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Minnesota Lawful Gambling Schedule C/D.. LG1010 General Information Organization License Number Organization Name SPRING LAKE PARK LIONS CLUB 00584 Month and year reported Is this an amended Schedule C/D? Y N 11 /2002 Page 2 of 3 pages Schedule C: Lawful Purpose Expenditures Current Monthly For Code Membershio Date of Check A AJ ant Approval Date Check Number Check made out to: TRCS Code Amount 10/24/2002 11/5/2002 12132 LIONS CHILDRENS EYE CLINIC 13K A-1 100.00 10/24/2002 11/5/2002 12133 LIONS MACULAR DEGENERATION A- 1 100.00 10/24/2002 11/5/2002 12134 LCIF A-1 100.00 . 10/24/2002 11/5/2002 12135 AMERICAN DIABETES ASSOC. A-1 100.00 10/24/2002 11/5/2002 12136 LIONS LEADER DOG A-1 100.00 10/24/2002 11/5/2002 12137 LIONS YOUTH EXCHANGE A-1 100.00 10/24/2002 11/5/2002 12138 LIONS HEARING DOGS . A-1 100.00 10/24/2002 11/5/2002 12139 HEARING AND SERVICE DOG A-1 100.00 10/24/2002 11/5/2002 12140 HEARING AND SERVICE DOGS OF MN A-1 5000.00 10/24/2002 11/5/2002 12141 BLAINE H.S. SPORTS TEAMS A-7B X X 5000.00 'NO TE: Check the TRC column if the expenditure is from the 'Tax Refund Total Schedule C Lawful Purpose Expenditures and Credit' (TRC) amount. Your organization may not expend money from for this month. this amount for lawful purposes A-8, A-9, and A-12 or for allowable expenses. Enter on line 41 of Schedule G-1 Schedule 0: Board - Approved Expenditures Current Monthly Board Membershio Date of Check B Aporoved Approval Date Check Number Check made out to: TRCS Code Amount Date I Board-Aooroved Exoenditures for Recreational. Communitv. & B3-A 7 Athletic Facilities Intended Primarily for Persons Under Age 21 M F \ Total schE!dule D Board-Aooroved Expenditures. - SIgnatures I Enter on line 42 of Schedule G 1 I declare that all information on this summary and tax return is true, correct, and complete. Signature of chief executive officer Date Date Signature of gambling manager Mail To: Gamblinq Control Board Suite 300 South 1711 West Countv Road B Roseville, MN 55113 If you use a TTY, you can call the Board by usinQ the Minnesota Relay SelVice at 1-800-627-3529 and ask to place a call to (612) 639-4000. This form will be made available in alternative format (i. e. lame print, Braille) upon request. The information on this form will be used by the GamblinQ Control Board to determine your compliance with statutes and rules QoverninQ lawful QamblinQ activities. All information su lied b au on this form will become ublic when received b the Board. Minnesota Gambler (Rev. 11/01)