Laserfiche WebLink
<br />~ <br />/],\~HILLS <br />. <br /> <br />City of Arden Hills <br />1245 West Highway 96 <br />Arden Hills, Minnesota 55112 <br />Phone: 651.634.5120 <br />Fax: 651.634.5137 <br />www.ci.arden-hills.mn.us <br /> <br /> <br />License No. <br />Receipt No. . <br />Amount Paid <br />Date Recvd. <br />Ins. Cert. <br />Total Fee Paid 1t>(QD.OO <br /> <br /> <br />2006 Charitable Gambling Premise Permit- <br /> <br />Application Form <br />(Terms of the License: 2 Year Agreement) <br /> <br /> <br />Information (allfields are reqaired) <br /> <br />Business Name: <br /> <br />~ f1.4-I2-'(--- (41'1.+-,(.// A-AJ <br /> <br />If 'f'l (. -7:; v :JeU;/ .4--VL. <br />4vJ.,~ H--, (I> ,MY' <;,",1 ('>- <br />, <br /> <br />JleN ~'-':uH.LlicL"__'Mn n <br /> <br />c.Huf'c. ff <br /> <br />&. R:.ffA> /h. y <br /> <br />'JI1"__~'-~_ <br /> <br />Property Address: <br /> <br />Nature of Business: <br /> <br />Local Contact: <br /> <br />Business Phone: <br /> <br />'II. _.JIL=LZ.l_i- <br /> <br />Business Fax: <br /> <br />Email Address: <br /> <br />W cbsite Address: <br /> <br />. <br /> <br />. Lf.1::,.,.l'i'i.L'il/ <br /> <br />Federal ID#: <br /> <br />Premise Permit and Investigation Fee Jt jCO-"--C' <br /> <br />*2005 Income and Loss Statement <br />'Projected 2006 Receipts/Prizes <br />'Copy of Lease Agreement <br /> <br />I <br /> <br />V" <br />7/ <br /> <br />(All organizations pel111ittcd to conduct lawful gambling within the City of Arden Hills shall contribute] 0% (ten percent) of their <br />net profits derived from gambling activities within the City to a special fund to be admimstered by the City Council for lawful <br />purposes. Payments to the fund shall be calculated for quarterly periods ending on the last days of March, June, September and <br />December. Quarterly installment payments shall be submitted together with verifiable supporting documentation not later than <br />the t\;vcMlcth day of the i"cnth f0llo\ving the end (. ':' ti,e quarterly period.) <br /> <br />Authorized Signature ,cJigCLJq~~1:n4flY <br /> <br />Date I-J'-j~Qk> <br /> <br />. <br />