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I <br />� s <br />'� MINNtYf)�A (JtMAFiMtNI ()i PIINLI�; 4AFitY <br />� 1 1 � ' I' . . <br />Minnesota �epartment 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 />TEMPORARY CONSUMPTION AND DISPLAY PERMIT <br />(City or county may not issue more than 10 permits in any one year) <br />Name of organization <br />Friends ofthe Ramsey County Libraries <br />Address <br />4570 N. Victoria Street <br />Name of person makinq application <br />Date(s) of event <br />February 7, 2015 <br />Organization officer's name <br />X Frank Harris, President <br />�( Dan Wall, Secretary <br />X Cathy Croghan, Vice President <br />X Gregory Bromen, Treasurer <br />Add New Officer <br />Date organized Tax exempt number <br />� January 1,1979 � 41-1597085 <br />City State Zi p Code <br />(Shoreview Minnesota �� 55126 ! <br />Business phone Home phone <br />� 651 486 2213 �� �— � <br />Type of organization <br />0 Club � Charitable ❑ Religious � Other non-profit <br />City State Zip <br />Roseville <br />Ile <br />Minnesota <br />Minnesota <br />le Minnesota � <br />le Minnesota <br />55113 <br />55113 <br />55113 <br />55113 <br />Location where permit will be used. If an outdoor area, describe. <br />Ramsey County Library, 2180 North Hamline Avenue, Roseville, Minnesota. This will be the Great Gatsby Gala indoorfundraiserforthe <br />Ramsey County Library. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />��.�-�,' l � L.�� <br />City/County <br />� J(� <br />City Fee Amount <br />� �_ ;' 1 � /�� i �-I <br />Date Fee Paid <br />Date Approved <br />Permit Date <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE: Submit tliis form to Alcohol and Gambling Enforcement Division 30 days prior to event. <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FGR THE CITY/COUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE l�PPLICATIOM SIGNED BY CITY/COUNTY TO AGE.TEMPQRARYAPPLICATIONCa)STATE.MN.US <br />Sheet 1 of 1 <br />