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F'IUU�YJO�LYJYJG 14� �lJ7 r 11V1'11VVC 6JJ1��LLG�G i. s,rc� vc <br />Mi�esota Department of Public Safety � <br />Alcohol and Gambling Enforcement Division <br />444 cedar St-SuitO 133 <br />St. Paul, MN 55101-5133 <br />�' : <br />(6s 1)296-6439 TDD (6s 1)282-65ss <br />APPLICATION AND PERMIT <br />FOR A TEMPORARY ON-SALE LIQUOR LICENSE <br />I'YPB OA �RINT Il�PORMATI N <br />f�AME OF ORGAMZATtON AATE OR�AN[ZEA TAX �'T NUMBER <br />St. Rose of j,�g Church 1'939 ES32148 <br />STRk"kT ADDR�SS C1TY STq'IE ZI�' CODE <br />048 Hamline Ave.•North Roseville MN 55113 <br />KAME OF PERSON MAKING A,�PI.�CATION BUSIIdESS PHONE HO1V�E �HONE <br />ue Beinart ( 8 i <br />DATBS LIQUOR w�L BE SOLD YY�E OF ORaANTZA'lI0 <br />❑ CLUH C] CHARITABLE OIOUS �OTHF,R NONPROFtT <br />�RGANIZATIOI�T O�FICF.R'S NAME ApDRESS <br />�RGANIZATION OPk�C�R'S NAME ADDRESS <br />ORGANrZATION OFFICER'S NAME ADDRESS <br />Location wbete license will be used, If an ou�dopr etcCe, desciibe <br />St. Rose School Parking Lot <br />Witi che applictu�t �ntract for iruoxicating tiquot 9e,[vi00b? � S0. $iwc t1�c name and address of ttle ltquor liconaee p�ovii,dieg the setvice <br />No <br />Will �he applicant cury liquor �,an,�,� i�surana? If so, e�e ceu�ier's name Aad a�o,ount of covara,ga <br />(N��TE: �I�,4lil'�IlCB l8 110[ II18qdflt0�t.) Yes Catholic 1�utug1 Insurance <br />ApP�ov,�u, <br />AP'PLiGTION M�7ST 8E APPKOVED BY QxY OR CO�I'1'Y BBFO� SiJB�VQtTIIdC't�0 ALCOiIOL & Q�A141AL�AVG ENFORCEMTNT <br />CT,TY/COVN'IY DAT E APPROVED <br />CITY FEE AMOUNT LYCBSVSE DA�'ES <br />DATB FEE Pa�D <br />SIGNATURE C�'i'Y CL,�WC OR COUNIY OFFICNL AI'}'1t0YED Aloohol � O�mblia` PaPo�emcnt Diroetor <br />Note: Do not s�caee tht� two parbr. sp�d 6oW p�c4 to t'h� rddcea �bove aad the orltlnat aitucd sy tpls dlvW on <br />NIIt bt �euut�d s� �e!leensa Sub�o�it to tbe dh► or Cannty se haet 3Q et�ys �efbn Nu eva�� <br />PS.09Q79 (ml <br />TC1TAl P . A� <br />