CITY OF DULUTH
CITY CLERK’S OFFICE
330 City Hall
411 West First Street
Duluth, Minnesota 55802-1189
Phone (218) 730-5500
Fax (218) 730-5923
LICENSE APPLICATION
LICENSE TOTAL FEE
1 Day Temporary Consumption &
Display Permit
$ 25.00
LICENSEE NAME/ADDRESS/PHONE NO.
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CONTACT’S NAME/ADDR/PHONE NO.
__________________________________________
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Email Address:______________________________
OWNER OF BUSINESS PREMISES:
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_________________________________________
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DATE OF EVENT:___________________________
IS LICENSEE A NON-PROFIT ORGANIZATION?
YES NO
Please note: There are only 10 One Day
Consumption and Display Permits issued per year
and they are processed on a first come, first served
basis.
I HEREBY STATE THAT ALL INFORMATION HERE IS TRUE AND CORRECT AND THAT I SHALL COMPLY WITH ALL
PROVISION 0F THE ORDINANCES OF THE CITY OF DULUTH AND LAWS OF THE STATE OF MINNESOTA AND THEIR
AMENDMENTS.
__
_____________________________________________
Signature of Applicant
MAI
LING ADDRESS (If different than licensee):
__________
___________________________
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FOR OFFICE USE ONLY
DATE_________________
GOVERNMENT DATA PRACTICE
S ACT - CLASSIFICATION WARNING
The data you supply on this form will be used to process the license you are applying for. You are not legally required to provide this data,
but we will not be able to process the license without it. Some of the data will be classified as public data if and when the license is
granted. Private financial information including a tax identification number and social security number are classified as private data and
will be available to governmental personnel and other governmental agencies whose access is necessary to perform their official duties.