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r <br />Minnesota Department of Public Safety <br />LIQUOR CONTROL DIVISION <br />444 Cedar StVSuite lOOL <br />St. Paul, MN 55101-2156 <br />(612)296-6439 TDD (612)282-6555 <br />APPLICATION AND PERMIT <br />FOR A1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATIONgscrares m./DATEORGANl :^9ii <br />CITY <br />DATES LIQU<ILLBESOLUll <br />/ <br />is PH<BUSINESS PHONE <br />( ) <br />HOME <br />( <br />TYPE OF ORGANIZATION <br />^LUB-&cCftARITABLE □ RELIGIOUS □ OTHER NONPROFIT <br />ORGANIZATICW C^CERS^AME , ^ <br />rg-\K>o ~~ YAOn ’. <br />ADDRESS ^ ^ ^ORGANIZATION OFFICER'S NAME <br />ten<^i wen (n>uX\ v <br />(j^^j^^^TI^^ICER^ A^ <br />Locttion^lieieike^ wilL^ used.-<l^ <br />abitoess -----z—: t" —P—rr—^—t" ' <br />on t^bere license will be used.--If an outdoor irea, describe TT j <br />Y>n\v>r\yW Vi^ fW^ > C3ron<^ <br />ix^'irc cPt-J K< aJ-^ U^^U^iy. /W- <br />Will the i^licant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. <br />A/o <br />Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage.^ . I nil J /l , <br />(NOTE: insurance is not mandatory) CL5\ <br />APPROVAL <br />APPUCATION must be APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO UQUOR CONTROL <br />CITY/COUNTY <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OITICIAL <br />DATE APPROVED <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 divbioD <br />will be returned as the license. Submit to the City or County at least 30 days before the event <br />PS4)9079(8/95)