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Y <br />� <br />Minnesota Deparknent of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 133, St. Paul MN S51p1-S13� <br />(6S�}215-6209Fc'tx (651)297-5259'I`�Y (651) 282-6555 <br />�'kk �h� C�f'�.�?:�TLr.��i�.l'� <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />Nf1ME OF ORGANIZATION DATG ORGAIVIZED TAX EXEMPTNUMBER <br />��3:�,§'rr'�l1Fr�'-r�'����� �o�`��C����}' I <br />�'Tll�•CT ltil}L1�F.� <br />� ��� '��� �c�,� r� �� <br />NAME OF PERSON MAI{ING APPLICATION <br />TC�M.�S �����-rrv�� <br />DATES I�QUOR WII,L BE SOLD ��x���� ���- <br />«��r��r{.�n�r� c�rr�f��:R-� �r� <br />'� �� �r������ <br />i i}#� �� � f��A'llCk�' t��'1�J4 k�M' � N�, <br />f�� �� � <br />rj <br />�:i�7 � �':3 t � �[P {'{ �f]l•. <br />,���� #����� h'"�'i' � �-��� } <br />BUSINESS PHONE HOME PHONE <br />�� ��5"- 4f3�.3 ���r �o! --�9�f/ <br />} �p�•.� H• 13E1{•r,4fV Il:+� li{1-�r �� <br />CLUD �!l4F.1TADLE F..Ei�[{.i�[}L'S �I�EiER N�bcPRi}� <br />�+�u�E�ti ��� 5������' ��►� <br />�� +�f r �`�' ����� <br />tl}tL�A*fl�lk'ElC}�' [F!� 17L:F.1�'4 NA1k{E — T . . :k!}L�J{E�`� � _. _ .. �. - — - <br />Location license will be used. If an outdoor area describe ��} � � � ��� � � � �, �����,��.��� ����. � � <br />� �� � ���Or'-!� � <br />�o���r���... � �� ���� <br />W �l,( the applicant contract for intoxicating liquor service? If so. give the name and address of the liquor licensee providing the service. <br />Will the applicant carry liquor liability insurance? If so, please provide the carrier s name and amount of coverage. <br />APROVAL <br />A�P�'LIGATION MUST BE APPROVED BY CI'�"Y OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING <br />ENFORCEMENT <br />CITYICOUNTY <br />CITY FEE AMOUNT <br />DATE FE� PAID <br />DATE APPROVED <br />LICENSE DATES <br />5,1�S��kT4:1ti' {'IT3'�F.FRk �MU ['a N ��4TY �F37CL4l, �P�'i�(l�'fiD ULli6[,-!'{Ht A�.('4HlN..�l�U I;AFiBL��C: £aVFp1iC.7�:7N��"1` <br />nQ�l'�'.: 4ubnHt r�:� rarw �a �Ka city or �+o�x 34 �a�s Frfu� �a tfto�, �arw�rd apy�ticAtiQa sl�oed h} cit} aa�/ur rouo�.v w N�e �Gdr�cF <br />aboVe. If the applieation is approved the Alcahol. a�►d Gambling Er�tprcement Division will return this application to be used as the �,iceuse for t�e eveuY <br />PS-09079(Q21U5) <br />