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<br />B3/25/2B03 12:2~ <br /> <br />6124641872 <br /> <br />CHATTERTONS PKG <br /> <br />PAGE 02 <br /> <br />ft' ,..,....11' ,.. <br />. :." ~_~va' or Acknowledgment <br />.'0Ie . III ~ds (~1iIy LG503 and LG2e5) <br /> <br />(11/011 <br /> <br />~......~. <__print) <br />Orpn__ NInte, ~ ~_~\f ~__lICen$e N~mber __G.~.eQ(')_ <br /> <br />~ ~~ ~-t--~+-~--~-s-O.3.e . <br /> <br />....u.huN h.~t"'~Ih88tslflllC~L_'1! <br />1. . ~d '~ Iawf.II putpMI--,dltln I S ~ ~ : <br />2. Chtdl. t".~~~: <br /> <br />. ~'C8t"_Oft to. ~., ~ftt - Unltect StaI", st.8le of MinnesO'.a, or any of its subdivisions, <br />... or In.trume~. NOTE: A contritlution /'nay not be made difactly to ;;; law enforcement Or <br />pr~. agency, such. Ii! I'Olloe deptnment, COI,inty sheriff, Of county attorney. <br /> <br />___ A.....,. ~ ~ ... l1IIn.tlts the public at large with l!IpprO'\lel of the 3tate agency \hat ha3 <br />~.a'<IW the~. <br /> <br />~ 1M JlfOI]GMd ..-ndllln, Indudlng \'endora. <br /> <br />__ .~.'- .., IM'*"fritI ~ or Illotemln vehicle trilll" with approval by DNR Ail trails must be <br />DPeIlto /IlUIlIC U\te. <br /> <br />.D~. ~.......... including \'Wldcn. <br /> <br />*' <br /> <br />.', Am~~cantrlbutDlor~. in IICcordanc8wilh Minnesota Rule 7661.0120. ~ubDar1 5D( 10). does no1 <br />.,.. ~ _nil ~.., OIl'" .-oonllWY benllflt to QJt organization. <br />./1IIf'IIl'm thlll,."." ~I ~ftJndt Il'e used f<< groomIng and malntafnlng sno.....moblle Dr ail-terrain venicle trailS <br />or ftll"~ 'WMIIfe ",.~.rn pI'OJeet tor whieh reimbursement is received from a unit of government, the reim~,urse, <br />ment fun. mu.t be d~ III'oor lawful gtl'l'lbting eccount atld l'eOorded Or'llrl9 LG1010 - Sch&dul~ CID report. <br /> <br />----,....~ <br />ChW........ aftIcn.....,... <br /> <br />Phoo. n\ilTl~ <br /> <br />DetE! <br /> <br />.....IlI...~m <br />~......~, tflI r......... of 1M unit of ~nrnenl <br />i. ....1tle project _ ~ itIove, WldJI:' <br />· _~ the CClI'Itributll;ln, wNch win not be ulCd for 8 pension Of retiremenl fund. <br /> <br />UnltofGMmrT*1t -=~~..b~~t i~\~ ~~_""_~~__' . pr'lcn~numbtJr~SI 4h~ :)1~ <br /> <br />Adc:tNII_le~O~~~ City_~~lL__...., Stat~. Zip S!;.<'l.::5F'::.. <br /> <br />,.,.. Nem8______ <br /> <br />.~ <br />----?? <br /> <br />_______________ Thte ____.. _......... <br /> <br />~1'It_ <br /> <br />Clate _......n <br /> <br />K..pthia camptet.d form 8tt8c'*l to the L.G1010 - SOhedule C/O in your Q1'9t'1ni<!:a\ion'~ recorcl1S. <br /> <br />Tf\le form wi tit InIC!e 1JV8IlIbIe In ........ rmn. (I.e, <br />. pdnl' Br-> lipIiIlI'8QU8It, M' yw LII8. TTY, you ceo <br />ell \It ~lNhI.H ~ ReIlly. SilrvicllIAd ask to <br />~ 8 cillO iSt<<it-4000. ".,. int\1llrlWlllGl\ NIqU_GiCI 01"1 <br /> <br />thJe tam will become publiC informatIon, when reQu6~led by <br />the Soard. n will be ~ to determine your c:ompli;:;nce <br />wlth Minn8$Ol8 statutes and f'.Jies goveming lawful gemoling <br />ac:thritiee. F'X additional information, chock our web site at <br />ww.gob..tlIIe,mn,u5 <br />