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. �,�� oF'�'s�M <br />�t� � <br />�� { <br />� � <br />''�� �-� <br />Attachment B <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar SFreet Suite 133, St. Paul MN SSIO]-5133 <br />(651) 201-7507 �'ax (651) 297-5259 7�TY (65 I) 282-65�5 <br />W W W.DPS.STAT£.MN.US <br />APPLICATIQN AND PERMIT <br />FdR A E TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />TYPE pR PIZINT INFORII�ATIOt� <br />l�'AME 01= ORGAN[ZATION <br />St. Rose of Lima Catholic Church <br />STREET A[71]RESS <br />NA E OF P�it50N M K1N� APPLIC TION <br />� h. �'✓� <br />DAT�S l.IQCIOR WTLL BE SOLD <br />5eptember 1 <br />ORGA]�i1ZAT10N OFFICER'S NAM£ <br />__�.�«��_� <br />TYPE OF ORGANIZA <br />A1�DItESS <br />ADDRESS <br />TAX �XEMP"E't�IUMBER <br />������ <br />x._. <br />�. -� <br />�;*i��, �_��< <br />Z[P CODE <br />� 551i3 <br />HOME PHONE <br />( ) <br />Lacation license wil] be used. ]f an outdoor area, describe <br />We w�:l.l have aicoho� available �n Che Iarge tent setup in our parking lot a�td <br />in the schoo� cafeteria. BoCh areas wi1� have food for sale as well. We would <br />have �eer and w�ne. <br />Will ihe applicant contract for intaxicating fiquor service? If so, give the name and address of the ]iquor licensee providing the service. <br />W ili The applicant carry liquor liability insurance? If so, please provide �he carrier's narne ant[ amoun[ of coverage. <br />We have insurance coverage th�ough our insu�er— Catholic Mutual Insurance. <br />APROVAL <br />APPLiCATi�N MUST SE APPROVED BY CITY OR COElNTY ��FOItE SUBMIT'iING 'CO ALCOI-30L & GAMBL[NG <br />ENFORCEMEN'T <br />CITY/COUNTY <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITl' CLEIiI{ OR COUN.TY OFFIC[AL <br />DATE APPROVED <br />LICENSE DATES <br />APPROVED DIR�CTOR ALCOHOL AhD GAMBLING ENFORCEMENT <br />��•u i �.: audcnir �nis �orm [o ine c�ry or councy 3v aays prior co evenc, rai'warp appluattan signed by city andlor caunty to the address <br />above. If ihe applicalion is approved the Alcohol and Gambiing Enforcemenl Divisipp rr•i!! return lhis appiication to 6e used as the License for the event <br />PS-09079{05/06) <br />