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5.g) Approve Temporary On-Sale Liqour License for Washington County Historical Society Meeting Date: 4/19/2011 Agenda Item: � � City Council Agenda Report City of Scandia 14727 209`�' St. North Scandia, MN 55073 (651) 433-2274 Action Requested: Approve a Temporary On-Sale Liquor License for the Washington County Historical Society, for a one-day event to be held at the Hay Lake School Museum complex. Deadline/Timeline: N/A Background: • The Historical Society is planning a Beer Tasting fund-raising event on Saturday, June 25, 2011. They hosted similar events in June 2008, 2009 and 2010. • Under Section 22 (H) of Ordinance No. 93, the Historical Society is eligible for a temporary license in connection with a social event sponsored by a club, charitable, religious or other nonprofit corporation that has existed for at least three years. Recommendation: I recommend that the Council approve the license contingent upon submission of the required certificate of insurance. Attachments/ • Application Materials provided: Contact(s): Brent Peterson, 651 433-4014 Prepared by: Anne Hurlburt, Administrator (Wash Co Historical Society Temp Liquor Beer Tasting 2011) Page 1 of 1 03/31/11 �°��� ��� Minnesota Department of Public Safety �� <..��� �'� ALCOHOL AND GAMBLING ENFORCEMENT DIVISION �. `�`' �. 444 Cedar Street Suite 133,St.Paul MN 55101-5133 �• ' - ��OF (65l)201-7507 Fax(651)297-5259 TTY(651)282-6555 �"��.'.. ^` WWW.DPS.STATE.MN.US —___ APPLICATION AND PERMIT FOR A ] TO 4 DAY TEMPORARY ON—SALE LIQUOR LICENSE TYPE OR PRINT INFORMATION NAME OF QRGA IZATION . DATE ORGANIZED TAX EXEMPT NUMBER �QS Vi� ► lul7� 5��� ��a ��Z-���:� STREET A DRESS CITY STATE ZIP CODE ��� �. �►����- ��f�� ��ii���-��� rn� �����- ME OF PERSON AKING APPLICATION B SIN S PHONE H ME PHONE I, /i��-, �� . � c��j)�3�' —��5�� (�))�f,�3 ��i� DATES LIQUOR WILL BE SOLD .t;,r��S�r�� TYPE OF ORGANIZATION J�f ORGANIZATION OFFICER'S NAME ADDRESS � "T,��'��-��9�u��'t�rr�,� �'hZ�,��.s� z .j� ��{� S� ORGANIZATION OFFICER'S NAME D SS / /� {��/a � . j�/��� ,l/�f{�� �l�it�.3�-' � �f���J-0���!/r- �'/hi�`��'' /1'I�l y �-- ORGANIZATIQN O ICER'S�TAM� ADDRESS Location license will be used. If an outdoor arsa,describe ° . ��� ` „o �?G�l.��� �- .f�� {��s�� . ` �r�it,� t� ��h��e.: �r�r�l�. ���cJ C�/�-��?��j�����/ Will the applicant contract for intoxicating liquor service? If so,give the name and address of the liquor licensee providing the service. Will the app' ant carry,liquor 'ability�sur ce? If s�please provide the carrier's name and amount of coverage. � , r-� .� APROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL&GAMBLING ENFORCEMENT CITY/COUNTY DATE APPROVED CITY FEE AMOLJNT ��O• �� LICENSE DATES DATE FEE PAID �3 -- 3 � - a o � I SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT NOTE:Submit this form to the city or county 30 days prior to event. Forward applicatioo signed by city and/or county to the address above. If t6e application is approved t6e Alcohol and Gambling Enforcement Division will return this application to be used as the License[or the eveot PS-09079(OS/06)