Laserfiche WebLink
OFPuk <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION" <br />444 Cedar Street Suite 133, St. Paul MN 55101-5133 i <br />(651) 201-7507 Fax (651) 297-5259 TTY (651) 282-6555 ^ <br />WWW.DPS.STATE.MN.US ..._..._ .......--- <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION DATE ORGANIZED TAX EXEMPT NUMBER <br />37116 /O 3-74a `%33O -JL 3� <br />STREET ADDRESS CITY STATE ZIP CODE <br />5�3 d F-f�y Ne, [�r-i +On <br />NAME OF PERSON MAKING APPLICATION <br />I�I rey 1. Ar.^0 Woad <br />DATES LIQUOR WILL BE SOLD <br />Au.4 us+ 6 <br />ORGANIZATION OFF'ICER'S NAME <br />Te_-�Fre.y L. F�rrtau)60d <br />nRC.ANIZ.ATIO OFFICER'S NAME <br />mitj-�O.e-j 3: Danson <br />GANIZATION OFFICER'S NAME <br />771z1nCJA b T10kns11n <br />cation license will be used. If an outdoor area, <br />I t I/ .. (J <br />BUSINESS PHONE HOME PHONE <br />( ) (651) (o4,1- 7837 <br />11007 IYEEOF ORGANIZATION <br />8, 9 `CL1jQ )CHARITABLE RELIGIOUS OTHERNONPROFIT <br />A D <br />TRESS <br />G iia- Izd- Ct 0cAL(r'y, Mil.'35'2-5 <br />ADDRESS �vlurnb,lx ei`gOr <br />5100 A), ft 5 ft , •r - 5Sya I <br />ADDRESS N Pew i3r�3 n <br />1712 Lon� �CtKe t�'1,-,•� . SS'// Z <br />cri err wl,)de ' Tne P4ve'//✓ibq <br />Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. <br />v <br />Will the applicant carry liquor liability insurance? If so, please provide the carrier's name and amount of coverage. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING <br />ENFORCEMENT <br />CITY/COUNTY New Brighton <br />CITY FEE AMOUNT 100.00 <br />DATE FEE PAID Fee Waived <br />DATE APPROVED <br />LICENSE DATES <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT <br />NOTE: Submit this form to the city or county 30 days prior to event. Forward application signed by city and/or county to the address <br />above. If the application is approved the Alcohol and Gambling Enforcement Division will return this application to be used as the License for the event <br />PS -09079 (05/06) <br />