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<br />MINNESOTA LAWFUL GAMBLING <br />LGIOIO SCHEDULE cm <br /> <br />C -t:i-V/u--' lie..--- <br />GAMBLING CONTROL BOARD <br />Lawful Purpose & Board Approved Expenditures <br /> <br />Organization Name <br />Dead Broke Saddle Club <br />Month and Year <br />October 2004 <br /> <br />Schedule C: Lawful Purpose Expenditures <br /> <br />Date Org. Check Check Check <br />Approved Date Number Made out to <br /> <br />City <br />Forest Lake <br />Page <br />1 of 1 <br /> <br />License Number <br />03800 <br />Amended CID? <br />No <br /> <br /> A A.7 <br />TRC Code M/F Amount <br />--- <br /> a(2) 500.00 <br /> a( 2) 500.00 <br /> a(2) 500.00 <br /> a(2) 500.00 <br /> a(2) 500.00 <br /> <br />9/28/2004 10/4/2004 8446 Hugo Community Food Shelf <br /> Purpose: Donation <br />9/28/2004 10/26/2004 8465 White Bear Lake Food Shelf <br /> Purpose: Christmas Donation <br />9/28/2004 10/26/2004 8466 Forest Lake Helping Hand <br /> Purpose: Christmas Donation <br />9/2812004 10/26/2004 8467 Our Saviors Lutheran Church <br /> Purpose: Christmas Donation <br />9/28/2004 10/26/2004 8468 Hugo Food Shelf <br /> Purpose: Christmas Donation <br /> <br />Total all Schedule C items $ <br />To line 41 of Form G-1 <br /> <br />2500.00 <br /> <br />Schedule D: Board Approved Expenditures <br /> <br />Date Org. Check Check Check <br />Approved Date Number Made out to <br /> <br />B A-7 <br />TRC Code M/F <br /> <br />Amount <br /> <br />Date Board <br />Approved <br /> <br />NONE TillS MONTH <br /> <br />For facilities intended ~rimarily for persons under 21: <br /> <br />Signatures <br /> <br />Total all Schedule D items $ <br />To line 42 of Form G-1 <br /> <br />I declare that this Schedule e/D is correct and complete to the best of my knowledge and belief. <br />Signature Date <br />Chief Executive <br /> <br />Signature <br />Gambling Manager <br />Mail to: Suite 300 South <br />1711 West County Road B <br />Roseville, MN 55113 <br /> <br />Date <br /> <br />Gss 11104 <br /> <br />4-\,b <br />