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<br />MINNESOTA LAWFUL GAMBLING <br />LGIOIO SCHEDULE CID <br /> <br />Organization Name <br />Dead Broke Saddle Club <br />Month and Year <br />Mav 2005 <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 />GAMBLING CONTROL BOARD <br />Lawful Purpose & Board Approved Expenditures <br /> <br />License Number <br />03800 <br />Amended C!D? <br />No <br /> <br />A A-7 <br />'IRC Code MIF <br /> <br />Amount <br /> <br />3/2212005 5/9/2005 8745 Camp Courage Center <br /> Purpose: Donation <br />5/16/2005 5/16/2005 8749 Main Street Bank <br /> Purpose: 2004 Taxes 990T <br />5/24/2005 5/24/2005 8764 City of Centerville <br /> Purpose: City Park Donation <br /> <br />a( 1) 2500.00 <br />a( 8) 3200.00 <br />a(10) 2500.00 <br /> <br />Total all Schedule C items $ <br />To line 41 of Form G-l <br /> <br />8200.00 <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 />IRe Code MJF <br /> <br />Amount <br /> <br />Date Board <br />Approved <br /> <br />NONE TillS MONTH <br /> <br />For facilities intended primarily for persons under 21 : <br /> <br />Signatures <br /> <br />I declare that this Schedule C/O is correct and complete to the best of my knowledge and belief. <br />Signature Date <br />Chief Executive <br /> <br />Total all Schedule D items $ <br />To line 42 of Form G-l <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 11/04 <br /> <br />61 <br />