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<br /> <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 133, St. Paul MN 55101-5133 <br />(651) 215-6209 Fax (651) 297-5259 TTY (651) 282-6555 <br />WWW.DPS.STATE.MN.US <br /> <br /> <br />APPLICA nON AND PERMIT <br />FOR A I TO 4 DA Y TEMPORARY ON-SALE LIQUOR LICENSE <br /> <br /> <br />TAX EXEMPT NUMBER <br /> <br />~"3 ~I <br /> <br />STATE ZIP CODE <br /> <br />M\J 5Sl\3 <br /> <br />HOME PHONE II Ct <br />(ItlSJ) 4?;""L( ~/ I T I <br /> <br />ADDRESS <br />54?:>??: ,ti' Le.,'f-~ V\ - -:\{N\. i 'S VLOYeVl'e.' <br />ADDRESS <br />/540 ~WOCk.~' B'vYoL'e- -Shot <br />ADDRESS <br />5S 30 ~'\'Iell\ <br />l C)-\- Lv CCL---k- ~-\- l\ ~ <br />~ c4- t6- \ VV\ €r-' 'D y- . <br /> <br /> <br /> <br />e name and address of the liquor licensee providing the service. <br />U <br /> <br />Iv- <br /> <br />Will the applicant carry liquor liability insurance? Ifso, please provide the carrier's name and amount of coverage. <br /> <br />APROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING <br />ENFORCEMENT <br /> <br />CITY/COUNTY New Brighton <br /> <br />DA TE APPROVED <br /> <br />CITY FEE AMOUNT <br /> <br />$100.00 <br /> <br />LICENSE DATES <br /> <br />DATE FEE PAID <br /> <br />June 21, 2006 <br /> <br />. <br /> <br />SIGNATURE CITY CLERK OR COUNTY OHICIAL 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 addl'ess <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 /> <br />PS.09079 (02/05) <br />