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I � <br />/ <br />MINNESOTA DEPAiiTMENT OF PUBLiC SAfETV <br />� � � � � <br />Name of organization <br />Rotary Club of Roseville <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />445 Minnesota 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 />Address <br />233 Hamline Avenue North, Suite 620 <br />Name of person makinq application <br />Date(s) of event <br />June 25, 2015 <br />Organization officer's name <br />�( IJan Vanderwall <br />Add New Officer <br />Location where permit will be used. If an outdoor area, describe. <br />Roseville Central Park Arboretum <br />Date organized Tax exempt number <br />� May 7, 1970 23-7068538 <br />City State Zip Code <br />Roseville Minnesota 55113 <br />Business phone Home phone <br />� 763-792-3621 651-489-1734 <br />Type of organization <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 />Celler'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 />Attached <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />' %C�'.��- � 1(. �io: a �.�. <br />City/County <br />� ��c� `� <br />City Fee Amount <br />��� i�-�' � �� <br />Date Fee Paid <br />Date App <br />erm <br />City/County E-mail Address <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enfnrcement <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event. <br />PLEASE PROVIDE A VALID E-MAIL ADDRE55 FOR THE CITY/COUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITY/COUNTY TO AGE TEMPORARYAPPLICATION STATE.MN.US <br />Page 1 of 1 <br />