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Minnesota Department of Public Safety <br /> Alcohol and Gambling Enforcement Division <br /> iv 444 Cedar Street,Suite 222,St. Paul, MN 55101 <br /> 651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br /> MINNESOTA DEPARTMENT OF PUBLIC SAFETY <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 f <br /> ti.Lr �3 a.i 1.1-vw - 7 r ( Q 3 - 1gt 1 Li 3 3e 2- <br /> 36 <br /> Address City State Zip Code <br /> ✓C6 3 61.6 I-twy me.? tQ12.,14,1-4(1 Minnesota 5-3// Z <br /> Name of person making application Business phone Home phone <br /> ©► ) I (S/-- 63q-q5--5 2 - A-5.0 4 yg <br /> Date(s)of event Type of organization <br /> Au v.4 7 qv./ 671 11TO' .2E91.3 Traub ❑ Charitable Ei Religious 0 Other non-profit <br /> Organization officer's name City State Zip <br /> X be 0444) i2 ti'Cic' (4/.c#,..1-/ Minnesota 5S// Z <br /> Add New Officer <br /> Location where permit will be used. If an outdoor area,describe. <br /> ',,bp? 1.1J c �z�v , t L v tom— �T't4 t� �A u p LL <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 /> /1/s04E.74,Le, �9n ,sot's� sic, /cffe4/2) .7y 1�h.viti a- L— �N 67414e co <br /> Ool0©0 CA, <-e$c/Y'Y� fcc /V.77-`/, <N�cia.,a✓z-e C- <br /> 7 <br /> 2,ovv ovO A 4'4`1tI? 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 /> $100.00 _ <br /> City Fee Amount Permit Date <br /> Fee Waived <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 />