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CITY OF RAMSEY MUNICIPAL CENTER USE PERMIT Name: Address: Representing Organization Date: Phone (W): (H): to use the lower level / Cguncil Chambers (circle one) of the Ramsey Municipal Center on (date) between the hours of and has permission for the purpose of , Fees must be paid al time $20.00 per event (resident) $40.00 per event (non-re~qident) $10.00 per event / 12 mohth lease (resident) $20.00 per event / 12 molnth lease (non-resident) $75.00 damage deposit (resident and non-resident) $15.00 key deposit (resident and non-resident) of application. Hours Receipt #' Receipt #' Receipt #' Receipt #' Receipt #' Receipt #' of Use: 7:00 a.m. to 10:30 p.m. Amount: Amount: Amount: Amount: Amount: Amount: .:' Total Amount: Key No. Key returned on: Initials: THE USE OF THESE FA~ CILITIES REPRESENTS A PRIVILEGE AND MAY BE REVOKED AT ANY TIME WITH OR WITHOUT PRIOR NOTICE BY THE CITY COUNCIL OR CITY ADMINISTRATOR. I, the undersigned, have read and understand the Priorities of Use and Rules of Use listed on the reverse side of this application. I underS,land that a violation of these rules may result in forfeiture of an>, deposits and additional liability for damages. I talso understand that I am responsible to report any vandalism or abuse to the Ramsey Police Department. It is hgreed by the parties hereto that those individuals included in the above group will hold the City of Ramsey harm)ess for any damages or personal injury incurred as a result of the use of this facility by those individuals. User Signature: CITY OF RAMSEY: Date: By: FOR CITY USE ONLY: Inspected By: Date: Comments: Copy of permit to: USer Administrative Services Finance Office