Laserfiche WebLink
m <br /> CITY OF ROSEVILLE <br /> GAMBLING GAMBLlNG LICENSE APPLICATION <br /> (FOR ORGANIZATIONS APPLYING FOR EXEMPTION. - FRO i STATE LICENSING) <br /> ORGANIZATLON INFI�R IATION <br /> t Pl-� <br /> Name ip lio 11-4 . <br /> Telephone Number <br /> Address 77 ,- <br /> 1 rf <br /> Organization's Purpose f - ' <br /> GAMBLING EVENT INFORMATION <br /> New Y111, Or Have Previously Applied <br /> ' - <br /> J <br /> Location of Event in Roseville <br /> Date of Gambling ActivitY <br /> ' f ACtI�'1tV <br /> Estimated Time <br /> r <br /> Dollar Amount of Total Prizes to be Awarded 0 C-' <br /> Funds Will be Used for - { <br /> APPLICANT INFORMATIO <br /> Name lr <br /> Telephone Number <br /> Signature z�Z <br /> `- <br /> Date / ,-- 7- <br /> LICENSE FEE $ 25. <br /> WITHIN TENT (10) DAYS OF FILING ANY REPORTS WITH THE CHARITABLE <br /> GAMBLING CONTROL BOARD, THE ORGANIZATION SHALL FILE A COPY OF SUCH <br /> REPORTS WITH THE CITY OF ROE ILLE, AS REQUIRED BY SECTION 125.060 OF <br /> THE CITY CODE. <br /> C oMce+Apu:r.emm,p roan --k IN,: <br />