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<br />Minnesota Lawful Gambling
<br />LG555 - Government Approval or Acknowledgment For Use of
<br />Gambling Funes (previously LG503 and LG265) (11/01)
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<br />Org~n"ization In~,rmation~aie prif)~\. 4 ,t~}
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<br />Organization Name ...)1:..Ai..-L"."" ,'!-3"; ,f"i .' I.; ./i )',;J,c( .<,.,"\""
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<br />Address \,.. ~;- - 'i: {-: -t-<~, J1..;;;
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<br />Expenditure Description (attach additional sheets if rfecessa I:)
<br />1. Amount of proposed lawful purpose expenditure
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<br />2. Check the appropriate expenditure category:
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<br />~ontribution to a unit of government - United States, state of Minnesota, or any of its subdivisions,
<br />, agencies, or instrumentalities. NOTE: A contribution may not be made directly to a law enforcement or
<br />prosecutorial agency, such as a police department, county sheriff, or county attorney.
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<br />Lic;nse N~mber . 1)(-l'ti5)(~.t.I-., it.')
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<br />_ A wildlife management project that benefits the public at large with approval of the state agency that has
<br />authority over the project.
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<br />Describe the proposed expenditure, including vendors.
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<br />_ Grooming and maintaining snowmobile or all-terrain vehicle trails with approval by DNR. All trails must be
<br />open to public use. '13
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<br />Describe the proposed expenditure, including vendors.
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<br />Oath
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<br />· I affirm that the contribution or expenditure, in accordance with Minnesota Rule 7861.0120, subpart 5D(1O), does
<br />not result in any net monetary gain or other pecuniary benefit to our organization.
<br />". I affirm that when lawful gambling funds are used for grooming and maintaining snowmobile or all-terrain vehicle
<br />trails or.for....,a.. .n. y. wildli~e management p roj e.. ct'for..~.,.,w"biCh reimb. ursement is received from a unit of government, the
<br />reimbursel m~nHund, ryust be depositedjri OJlf- .lawful gambling account ~nd recorded on the LG 1010 - Schedule
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<br />/ I Chief ~xecufive officer's signatur~ ,. Phone number Date
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<br />Government Approval/Acknowledgment
<br />By signature below, the representative of the unit of government
<br />. approves the project as described above, and/or
<br />· acknowledges the contribution, which will not be used for a pension or retirement fund.
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<br />Unit of Government Phone number
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<br />Address
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<br />City
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<br />State
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<br />Zip
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<br />Print Name
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<br />Title
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<br />Signature
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<br />Date
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