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PS 09079 (S^3)Minnesota Department of Public Sa'ety <br />LIQUOR CONTROL DIVISION <br />190 5tn St. E.. St. Paul. MN 551 Ot <br />(612)296-6430 TOD (612) 297-2100 <br />application and permit <br />for a 1 to 3 DAY TEMPORARY ON-SALE LIQUOP. LICENSE <br />NO. ORMCM8E.RS <br />HCO <br />NAME OE PERSON MAKING APPLICATION <br /><?• L • ^ V A % A <br />CITY <br />rv\ \ vi ^o\ b <br />ivie orren»wni r^r. w—. <br />P- aa Vt <br />DATES LIQUOR WILL 8E S0L0» O TO 3 DAYS) <br />•USINESS PHoi^E <br />ii5:iZ I ^31 - <br />TAX EXIM*T NUMSER <br />STATE riPCODE <br />r>\K) STHol <br />home PHONE <br />^71 <br />Se pA< r*^ ^ P ‘ \*7°ljj~ ----------------- <br />DOSyiROANIZATION HAVE A CHARTER GENERAL PURPOSE OP ORGANIZATION <br />ORGANliATION OPPICER'S NAME <br />la.vvx. ~ (^TesiJtewVT <br />ORGANIZATION OPPICER'S NAME <br />CV<;^V\ Lay S4»y\ ~-Tfca^o«.^ <br />ORGANIZATION OPPICER'S NAME <br />ADDRESS <br />/2g* (<Jg.vVyo;A-V CA. 7^ »\V.A ^<*-«->. ^5*33i V <br />ADDRESSAUUHb^lS . ^ , <br />Sleep tYl«xv\g^ <!y*(Acv\ V/o-t^. <br />organization opriuen «ft il_ <br />16>^U yn ■g>v^rV>r.AS- f 470H l4USU.v U <br />Location wh«r* licpnta will b« usod. If «n outdoor area, describe <br />M <br />non wrwre ------- <br />......L,.«V., O-^VV. v^A<. - 22HO f.v.-VW wrj.ggg:ii <br />-- ' — -------------------------------------------------——----------------------------------- <br />Will the loot) <br />the services <br />icant contract for intoxicating liquor services? If so. give the name and addrass of the Uqoor licensee providing <br />0®V ^ WV <SLvO-0-^ €_ <br />Will the applicant carry liquor liability insurance? If so. the carrier s name end amount of coverage. <br />(Note;Insurance is not mandaioryi <br />CITY OP <br />CITY PEE AMOUNT 6L^ <br />DATE FEE PAID___^ <br />DATE APPfiOVEO <br />LICENSE DATES <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE; <br />TOTAL P.Ol