2002-03-27 CC Packet - Laserfiche WebLink

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lAinne,<;ota Lawful Gambling LG1 01 0 - Schedule C/O "\ .. .. Rev, 11/01 Organization name D~ ~ ~LAiZ. CI..V~ Monthlyear reported: -z. I t:> ~_ I Page __ I License number 'l?,-c>3'l1JO of pages Is this an amended Schedule C/O? y N Schedule C: Lawful Purpose Expenditures Current Monthly For Code Membership Date of Check TRC A A-70nlv Approval Date Check Number Check Made Out To: -.J Code Mala F."""" Amount ,J\1l\- ,..,Ii'\- ,.J\'A T(U..1\ \4.Fv<v'i:> A- <"""'17.. n I A- A- A- A- A- A- A- A- A- A- 'NOTE: Check the TRC column (-.J) if the expenditure is from the 'Tax Total of all SChedule C Lawful Purpose Expenditures: $ <n'1"7..1.'il ') Refund and Credit" (TRC) amount vour organization may not expend Enter on line 41 of G-1 Monthly Lawfui money from this amountfor iawful purposes A-8, A-9, and A-12 orfor allowable expenses, Gambling Activity Summary and Tax Return, Schedule D: Board-Approved Expenditures Current Monthly Date Board Membemhip of Check 'mC B Approval Approval Date Check Number Check Made Out To: -.J Gode Amount Date B- B- B- _d~ Board-Approved Expenditures for Recreational, Community, & B3-A7 Athletic Facilities Intended Primarily for Persons Under Age 21: Code -I ,. TRC",I Mala Female Total of all Schedule 0 Board. Approved Expenditures: $ Signatures Enter on line 42 of G-1 Monthly Lawful Gambling Activity Summary and Tax Return. I declare thet thiS Schedule C/O IS correct ~~omplete to the best of my knowledge and belief, ~;:7 / '7 Chief Executive Officer (or deSignee) ----:-7--5"~~~~--------------------- Date: __:X__I"!"f.__I!-'!_=__ /;7 ~? ~ ~-, 3 /P 6> ~ Gambling Manager (or deSignee) _ _ZC ~- ___ ____ __ ___ ___ Date: _ 1___ 1__ oC~ Mail to: Gambling Control Board Suite 300 South 1711 West County Road B Roseville, MN 55113 if you use a TTY. you can call the Board by using the Minnesota Relay Service at 1-800-627-3529 and ask place a call to 651-639-4000, This form will be made available in alternative format (Le. large print, Braille, upon request. The information requested on this form wiff be used by the Gambling Control Board (Board) to determine your compliance with the Minnesota statutes and rules governing -laWful gambling activities. All information supplied by you on this form will become public information when received by the Board.