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�� N� 6��c ^� <br />�� � <br />� <br />�s o�P <br />a?etM�,rtNeS <br />Mii���esota Departmeait of Public Safety <br />�LCOH4L �ND GAMBLING ENF4�2CENS�NT DIVISION <br />444 Cedar Street Suite 133, St. Paul MN SS101-SI33 <br />(651) 20I-7507 Fax (G51) 297-S2S9 T'I'Y (6Sl) 282-GSSS <br />W �W.DF'S.S'i'AT�.MN.US <br />APPLICATION AND PERMIT <br />FOR A 1 TD A IIAY T�MPORARY ON-SALE LIQUOR LICENS� <br />�'Yl'� OR PRINT INFOI�Ivt�TiON <br />NANIE p� OT2GA.NT�ATION <br />``� r ���L 6 -� � 1�v�-. <br />�TRE1,T AAI�RESS <br />�-�, `.� � � 1.��-� � i�-�- f�l?.. . /�J <br />NAME Qr �'�RSQN Ml�.KiNG APPLICATIpN <br />�AT�S LTQUflR WILL BE S�LD C' p�„ ��`-c ��� cL, <br />Y�� �f � <br />DA`i'� QRGAI�IIZ�� <br />I��? <br />CITY <br />j2-� �.���L� � <br />BUS�SS �'�QN� <br />{� Si �`�� S � -�- ] �--c, <br />TYl'E O� C3I2�'r�1'1�7�A <br />ORGANIZA'TI�N OFFICER'� NAME ADDI2ESS <br />� ��." � j .� Z �/ �j`-�}�'j (i%C.-r �� ��` �,. ( '�ti `.� L? <br />]ieense wwll be used. If an <br />� � <br />area, descr€be <br />« <br />'�I�1.� ��� ��i <br />' f 1,,�r..�'.f_.� �.� <br />���'�� € <br />2„�,s�`��r ��4 <br />;i��� '�'�:� <br />:t�* ���,,,��.�-�,� <br />.� .i Yk <br />TAX EXEMP"I' 1�i�JM�3�R <br />�wS- 3Ji �-�� <br />S`['�'!'E ZSP COIJE <br />� w ��� � <br />IIOME PHOI�� <br />( ) <br />. �VL: JV• <br />Y <br />��� �� ���,� <br />Will the a�plicant contract for intoxicating liquor service? Iiso, give the na�ne and address of t3ie liq�or licensee providing tl�e service. <br />t�/ �7. <br />Wi]I the app!Iicant carry liq�or liabslity insurance?! I�f So, �Slease prnviPde th� carrier'S ��ame and amount of coverage. <br />�n ! t f(t 1� ,S !�? 1 in G'! zdtrfnn, � ! /f,fl�'�i7i �,C_A�.rt _ -7'7n .rn.�it,l/L, i=, ! . ♦ I In G,.� .lrPA/' .- <br />�PROVA�� <br />APPLICATI(lN MUS'� �E APPnOVED �Y CiTX OR COUN'CY SE�OR� ,SUSMIT'I'ING '�O AI.�C�H4L � GAMB�,ING <br />�Nk'�AC�M�NT <br />CTT'Y/COUNTY <br />CI'I"Y F�� AM4UNT <br />DATE �'EE PATD <br />�AT'E APPROVEI3 <br />LIC�NS� DA'I'�S <br />SIGNATTJ�2E C�'�'Y CJ..iZt� p12 CRUNTY OFFICIAL APPROV�;� DIRECTbR ALCOTi()�, AND GAMl3LI1�G �N�QRC�MENT <br />1�pT�: S�banit tl�is farrn to tlye cit� o�• county 30 days p�'iur to event. �o��va�•d appl'rcalion signed by city and/ar caixnty to tixe ��ld�•ess <br />abovc. If the applicatinn is approved the Afcohol and Ga�nbli�Fg EnE'orcemeE�t Aivisinn will return this a�plication Yo he used as tl�e Lice��se t'or the event <br />PS-Q9079(OS/OG) <br />