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FEB. -04 01 F R 1) 1 IM ;4 PREFLERED Ot TEL h AID 3 8?$? Organization License Renewal Application (Cori -iu aed) Page 2 ❑f 2 Ili c inl`orm4on requested on iIAa form(and any AUcnmcnts)1wiII b ui--A 1=y-he Ctmh i in Control Board ostt)to derarmijig your Qus#i ri canons to be i nvolved in lawfiut gemh#i ng WrIvi tlas in Nj jnnost•;.u,and V Mist the Hurd in conducing a bwkffMu jW utvestig*uan of y011. You have the right to refUse to supply the in oruiian reque3le '%w4--vtr,if you n6umco supply#jib inrartnanon,ft Board may not be ahl C 0 ditrMine YOUY qualification9 und, as a consequence, muy ref. ;e n7 6sL;t you ti 3.,wanse. if you supply the information requested, the Board will be 4b1c 10 process your application. Your namc and address will be public infiormation when r=ei cr by :ire 30ar . All the other informadon thdi you providc will he privwc data about you until T :Roard issues your liconjr, %en Iha Board a; uc°year 3iccr,fie, all or the infbrmsdon that you have provided w the Board in the processof applying 1br your license wilt become public. ifthe, Board docs nor is -iG you a limse, all The information you have pray€ded in the process cif applying for i i iceno remains r v ::.:�:ir.tic cxmrption of your n=a and address which will remain public. Prime Baia about you are avaltahle only T o the fallowing; Soad rnt m. bars,3LAT of the 8nurd whole work a %g=*nt Tequim that they have acccsy to the information;The Minncsota Ueponment of Public SafcP;�-a NUt',neaam Attorney QcnerW;the WrinesomCaTiami lonors of Administration, Finance,and Revenue; the Minneaota Legislative Al. ,Ji T-a r, stational mid intert►adonal gambling regulatory agencies; anyone pursuant to court ordcit;other individuals and pgencies;l),t arc jpw-;, }ca';y cwt,10ozod bli state or fadaW law to hwe accem to the information: individuals end agcn6ow t"nr which law or legal order auLhorlzes a ;c v uv c or :Ihw ng of information air thin notice wig given;and unyone with your wrinen condwnt.