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<br />State of Minnesota <br />Gambling Control Board <br />Organization License Renewal Application <br /> <br />I For Board Use Only I <br /> <br />-'G2000R Printed: 12/8/1999 <br /> <br />License Number: A-00489 <br /> <br />Effective Date: 5/111998 <br /> <br />Expiration Date: 413012000 <br /> <br />Orlanization Information <br /> <br />Church of St Mary Romanian Orthodox St Pau <br />854 Woodbridge St <br />St. Paul, MN 55117 <br />County: Ramsey <br /> <br />MN Sales & Use Tax permit #: 24806 <br /> <br />Phone Number: <br /> <br />(612) 489-5618 <br /> <br />Chief Executive Officer Information <br /> <br />Nicholas Manciu <br />2816 McKinley St NE <br />Minneapolis, MN 55418 <br /> <br />Date of Birth: <br /> <br />2/17/1959 <br />(612) 789-6172 <br /> <br />Phone Number: <br /> <br />Treasurer Information <br /> <br />Daniel Muntean <br /> <br />Phone Number: <br /> <br />9/16/1924 <br />(651) 484-6793 <br /> <br />Date of Birth: <br /> <br />~rganization's regularly scheduled meetings are: <br />Number of active members over the age of 18: <br /> <br />2nd Tuesday from 7:30 PM to 8:30 PM <br />.;.% Cj I <br /> <br />ACKNOWLEDGMENT <br /> <br />I DECLARE THAT: <br /> <br />. I have read this application and all infonnation submitted to the Gambling Control Boan!; <br />. All the information is tnJe, accurate and complete; <br />. The compensation schedule is current and on me with the board; <br />. The proof ofnonprofrt Stalu8 fur the organimtion is on file with the bean!; <br />. Our organimtion remains in good standing as a nonprofit corporation with the Minnesota Secretary of Stale's Office <br />and/or continues to be recognized by the Internal Revenue Service as an income tax exempt organization and, if applicable, ou <br />charter remains in good standing with our national organization; <br />. All other required informatinn has been fuDy disclosed; <br />. I am the Chief Executive OffICer of the organimtion; <br />. I asswne full responsibility fur the fair and lawful nperation of all gambling activities to be conducted; <br />. I will fiuniliarize myself the the laws ofMilUlCsota governing gambling and rules of the Gambling Control Board and agree, if <br />licensed, to abide by those laws and rules, including amendments to them; <br />. A membership list of the organimtion will be available within seven days after it is requested by the Gambling Control Board; <br />. Any changes in application infurmation wiD be submitted to the Gambling Control Board and the local unit of government wit <br />10 days of the change; <br />. A license tennination plan wiD be submitted to the Gambling Control Board within 30 days of termination of aD Premises <br />Penni1(s ); <br />. The gambling manager is booded and licensed as required by Minnesota statute; and <br />. I understand thai failure to provide required infurmation or providing fulse or misleading infonnation may result in denial or <br />revocation of the license. <br /> <br />QL~. <br /> <br />. <br /> <br />" <br /> <br />Date..,., I '"J _ <br />'- - - (..JVoO <br /> <br />Signature of CbiefExecutive Officer <br />