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<br />MINNESOTA LAWFUL GAMBLING <br />LGIOIO SCHEDULE cm <br /> <br />Organization Name <br />Dead Broke Saddle Club <br />Month and Year <br />November 2005 <br /> <br />Schedule C: Lawful Purpose Expenditures <br /> <br />Date Org. Check Check Check <br />Approved Date Number Made out to <br /> <br />11/22/2005 11/22/2005 9041 Our Saviors Lutheran Church <br />Purpose: Food Shelf Donation <br />11/22/2005 11/22/2005 9042 Forest Lake Helping Hand <br />Purpose: Food Shelf Donation <br />11/22/2005 11/22/2005 9043 White Bear Lake Food Shelf <br />Purpose: Food Shelf Donation <br />11/22/2005 11/2212005 9044 Hugo Community Fo<?d-Shelf <br />Purpose: Food Shelf Donation <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 CID? <br />No <br /> <br /> A A-7 <br />TRC Code MJF Amount <br />--- <br /> a(2) 2000.00 <br /> a(2) 2000.00 <br /> a(2) 2000.00 <br /> a(2) 2000.00 <br /> <br />Total all Schedule C items $ <br />To line 41 ofFonn G-l <br /> <br />8000.00 <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 MONm <br /> <br />For facilities intended primarily for persons under 21 : <br /> <br />Signatures <br /> <br />I.declare that this Schedule CID 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 ofFonn G-l <br /> <br />Signature <br />Gambling Manager <br />Mail to: Suite 300 South <br />1711 West County Road B <br />RoseviIle, MN 55113 <br /> <br />Date <br /> <br />Gss 1 1/04 <br /> <br />:Ss <br />