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FEB -��. 00 €F R I � 12�4- FREFERED O.F 'i t 1 r 0-.0 1 V U,r <br /> 0 <br /> 1 to of"innascita For Board Uk_e_Anjj__ <br /> Gw tablins Control Board <br /> Organizatiall I;icense Renewal Application <br /> i.G.100OR Printed: 1111 5/1999 <br /> License Number: B-00330 ?f#.Y =ire Date: 4/1/1998 Expiration Date;3131/2000 <br /> �r=�����•:ion ����r��$Iiun <br /> B-dole Roseville Club MN Sales & Use Tax permit #:6945381 <br /> 2100 N Dale St <br /> Roseville, MN 55113 <br /> County: Ramsey Phone Number: (612)489-5386 <br /> r <br /> Olicy E�ecutiv a Officer Information <br /> n{i y�r <br /> Innis Michael Rrntt Date of Birth: <br /> i <br /> hilt•err+ a�■■f *■w" .AV 'a W..v. k� ......... <br /> Roseville :1V11N 5)M I Phor e Number: (6 51) 2 9 6-112 8 <br /> ...... ......... ........ <br /> J T-eau rur Information <br /> Kevin Turnquist Date of Birth: <br /> Phone Number: (651) 489-5265 <br /> Organization's regularly scheduled meetings ar 1st Tuesday from 7:00 PM to 8:00 PM <br /> Number of active mernWr5 over the age off 8: 156 <br /> ,_XXN0WLEDGMENT <br /> I DECLARE THAT: <br /> have read this app]ice dop wci o11 in r'armfAlion subm i=tO I rhe-Gmi' ling Control Board; <br /> All the information is true,accurate and wmp1cw; <br /> o The comwsudon whedule is current and on file%i*tW b,%af;: <br /> I '1110 proof of nonprofit gj4jus for the organizatioli is on f;lu -11 dtc b ird; <br /> s Our organi2ation remains in good standing m s nonprol y a•vniLlon witli the 'Ahinesotz Secretary of SlAte's Off= <br /> and/or continuos to be recc nj?,e by the Internal Revenue"-:.Tvicc as in income im exempt organization and, if apps icable� our <br /> charw remains in good olarW' SiZ1.'0=': <br /> s A11 other required I n norm.rorm.aOon 1►as bean fully disclosed. <br /> I BM ilia Chid Executive Off1per of the orgtini=ion; <br /> e 1 assume ft1I1 responsibility fvr the fair and lawful opera,ion-of?J1 aarNing amivitics to be cnndueted; <br /> will ri rn iliarize mysel f the tho laws of'►Minnesota bovcrmn�ge-mbl►Ig and rues of the Gambling Control Board 4nd agree,if <br /> liccnscd.to ghide by those lawn and Tuies,including em.ijid-•mmns to Them: <br /> s A mcm berm hlp i 19t of the a pn i Won wit I be avei I*1 o w.W-m,n-cvon Gaya a tier i t iA req nested by the Cmm tiling Control board; <br /> s Any changes in eppiic ksUon Information will be submitd tc:tho Gambling ConlTol Board and the loci!unit of gavornmcnt within <br /> 10 days of the change; <br /> s A license wirninalion plan will be submitted to the rt 4 Contra paara within 30 doys oftcrminetion orals Premises <br /> >=orml u,)., <br /> s Tbr. seam Mine manager is bonded and licensed m requirt-tc! �::tnn; <br /> t understand that failure to provide required 111foMetjot or ironsiding/Also or misleading informatian may result in denial or <br /> revocation of the ii con C. <br /> 3 ro-1!::Z <br /> 0 0 fA L <br /> � . <br /> Signature of Chief T cutiive officer I]�te <br />