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Minnesota Lawful Gambling <br /> Schedule CID - LG1010 <br /> General Information <br /> Orgaizationname Nat'l MS Society — MN Chapter Ucensenumber A -00562 <br /> Month/yearreported: 0% / X19 Page i of 3 pages Is this an amended Schedule CID? Y N <br /> :dule C: Lawful Purpose Expenditures Check here if no Schedule C expenditures for this month: ❑ <br /> Current Monthly For Code <br /> Membership Date of Check TRCS A A -7 Only <br /> Approval Date Check Number Check Made Out To: 4 Code Mara Female Amount <br /> 10-23 -97 311 199 4it4t9 MN Ms Soucy A-01 _30, O ODO <br /> 10 318199 `13o5 M MS A -01 42,iiC.0I <br /> )0 5--97 3 1`j199 47305 m lU MS Sec f; A -0r 7, 8-8'x. <br /> . ii - a5 - 31ts191 4/355 MN MS SCGICAI A_01 %ilq <br /> 1a ((g -97 31is191 47355 MN MSScCtET'j A -oi 44,20'3 45 <br /> Ia- I (Q-g1 309199 T7443 MrJ ms Scci A-01 '30,oco.c ) <br /> (a,- (lli 7 31c/99 ,91'4 M►J KS SOC l cry A -o) . (rt-lq 1.51 <br /> .1 9 3 13499 1 17474 MN nits s oc t L- A_0) _ (¢3,144.41p <br /> 2 -1 + -q' 3136199 4?L MN ms SOU ET‘( A -oI L 1O I 30.03 <br /> - 2,3 -99 31a4149 41391 (,1"(y or- 51 P.MnL A -01 58.x3 <br /> February Onty Total of all Schedule C Lawful Purpose Expenditures <br /> Enter the amount from line 14 of the Tax Savings Worksheet in the for this month $ 3214 35`2.7'2 <br /> " CID Instruction Booklet $ Enteronlme4lof Monthly Summary &Tax Return G-1. <br /> _ edule D: Board - Approved Expenditures Check here it no Schedule D expenditures for this month: d <br /> Current Monthly late Board <br /> Membership of Check MRCS B Approval <br /> Approval Date Check Number Check Made Out To: 4 Code Amount Date <br /> B - <br /> B- _ <br /> B- _ <br /> Board - Approved Expenditures for Recreational, Community, & t Code <br /> Athletic Facilities Intended Primarily for Persons Under Age 21: Code <br /> rncs d WM kmde <br /> Total Schedule D Board- Approved Expenditures <br /> Signatures Enter onrine42of Monthly Summary &Tax Return G1. $ <br /> 1 dedare that this Schedule CID is correct and complete to the best of my knowledge and belief. <br /> Chief Executive Officer. . .. 4,-GE l Date: 9 29 <br /> / / 6 I 7 <br /> Gambling Manager. 62114.12--- MedZifiry Date: T / /a- / 9, <br /> Mali to: If you use a TTY, you can call the Board by using the Minnesota Relay Service at 14300-627-3529 and ask tc <br /> Gambling Confrot Board place a call to (612) 639 -4000. This form will be made available in alternative format (i.e. large print, Braille <br /> wife 300 South upon request <br /> 11 West County Road 8 The information requested on this fore will become public information when received by the Board, and will b <br /> o seville, MN 55113 used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities. <br /> E <br />