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 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE Name of organization Date organized Tax exempt number Address City State Zip Code Name of person making application Business phone Home phone Date(s) of event Club Charitable Religious Other non-profitType of organization Organization officer's name City State Zip Code Organization officer's name City State Zip Code Organization officer's name City State Zip Code Organization officer's name City State Zip CodeLocation where permit will be used. If an outdoor area, describe.If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service.If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. City or County approving the license Date Approved Fee Amount Permit Date Date Fee Paid Signature City Clerk or County Official Approved Director Alcohol and Gambling EnforcementAPPROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT City or County E-mail Address City or County Phone NumberCLERKS 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 Microdistillery Small Brewer American LegalNet, Inc. www.FormsWorkFlow.com