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IMAlcohol <br />— I <br />Minnesota Department of Public Safety <br />and Gambling Enforcement Division <br />4 4 <br />445 Minnesota Street, Suite 222, St. Paul, MN 55101 <br />651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br />Alcohol & Gambling Enforcement <br />I APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization Date organized Tax exempt number <br />Address City State Zip Code <br />Name of Derson makinu aDDlication <br />Date(s) of event <br />Organization officer's name <br />f-YAK_F_F .. <br />Business phone Home phone <br />Type of organization <br />❑ Club charitable ❑ Religious ❑ Other non-profit <br />City State Zip Code <br />in.14Dp 6 MN I'/ <br />Organization officer's name City State Zip Code <br />i MN i <br />Organization officer's name City State Zip Code <br />MN <br />Organization officer's name City State Zip Code <br />MN <br />Location where permit will be used. If an outdoor area, describe. <br />e;7-1'��J zW i 5 <br />e�23�__O t/ bv*-1 7A --F,4 t' -L)P, t-dn,'u LAK -IL, 4� 55_35-6 <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />[A/CS6C-1-J0 lW17-cIA-L IAIsLJCA--J(�_� <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City or County approving the license <br />Fee Amount <br />Date Fee Paid <br />Date Approved <br />Permit Date <br />City or County E-mail Address <br />City or County Phone Number <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event. <br />ONE SUBMISSION PER EMAIL, APPLICATION ONLY. <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITY/COUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITY/COUNTY TO AGE.TEMPORARYAPPLICATIONOSTATE.MN.US <br />