Minnesota Department of Public Safety Alcohol and Gambling Enforcement Division 445 Minnesota Street, Suite 222, St. Paul, MN 55101 651-201-7500 Fax 651-297-5259 TTY 651-282-6555 APPLICATION AND PERMIT FOR A 1 DAY TEMPORARY CONSUMPTION AND DISPLAY PERMIT (City or county may not issue more than 10 permits in any one year) Name of organization Address Name of person making application Date(s) of event Organization officer's name City Date organized State Business phone Type of organization Club City Charitable Tax exempt number Zip Code Home phone Religious State Other non-profit Zip Location where permit will be used. If an outdoor area, describe. APPROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT City or County approving the license Fee Amount Date Fee Paid Date Approved Permit Date City or County Email Address City or County phone number Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event. ONE SUBMISSION PER EMAIL, APPLICATION ONLY. PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITY/COUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITY/COUNTY TO AGE.TEMPORARYAPPLICATION@STATE.MN.US American LegalNet, Inc. www.FormsWorkFlow.com Sheet of