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State of Minnesota or Boar se n y Gambling Control Board Organization License Renewal Application LG200OR Printed: 2/161'2000 License Number: B-02069 Effective Date:7/1/1398 Expiration Date:6/30/2000 Organization Information TSE MN Sales & Use Tax permit #: 9220121 2027 Rice St Roseville, MN 55113 County: Ramsey hone Number: (cuict2) 84-2595 y � Chief Executive Officer Information Phillip Saari Date of Birth: 3374 Owasso St Shoreview, MN 55126 Phone Number: 484-0303 Treasurer Information Amy Date of Birth: Phone Number(Vi)(6 12) A-106,W -,P2,t)%-7 Organization's regularly scheduled meetings are: 3rd Tuesday from 5:00 PM to 6:00 PM Number of active members over the age of 18: 15 ACKNOWLEDGMENT I DECLARE THAT: • I have read this application and all information submitted to the Gambling Control Board; • All the information is true, accurate and complete; • The compensation schedule is current and on file with the board; • The proof of nunproft status for the organization is on file with the board; • Our organization remains in good standing as a nonprofit corporation with the Minnesota Secretary of State's Office and/or continues to be recognized by the Internal Revenue Service as an income tax exempt organization and, if applicable, ou charter remains in good standing with our national organization; • All other required information has been fully disclosed; • I am the Chief Executive Officer of the organization; • I assume full responsibility for the fair and lawful operation of all gambling activities to be conducted; • I will familiarize myself the the laws of Minnesota governing gambling and rules of the Gambling Control Board and agree, if licensed, to abide by those laws and rules, including amendments to them; • A membership list of the organization will be available within seven days after it is requested by the Gambling Control Board; • Any changes in application information will be submitted to the Gambling Control Board and the local unit of government wit 10 days of the change; • A license termination plan will be submitted to the Gambling Control Board within 30 days oftermination of all Premises Permit(s); • The gambling manager is bonded and licensed as required by Minnesota statute; and • I understand that failure to provide required information or providing false or misleading information may result in denial or revocation of the license. 011 jolw� Signature of Chief Executive 0 ice N Date 4�/\ri