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H S^ <br /><r*,ijis;xv <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />444 Cedar St-Suite 133 <br />St. Paul. MN 55101-5133 <br />(651 )296-6439 TDD (651 )282-6555 <br />APPLICATION AND PERMIT <br />FOR A TEMPORARY ON-SALE LIQUOR LICENSE <br />TYPE OR PRINT INFOR.MATION <br />N.AME OF ORGA.NIZATION <br />V/Tif ArH> <br />STREET ADDRESS _ <br />Z'2-'^0 A/hr\^ Shore. <br />D.ATE ORGANIZED <br />STATE , <br />T.A.X EXEMPT NUMBER <br />ZIP CODE <br />NAME OF PERSON .MAKING APPLICATION <br />/C^s£.(Xr>nr^ A A4^0oh<Tt^_____ <br />BUSINESS PHONE <br />iy.52^4^7G-736/ <br />HOME PHO.NE <br />(^2)9^/-3B^ <br />DATES LIQUOR WILL BE SOLD/7 , zooo TYPE OF ORGANIZ.ATION <br />“CLUB ^CHARITABLE “RELIGIOUS ZOTHER NONPROFIT <br />ORGANIZATION OFFICER S NA.ME ADDRESS <br />9pjQi /ca/s-^/^ /V-t. <br />ORGANIZATION OFFICER S NAME ADDRESS ^ <br />. ^oac/s> <br />ORCANIZ-ATION OFFICER'S N.A.ME <br />/^Sun CooC.______ADDRESS _ •eSo cue^-r <br />Location where license will ^ used. If an outdoor area. de>'ribe . . - <br />Will the applicant contract for intoxicating liquor scrx ices.’ If so. give the name and address of the liqucr licensee providing the serv ice <br />________________________________________________________]____________^_______ <br />Will the applicant carry liquor liability insurance? If so. the camp's name and amount of cov^age. <br />(NOTE: Insurance is not mandator) ) J^L/Lr Oq ,y- <br />APPROVAL <br />AITLIC.ATION Ml SI BE AFfKON EU BV CH Y OK COIMA BEFORE St BMITTENG TO Vl.COHOI. 4 GAMBt INC ENFORCEMENT <br />CITY/COUNTY__________________________________D.ATE APPROVED________________________________ <br />CITY FEE A.MOUNT ^ ^ ^________ LICENSE D.ATES__________________________ <br />DATE FEE PAID <br />SIGSATCRE CITY CLERK OR COUNTY OFFICIAL APPROV ED .Alcohol it Gamblir.;: Er.torcerr.efii Director <br />Note: Do not separate these two parts, send both parts to the address above and the original signed bv this divLsion <br />uill he returned as the license. Submit to the cits or Countv at least 3t) davs before the event. <br />PS.09079 ( 6/98)