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PS-09079 (5/93)Minnesota Depanrr.ent of Public Safe^/ <br />LIQUOR CONTROL DIVISION <br />190 SV". St. E.. St. Paul. MN 55101 <br />(612)295-5430 700(512)297-2100 <br />APPLICATION AND PERMIT <br />FORA 1 to 3 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />• TKfe rnim i i.'herv^n.-mAAi iw‘'« <br />NAME OF organization <br />•Ti'TI'I < - 1 IjJ'k . L lt'r» <''/ /M/i")/U• <br />1 DATE ORGANIZED! n NO. OF members <br />^\CC <br />TAX EXEMPT NU.V8E: <br />^ 1 * l'^r'C,2S^ <br />STREET ADDRESS <br />^T<‘LiiyJ<r> Tritc'-u <br />£ <br />In- €-. if‘i <br />1 9'^'*1 Srf fC i V f <br />STATE <br />A//L <br />:i»coo! <br />UncTfrt t: s 'S o <br />DATES LIQUOfl WIU8E SOLO’ O TO 3 DAYS) <br />(r:Ji 7 ________________________ <br />I DOES 0AGA.M2AT10N' HAVE A CHAt^TER ( GENERAL PURPOSE OF 0«Gamzat IC <br />Yes z N: II >:«•*» f ri - <br />CRGANI2ATIO.'.' 0FF:C£R'S NAME <br />/ <r» c I<1 1 / I V *1 r^C / <br />ADDRESS <br />2,iC <br />OROANIZATION OFFICER'S NAME ^ <br />fK ], t i TVI n — V ^ f <br />> address <br />t-2»7 **> P,' Fi lif-kri <br />ORGANIZATION OFFICER’S NAME ADDRESS ^ ^ _ <br />*■> 7 ^ LO ^ Yv:;v-> , { Pci ( CK f <' <br />Location wh^rt licenaa w»ll b« If an outdoor area, describe. <br />M,rniU.tc.nl<n Ak ‘<C Ll'r^‘ il\W <br />v/ill the applicant contract for intoxicating l.cuor services? If so. give the nawe address of the Uouor licensee providif'g <br />the services. <br />hsiO <br />Will the applicant cat/V liouor liability insurance? if so. the carrier’s narne and amount 0? coverage. <br />I.Note;lnsuranc« is not mandatorvl <br />K'> <br />r.TvnP (£)^O0 DATE APPROVED---------------------------------------------------------------- <br />^/T ^ ®riTV tcc amouwt ^^ -------LICENSE DATES____________—--------------------------- “ <br />DATE FE= PAID . . _ <br />• <br />APPROVED LIQUOR CONTROL DIRECTOR <br />SIGNATURE CITY CLERK <br />____________________________________________________ <br />Do not separate these two parts, send both parts to the address above and the original signed oy <br />NOTE: ^ returned as the license. Submit to the City Clerk at leist 30 days be'ore the event. ___— <br />TOTPL P.Ol