Application And Permit For A 1 Day Temporary Consumption And Display Permit
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Application And Permit For A 1 Day Temporary Consumption And Display Permit Form. This is a Minnesota form and can be use in Alcohol And Gambling Enforcement Division Statewide.
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Tags: Application And Permit For A 1 Day Temporary Consumption And Display Permit, PS-09098, Minnesota Statewide, Alcohol And Gambling Enforcement Division
Minnesota Department of Public Safety
ALCOHOL AND GAMBLING ENFORCEMENT DIVISION
444 Cedar St./Suite 222
St. Paul, MN 55101-5133
(651) 201-7507 FAX (651) 297-5259 TDD (651) 282-6555
APPLICATION AND PERMIT
FOR A 1 DAY TEMPORARY CONSUMPTION & DISPLAY PERMIT
(City or county may not issue more than 10 permits in any one year)
TYPE OR PRINT INFORMATION
NAME OF ORGANIZATION
DATE ORGANIZED
TAX EXEMPT NUMBER
STREET ADDRESS
CITY
STATE
NAME OF PERSON MAKING APPLICATION
BUSINESS PHONE
(
)
DATE SET UPS WILL BE SOLD
ORGANIZATION OFFICER'S NAME
TYPE OF ORGANIZATION
CLUB CHARITABLE RELIGIOUS
ADDRESS
ORGANIZATION OFFICER'S NAME
ADDRESS
ORGANIZATION OFFICER'S NAME
ADDRESS
ZIP CODE
HOME PHONE
(
)
OTHER NONPROFIT
Location where permit will be used. If an outdoor area, describe
APROVAL
APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL
CITY/COUNTY___________________________
DATE APPROVED_________________________
CITY FEE AMOUNT_______________________
PERMIT DATE____________________________
(Not to exceed $25)
DATE FEE PAID________________________
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 application signed by city and/or county to the
address above. If the application is approved the Alcohol and Gambling Enforcement Division will return this application to be used
as the permit for the event
PS-09098(12/09)
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