Laserfiche WebLink
Application for 1 to 4 Day Temporary On-Sale Liquor License <br /> <br /> Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar St., Suite 133, St. Paul, MN 55101-5133 <br />(651)296-9519 FAX (651)297-5259 TTY (651)282-6555 <br /> <br />Page 1 of 2 <br /> <br /> ? 2202 <br /> <br /> A PPI,tCAT1ON AND PERaM IT <br />FOR A l TO 4 DAY TEMPO~RY ON-SALE LIQUOR LICENSE <br />(Orsaa~atioa or k~;~li.oa thni~ ~ 3 ~rmits m a [2 moath p~.iod) <br /> <br />~PE OR. PRiN]' iNFORMATION <br /> <br />NAME OF ORGAN!7~\TION <br />Church of Si;, <br />STILEET ADDRESS <br />566 4Ch St. <br /> <br /> NAME OF P[RSON MAKING APPI;,[CAFK)N <br /> Nary T ~mp 1: e___ <br /> DA! ES LIQUOR WII.I. BE S(;,L~) ( 1 ~o <br />..... 5...)~.Cmmber 22, 2002 <br /> OR(iAN~Z2VtlON O['TICER'S NAME <br /> Fr. Joseph Kogf, Pastor <br /> <br />ORGANITATION OFt-'tCER~S NA ME <br /> Larry Toth, Trustee <br />OR()ANIZ.,~ llON' O[:F)CI~R'S NAME <br /> <br />tDATE ORGANWuT. E:D TAX E~.,bw'r NUMBER <br />yr- 1891 ES25028 <br />]ElklCIW River <br /> e63~ 441- 1483 (763 44 I- 1523 <br />' 1:WPE OF ORG4NIZAT[ON <br /> :J CLt:!} 2 C[b~IT~I~:~:~' REUGIOUS_ ,g ~ OD~R NONI~OFK <br /> <br />AI)D[~SS <br /> 566 4th St., Elk River, MN 55330 <br /> <br />ADI)RIi!SS <br /> 813 Faw~,,Rd~,,,,,,E,,,lr¢ River~..MN 55330 <br />Al) DR ESS <br /> <br />Loc~tiort wbem liee~tsC!w~U be used. Il'an mmtc~ =ma, describ,~ <br /> Parking lot of the church at 554 4th St.., Elk River, MN 55330 <br /> <br />Grosslein Beverages, Inc. 1355/4 Tungsten St NW, Anoka, NS 55303 <br />763-42 1-5804 <br /> <br />Will the app~anl eoa~y Iiqnor liahitily insn~nce? If~. thc earri~r' .q atone and amom:l of ¢overa~t,e. <br />{NOTE:: Ir~mta~tceis~m~mand,~tmy) Yes, with Catholic blutual, Omaha, Nebraska <br /> <br /> APPROVAl:, <br />APIq.ICATION MUST BE APPROVED BY CITY' OR COUNTY BEFORE SUBMiTTING't'O LIQUOR COi~;ROL <br /> <br />CITY/COUSNTY <br /> <br />CITYFEE , '" ' ' <br /> AMOLNT <br /> <br />DATE FEE PAID <br /> <br />SIGNATURE CITY CI,FaRK OR COUNTY ()I:FICIAL <br /> <br />DATE APPROVED <br /> <br /> 'N <br />JCE~. SE DATES <br /> <br />&PPRO~D LIQUOR CONTROl, DrR.ECTOK <br /> <br />NOTE: Do not separate these twn. part~, send both pa~s 1o the addres$ alm~*e and the o:~glnaI sig~cd by [hi~ d~i~ion <br /> <br /> PS~O0~9{Sg~5 <br /> <br />http ://www. dps. state, nm. us/alc gamb/alc enf/forms/4daytemp.html 8/1/2002 <br /> <br /> <br />