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Memer Consumer',a serv*w,:r of
<br /> II HeWth& „ ,m 'fitmm Adminishaflon II,,,,II,,,,
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<br /> IR
<br /> IPO Box'1457'5
<br /> Dies Moines, 60306 CER
<br /> Cartifillicato of 'fins lllr� st F Illi W I
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<br /> er fcae r � � llbrrin is oir 11p f- I l fm ii ua ,clubs, � oipt u ......:
<br /> imame of OrganiziII I m u V rm: Anoka Czuwity Radio Club
<br /> Name I Chaw.III N ''rim:V"q ur
<br /> Ips Icy Plumrrrmber our CHerd Number. RGI..42,40 331
<br /> Name,T109,&Addiressof IrwsuiwedMernbar I Requesting rr ,,, mctsm
<br /> Anoka ;".mmmmnty Radio Oub
<br /> ,u:IH 982
<br /> Ancdm.M.N 55303
<br /> °'j"uslH �-mmrrm INumber. 651-366-0021 Errmalll, udr e s: mimmn.mmmw mm(�; V.r�,mmwii
<br /> VI°V o m rrmr'V you VIM llfllhm 11C.1ardficate id Hnsurance sent to'yow"?
<br /> I,,,,,,,,, Hlimu mm uY; m mglC u u Holder:
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<br /> m m 'HIH tomIllm°muwmuiredwVrhn-ne r(ftil-com iDert-Ifl u, Holdw"w
<br /> Imaill too �mml ,,,� Huimummrrr�I� E uP,� rmVuirdH 'ImHur u
<br /> „ iName of event, Halloween special event station
<br /> Ism H,„ocu" dorm ofthe uII,I t(Nairne ,OiiHIu m�
<br /> Lauiie Lamofte IS' u,.
<br /> 0111airmnn,muHHaI Dr
<br /> 3. Date f the avendfmmrm 'Hmrrm, 10/31/17
<br /> 4. rmrrm of entRy(Iiiiiicluding rrm llll ng mmmlmlrr ')requiestfing proof d Hablifty move
<br /> City o1"Cenw,,m ill
<br /> 1880 Malum Street
<br /> 5503
<br /> TALENT-IHr i,m:TIV°Ip IIdEn T-m %ism ' ..
<br /> 9
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