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Organization Name Dead Broke Saddle Club Month and Year December 2004 Schedule C: Lawful Purpose Expenditures Date Org. Check Check Check Approved Date Number Made out to City Forest Lake Page 1 of 1 GAMBLING CONTROL BOARD Lawful Purpose & Board Approved Expenditures License Number 03800 Amended C/O? No MINNESOTA LAWFUL GAMBLING LGIOIO SCHEDULE cm A A-7 TRC Code M/F Amount --- a( 4) 3000.00 a( 5) 2000.00 a(1) 40000.00 a(10) 0.00 a(12) 3400.00 a( 7) Both 110.00 11/23/2004 12117/2004 8542 Centerville Elementary Purpose: Donation 12/28/2004 12/31/2004 8560 Gordan Nelson Foundation Purpose: donation 12/28/2004 12/31/2004 8561 MN High School Rodeo Purpose: 2005 Rodeo Donation 12/28/2004 12/31/2004 8562 City of Centerville Purpose: 100/0 Donation 12/28/2004 12/31/2004 8564 Burke Wheeler & Assoc Purpose: Annual audit 12/28/2004 12/31/2004 8573 WSCA Spotlight Purpose: 2005 Youth show Total all Schedule C items $ To line 41 of Form G-l 48510.00 Schedule D: Board Approved Expenditures Date Org. Check Check Check Approved Date Number Made out to B A-7 mc Code M/F Amount Date Board Approved NONE TIDS MONTH For facilities intended primarily for persons under 21 : Signatures I.declare that this Schedule C/D is correct and complete to the best of my knowledge and belief. SIgnature Date Chief Executive Total all Schedule D items $ To line 42 of Form G-1 Signature Gambling Manager Mail to: Suite 300 South 1711 West County Road B Roseville, MN 55113 Date Gss 11/04 41