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Minnesota Department of Public Safety <br />�.'��•.,.�, LIQUOR CONTROL DIVISION �" � <br />: .�p\L6DU,y0�.'. <br />'�� 444 Cedar St./Suite 100L <br />St. Paul, MN 55101-2156 <br />�•. - - <br />(612)296-6439 TDD (612)282-6555 �� � <br />�+�ie5a*. <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />TYPE OR PRINT <br />NA,�� OF ORGA <br />���TI�I <br />DATES <br />TION <br />. <br />to <br />�T� o s��c�t�s ,� F�d� � o�i.�#' <br />1TION QFFICER'S NAME <br />? cb .uil — Tr.l G+�-�/ <br />\TION OFFICER'S NAME <br />�, r� - �st Pn.cs . <br />�ere�icense will be used. I an outdoor area, descril <br />DATE <br />TAX EXEMPT NLJMBER <br />— 9��i0�i js <br />ATE ZIP CODE <br />cQS1i �15��'G2q g �(Q�� �'y2 O li L l <br />TYPE OF ORGANIZATION <br />❑ CLUB CI'�IARITABLE ❑ RELIGIOUS ❑ OTI�R NONPROFIT <br />�ss <br />2 Gs G�v .�v�e �. s r Pa�.C. <br />�nr�n�rr _ + <br />. <br />sT <br />Will the plicant co tract for intoxic �ing liqpor services? If so, �ive the name a d addr ss of the Liquor license providing the service. <br />L �,1dCS G�t� �u4�� � <br />�i <br />� <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatory) i�y� „n <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY/COUNTY �pg�v,\��, DATE APPROVED <br />CITY FEE AMOUNT g� �fi , C"�('`� <br />DATE FEE PAID �� ry � o i <br />SIGNATj_JRE CITY CLERK OR COj_JN'I'Y OFFICIAL <br />LICENSE DATES <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this division <br />will be returned as the license. Submit to the City or County at least 30 days before the event. <br />PS-09079(8/95) <br />