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City of Arden Hills License No. <br /> 1245 West Highway 96 Receipt No. <br /> Arden Hills, Minnesota 55112 Amount Paid <br /> _AVEN HILLS Phone: 651,792.7800 Date Recvd. <br /> Fax: 651.634.5137 Ins. Cert. <br /> www.cLarden-hills.mmus M Total Fee Paid <br /> 2013 Charitable Gambling <br /> Application Form <br /> Information (all fields are required) <br /> Business Name: FA)ZiZ We>i4S <br /> Property Address: Oz1vf- <br /> I-Ak::-F PA-P-k� MAI S�.,54 3-;Z- <br /> Date of Event: ;1 Yak <br /> Gambling type: t J <br /> Local Contact: <br /> Business Phone: Business Fax: <br /> Email Address: e Address: <br /> Federal 1D#: <br /> Please submit the following forms with your application: <br /> *Correspondence with event details and description of organization <br /> *Form L Premise Permit Application <br /> Authorized Signature Date <br /> it <br /> II <br />