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TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of o anization Use or an' ed Tax exempt number <br />C) 12DV0 1 -7 <br />Address City State Zip Code <br />,e tJ Minn esnta <br />Name of person maldnj a plication Business hone Home phone <br />,rz`� <br />Date(s) of event <br />Organization officer's na e <br />Organization officer's name <br />Organization officer's name <br />Type of organization <br />S–Club ] Charitable ❑ Religious Other non-profit <br />C State Zip Code <br />-oMinnesota 3Z 7 <br />C State Zip Code <br />Minnesota <br />city State Zi Code <br />Mirmesota <br />71 <br />Organization officer's name City State Zi Cade <br />Minnesota <br />Location where permit will be used. If an outdoor area, describe. <br />10,IZ.- /4P.4 'e�? , IA.,) d �� <br />If the applicant will contract far 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 camel's name and amount of coverage„ <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CrrY OR COUNTY BEFORE SUBMWnNG TO ALCOHOL AND GAMBLING ENFORCEMENT <br />L v 0 V �vn U q ( lCu <br />City acKounty approIV a license Date Approved <br />'d crit Permit Date <br />ate F Id ity r County E-mail Address <br />9-E�-D -Q-Ag _ .(,0E; <br />City or CountyPhone Number <br />or County al Approved Director Alcohol and Gambling Enforcement <br />i_LERKS N01R-E: Submit this fora J AlcWiw and Gambling Enforcement UEvision 30 days prior to event. <br />ONE SUBMISSION PER EMAIL, APPLICATION ONLY, <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITYICOUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITYICOJNTY TOAggTEMPORARY—APPLICATION@StATF-.MN.US <br />Minnesota Department of Public Safety <br />r <br />Alcohol and Gambling Enforcement Division <br />da <br />445 Minnesota Street, Suite 222, St Paul, MN 55101 <br />--V <br />, <br />651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br />Atj�*MO P, GMfPbbhp 61WM1 0FJ � <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of o anization Use or an' ed Tax exempt number <br />C) 12DV0 1 -7 <br />Address City State Zip Code <br />,e tJ Minn esnta <br />Name of person maldnj a plication Business hone Home phone <br />,rz`� <br />Date(s) of event <br />Organization officer's na e <br />Organization officer's name <br />Organization officer's name <br />Type of organization <br />S–Club ] Charitable ❑ Religious Other non-profit <br />C State Zip Code <br />-oMinnesota 3Z 7 <br />C State Zip Code <br />Minnesota <br />city State Zi Code <br />Mirmesota <br />71 <br />Organization officer's name City State Zi Cade <br />Minnesota <br />Location where permit will be used. If an outdoor area, describe. <br />10,IZ.- /4P.4 'e�? , IA.,) d �� <br />If the applicant will contract far 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 camel's name and amount of coverage„ <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CrrY OR COUNTY BEFORE SUBMWnNG TO ALCOHOL AND GAMBLING ENFORCEMENT <br />L v 0 V �vn U q ( lCu <br />City acKounty approIV a license Date Approved <br />'d crit Permit Date <br />ate F Id ity r County E-mail Address <br />9-E�-D -Q-Ag _ .(,0E; <br />City or CountyPhone Number <br />or County al Approved Director Alcohol and Gambling Enforcement <br />i_LERKS N01R-E: Submit this fora J AlcWiw and Gambling Enforcement UEvision 30 days prior to event. <br />ONE SUBMISSION PER EMAIL, APPLICATION ONLY, <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITYICOUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITYICOJNTY TOAggTEMPORARY—APPLICATION@StATF-.MN.US <br />