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<br /> - <br /> LG2JO Minnesota Gambling Control Board For Board Use onl\ <br /> 09/20/95 Application for Authorization to Conduct <br />e One-Day Off-Site Gambling <br />Organization Information <br />Organization Name <br />Circle Lex Lions Club <br />P. O. Box 13' <br />C:.zcl.:: :-'ifl.":3, : :~: :):: 01 ". <br />Class of Organization License Base License Number License Expiration Date <br /> P\ 01106 08-31-99 <br />Chief Executive Officer (CEO) Information <br />Name of Chief Executive Officer (Cannot Be Gambling Manager) Daytime Phone Number <br /> (110) (/7...--635-5'52.0 <br /> Jan Kreminski (~) (f) 1 7) 7>< 4 _ 7 7 ; 1 <br />Gambling Premises Information <br />.Name of Establishment where gambling activity will be conducted <br />!-Iou fJ /rL1 --I- AI ;J - F;- fJ/Juc. /VJr17),/ 1 &<,)1 WEIr CC"";1.-7'1 /Z<;'Yh:J .~- <br /> Street Address City /1-1l/Jc-:V rI){_U~ /f?/V. S-S-/I"'>....- .. <br />Does your organization own the gambling premises? 0 Yes g No <br />If no, a lease agreement must be submitted with this application. (See instructions) <br />Activity Date <br />Date of One-Day Off-Site Activity 04 / 7" / QR <br />The gambling activity conducted on this day may not exceed 12 hours <br />Type of Gambling Activity <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br />for this one-day off-site activity. <br />e D Bingo @ Raffles D Paddlewheels D Pull-tabs D Tipboards <br />