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Minnesota Department of Public Safety <br /> pr, <br /> Alcohol and Gambling Enforcement Division <br /> ® 445 Minnesota Street,Suite 1600,St.Paul,MN 55101 <br /> r... r P " • 651-201-7507 Fax 651-297-5259 TTY 651-282-6555 <br /> Alcohol&Gambling Enforcement APPLICATION AND PERMIT FOR A 1 DAY <br /> TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br /> Name of organization Date organized Tax exempt number <br /> J tees I I l 11434 y 1 -16068 3 <br /> Organization AddrM City State Zi•Code <br /> Th 't'SM 3S f 5rttNirpp'% MN K 0 <br /> Name of person making application Business phone Home phone <br /> 117 bPA, A r l 218--vo-31(D I <br /> Date(s)of event Type of organization ❑ Microdistillery 0 Small Brewer <br /> ri Z 1 ti 12,023 ❑ Club ❑ Charitable ❑ Religious7�/Other non-profit <br /> Organization officer's name City State Zip Code <br /> AO- g‘uxia. Trampett MN <br /> Organization officer's name City State Zip Code <br /> MN <br /> Organization officer's name City State Zip Code <br /> MN <br /> Location where permit will be used. If an outdoor area,describe. <br /> Sbk Ltt <br /> If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br /> NIPt <br /> If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br /> West Bend( Akav o . S42INce COQ -- 1GO0 000 <br /> Kle n �i no Sewns. SeU s �'nc . 2-( umshcv r) 34. Si't 2-003tco perdu,MA 5401 <br /> ttTT APPROVAL <br /> APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br /> City or County approving the license Date Approved <br /> Fee Amount Permit Date <br /> Date Fee Paid City or County E-mai Ad ress <br /> City or County Phone Number <br /> Signature City Clerk or County Official Please Print Name of City Clerk or County Official <br /> CLERKS NOTICE:Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event. <br /> ONE SUBMISSION PER EMAIL,APPLICATION ONLY. <br /> PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITY/COUNTY AS ALL TEMPORARY <br /> PERMIT APPROVALS WILL BE SENT BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY <br /> CITY/COUNTY TO AGE.TEMPORARYAPPLICATION@STATE.MN.US <br />