Laserfiche WebLink
It City of Arden Hills License No. <br /> 1245 West Highway 96 Receipt No. <br /> T7 Arden Hills, Minnesota 55112 Amount Paid <br /> DEN HLLL S Phone: 651.792.7800 ' Date Recvd. <br /> Fax: 651.634.5137 Ins. Cert. <br /> www.cLarden-hills.mmus Total Fee Paid <br /> 2012 Charitable Gambling <br /> Application Form <br /> Information (all fields are required) <br /> Business Name: 5 yt--fit KF F-'AIZ z 1-1&i j S <br /> Property Address: -;x}•33 <br /> E'R] L-Ak f S 3 2- <br /> Date of Event: ppy5 <br /> Gambling type: PAPEXt P1 GA- 7,4-J35. <br /> Local Contact: 51-�kVJ t�l pof�/4 NU <br /> Business Phone: 7103- 7 8.4- 0117!) Business Fax: 71�3-7 Q4-91 b7 <br /> Email Address: � <br /> <br /> <br /> <br /> Please submit the following forms with your application: <br /> *Correspondence with event details and description of organization <br /> *Form I,G2-20 Permit Application <br /> Authorized Signature _ Date...... ...'.._L1.........1�. <br /> ---._..................................................._....................................._. <br />