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� <br />r <br />� �� <br />a <br />Minnesota Departmentof Public Safery <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar St./S�ite 133 <br />St. Paul, MN 55101-5133 <br />(651)296-6439 FAX (65l)29'7-5259 TDD (612)282-6555 <br />APPLICATION AND PERMIT <br />FOR A 1 DAY TEMPORARY CONSUMPTION & DISPLAY PERMIT <br />(Ciry or counry may not issue more than 10 permits �n any one year) <br />��i r�- <br />� �. <br />:�ry-.��.��•e. <br />'� ���;� <br />'C�'�� OR PRINT INFORMATION <br />�A,ME OF ORGANIZATION �T�''�� � � •�'`"?L'l� TAX �i�� NUMBER <br />St. Rose of Lima Chur <br />�TREET ADDRESS GT�'Y STATE ZIP CODE <br />�$, ��m� i n�• ��r;•r�� 551 1 1 <br />�TAME OF PERSON MAKING APPLICATION BUSINESS PHONE HOME PHON� <br />Sue Reina�t �65� 645-9389 � i <br />PATE SET UPS WILL SOLD TYPE OF QT�GAN�ZA'7"I��T+I <br />October 1, 2U�� CLUB CIIARITABLE � F I��� I�}�•S OTHER NONPROFIT <br />i�RGAN�ZA.TI�N OFFICER'S NAME ADDRESS <br />i�r. Robert �itzpatr�ck 2048 Haml�.ne Avenue North <br />ORGANIZATIQN OFFICER'S NAME ADDRESS <br />QRCrA�NiZA'I'IpN OFFICER'S NAME ADDRESS <br />ILocation where permit will be used. If an outdoor area, describe <br />St. Rose of Lima School arkin lot and Cafeteria <br />.. _ - � � - 'y <br />- , - <br />APROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />C�TY/CdUNTY G` : ��, � +� �2 � ;� F � ? ��_ DATE APPROVED <br />CITY FEE AMOUNT � 5`� �� PERMIT DATE <br />i �;i� to exceed $2s) <br />DATE FEE PAID_����.�� � <br />SICrNAiUR� CITY CLERK {5p, COUNTY OFFICIAL APPROVED DTRECT'Olt ALCOHOL AND C�AMBLiNE'r ENFORCEMENT <br />NOTE: Submit this form to the ciry or counry 30 days prior to event. Forward application signed by eiiy and/or counry to the <br />address above. If y3i� applicarion is approved the Alcohol and Gambling Enforcement Ilivision will return this applicarion to be used <br />as the permit for the event PS-0909$(x2198) <br />