINNESOTA DEPARTMENT OF PUB�IC S <br />� � � , � <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 />TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />Name of organization Date organized Tax exempt number <br />Church of Corpus Christi Jan 1, 1939 ES 25499 <br />Address City State Zip Code <br />2131 Fairview Ave N Roseville Minnesota 55113 <br />Name of person making application Business phone Home phone <br />Maureen Boxrud - Stephen Klein 651-639-8888 <br />Date(s) of event Type of organization <br />June 21, 2014 <br />Organization officer's �me <br />�( �Stephen Klein <br />Add New Officer <br />Location where permit will be used. If an outdoor area, describe. <br />At location address and on surrounding grounds. <br />� Club ❑ Charitable � Religious � Other non-profit <br />City State Zip <br />Roseville 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 />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />Catholic Mutual Insurance <br />Policy # 8589 <br />$500,000 coverage <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />����'V � L'�°-�'a MN Date Approved <br />City/County <br />� '" � Permit Date <br />City Fee Amount <br />(vl2 l 2b t�i <br />Date Fee Paid <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />NOTE Sub�r�it 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 />permit for the event. <br />Page 1 of 1 <br />