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Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />pGamblino 444 Cedar Street, Suite 222, St. Paul, MN 55101 <br />651- 201 -7500 Fax 651 - 297 -5259 TTY 651 - 282 -6555 <br />APPLICATION AND PERMIT FOR A 1 DAY <br />Aleaho! Enloreemant TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization Date organized Tax exempt number <br />Benedictine Health Center at Innsbruck lian 1, 1965 65 - 3-7 B70 <br />Address City State Zip Code <br />1101 Black Oak Drive lNew Brighton Minnesota 55i 12 <br />Name of person making application Business phone Home phone <br />Susan Ager 651 - 633 -1686 <br />Date(s) of event Type of organization <br />Friday, May 2nd, 2014 ❑ Club ® Charitable ❑ Religious ❑ Other non - profit <br />Organization officer's name City State Zip <br />X r, New Brighton Minnesota 55112 <br />Add New Officer <br />Location where permit will be used. fan 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 />e*1Ak1 r C1 (K kt -S i , UPC , eve <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />New Brighton <br />City /County <br />$100.00 <br />City Fee Amount <br />04/04/2014 <br />Date Fee Paid <br />Date Approved <br />Permit Date <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 />