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<br />Minnesota Lawful Gambling <br />GL 1010 - Schedule em <br /> <br />Rev. 08/02 <br /> <br />Organization Name: <br /> <br />MN/USAW, INC, <br />11/2005 Page: <br /> <br />License Number <br /> <br />B-O_ <br />Y {Nt <br />"-J <br /> <br />MonthfYear Reported: <br /> <br />1 <br /> <br />of: <br /> <br />1 <br /> <br />Is this an amended Schedule C/D: <br /> <br />Schedule C: Lawful Purpose Expenditures <br /> <br />Current Monthly For A-7 <br />Mem bership Date of Check TRCA" co~e Code Only <br />Approval Date Check Number Check Made Out To: (check) Male ,I t-emale Amount <br />10/9/2005 11111/2005 6240 City of Arden Hills A-10 $677.43 <br />10/9/2005 1111112005 6241 Iron WC A-7 $3,387.15 <br />10/9/2005 11111/2005 6242 City of Excelsior A-4 $970.09 <br />10/9/2005 1111112005 6243 Hi-Flyers WC A-7 $970.09 <br />1019/2005 11/11/2005 6244 Rockford His! Socieiy A-1 $49.38 <br />10/912005 11/11/2005 6245 Rockford Youth WC A-7 $123.45 <br />10/9/2005 1111112005 6246 City of St Paul A-8 $21.03 <br />10/9/2005 11111/2005 6247 Mpls Finance Office A-8 $245,61 <br />11/13/2005 11/1612005 6250 Gladiators WC A-7 $180.43 <br />11/13/2005 11/30/2005 5959 City of Arden Hills A-10 ($1,120.08) <br />11/13/2005 11/30/2005 6036 Como Park FB and Wrestlin ($45.80) <br /> <br />*NOTE: Check the TRC column if the expenditure is from the "Tax <br />Refund and Credit" (TRC) amount. Your organization may not <br />expend money from this amount for lawful purposes A-S, A-9, and <br />A-12 or for allowable expenses. <br /> <br />Total of all Schedule C La\oVful Purpose Expenditures: <br />Enter on line 41 of Monthly Lawful <br />Gambling Activity Summary & Tax Return. <br /> <br />$5,458.78 <br /> <br />Schedule D: Board-Approved Expenditures <br /> <br />Current Monthly <br />Membership Date of Check <br />Approval Date Check Number Check Made Out To: <br /> <br />TRCA" B <br />(check) Code <br /> <br />Amount <br /> <br />Board <br />Approval <br />Date <br /> <br /> <br />~ <br /> <br />Board-Approved Expenditures for Recreational. Community, & <br />Athletic Facilities Intended Primarily for Persons Under Age 21: <br /> <br />B3-A 7 <br />Code <br /> <br />Current Monlhly Board <br />Membership Date of Check *TRC Approval Date <br />Approval Dale Check Number Check Made Out To: (check) M F Amount <br /> = <br /> <br />T olal of all Schedule D Board-Approved Expenditures: <br />Enter on line 42 of &1 Monthly Lawful Gambling Activity Summary & Tax Return. <br /> <br />$0.00 <br /> <br />Signatures <br />I declare that this Schedule C/D is correct and complete to the best of my knowledge and belief. <br />Chief Executive Officer (or designee) , (, ), :I t. D N:. ~ <br />Gambling Manager (or designee) ~ ___ <br /> <br />Dale: ~JJLI cJdll5 <br />Date: JJ,,__.J~I oS <br />. <br /> <br />Mail to <br />Gambling Control Board <br />Suite 300 South <br />1711 West County R08d B <br />I Roseville, MN 55113 <br />