1b Rotary Club Beer License Ma~Z BOulevard
:Chanha~n,POB°x14IMN55317 TO: Todd derhgdt, citY:.Manfiger (; f':~ :,", :':::" ~:~'::- ~::::~;": ~:
Buildin~ Inspections
"Pfi0ne:952.~7.1180 - S~j:: . ~::APproCai Of T~mor~
~(Engineering ~ r
Phone5952.22Lll~
' ' Attached please find anapplxcat~on foranon~sale beer lmense from:the-
~ance :/ chanhaSseh R°t~ Club~ TheR0t~
. Ph0,~:gSZ22~:~40 ~: ::_ ~ jUlY celebratiOn on hlY 3~ 2002;dUfi-ng'the:dr~r~d~ceand trade faff.::The.:.~:;,
952 22~ 1110
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::: } ~95222Z:14°4:: ~:: ":'- staff reco~en~ appr°v~of-theChanh~senfRo~:ClUb~;g:'~ue~t-tOSelib~r
?'::Pia,~in a- ~ ~ ~: at the anfiual Fou~h °fjulyStreaD~ceafidT~adeF~oniaiY3'¢:2002
~at~ai ~e~ou~c~s ::: :~ 5 Co~ti~gCnt upon-r~eiPt of their ]iqUo[liability~insurance:ce~ifieate;'-Additionally,
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CiW orch~hassan' AorOwing C0mmu~¢.wlth &aniak~s~qualit~ ~ ~1 i =
Minnesota Department of Public Safety
LIQUOR CONTROL DIVISION
444 Cedar St./Suite 100L
St. Paul, MN 55101-2156
(612)296-6439 TDD (612)282-6555
APPLICATION AND PERMIT
FOR A 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
(Organization or location limited to 3 permits in a 12 month period)
TYPE OR PRINT INFORMATION
NAME OF ORGANIZATION
STREET ADDRESS '
NA~ OF PERSON N~ING ~PLICATION
DATES LIQUOR WILL BE SOLD (1 to 4 days)
ORGANIZATION OFEICER'S NA~
ORGANtZA'flON OFFICER'S NAME
l,ocation x~ hcrc liccnsc will be used. If an ot,td~z' area, dcscrib~~
DATE ORGANIZED
CITY
TAX EXEMPT N'UM~ER
STATE ZIP CODE
BUSINESS PHONE I HOME PHONE
TYPE OF ORGANIZATION
U CLUB '~CttARITABLE U RELIGIOUS [] OTHER NONPROFIT
ADDRESS
ADDRESS
ADDRESS
Will Ibc applicant contract tbr intoxicating liquor services? If so, give lhc namc and address of the Liquor license providing the sen'ice.
Will ibc applican! cam' liquor Liability insurance? If'so. the carrier' s name and amoun! ofcoveraee.
(NOTE: Insurance is no! mandatory) ~/.~ ~ "
APPROVAL
AP.~PLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL
CITY/COUNTY
CITY FEE A.MOUNT
DATE FEE PAID
SIGNATURE CITY CI,ERK OR COUNTY OFFICIAL
DATE APPROVED
LICENSE DATES
APPROVED LIQUOR CONTROL DIRECTOR
NOTE: Do not separate these m'o parts, send both parts to the address above and the original signed by this dMsion
will be returned as the license. Submit to the City or County at least 30 days before the event.
PS-09079(8/95)