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Minnesota Department of Public Safety <br /> Alcohol and Gambling Enforcement Division AG <br /> 0 444 Cedar Street,Suite 222,St.Paul,MN 55101 <br /> 651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br /> MINNC6OTA UI:PAIITMI,IIT-M PUtllrt t1MtT V <br /> APPLICATION AND PERMIT FOR A 1 DAY <br /> Alcohol&Gambling Enforcement TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br /> Name of organization Date organized Tax exempt number <br /> Benedictine Health Center at Innsbruck ' Jan 1,1965 ES 37801 <br /> Address City State _ Zip Code <br /> 1101 Black Oak Drive New Brighton Minnesota (55112 - <br /> Name of person making application Business phone Home phone <br /> Susan Ager 651-633-1686 612-220-5371 • <br /> Date set ups will be sold Type of organization <br /> April 27,2012 ❑ Club ❑ Charitable ® Religious ® Other non-profit <br /> Organization officer's name City State Zip <br /> X David Hoel New Brighton tvlinnesota 55112 <br /> Add New Officer <br /> Location where permit will be used. If an outdoor area,describe. <br /> St.John the Baptist Catholic Church,835 2nd Ave NW,New Brighton,MN 55112 <br /> If the applicant will contract for 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 carrier's name and amount of coverage. <br /> Catholic Mutual $1,000,000 <br /> APPROVAL <br /> APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br /> New Brighton <br /> City/County Date Approved <br /> $100.06 <br /> City Fee Amount Permit Date <br /> March 27, 2012 <br /> Date Fee Paid <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 <br /> permit for the event. <br /> Page 1 of 1 <br />