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L- <br /> - R R <br /> CITY OF ROSEVILLE <br /> GAMBLINO LI CE APPLICATION <br /> (FOR ORGANIZATIONS APPLYrNG FOR EXE IPTION FROM STATE LICE KNG) <br /> ft <br /> I FORMA�'II <br /> X,F.L_%'I"I- L-=19':�i T f � /7/ <br /> r <br /> fffri �� <br /> Y <br /> Telephone Number <br /> REZ) TkS <br /> Address 4 <br /> AJ e;;�T)42"j A( Fro7 <br /> 17 A <br /> EVENT INFORMAIMN <br /> New Or Have Previously A lied <br /> s <br /> Locati On of Event in Roseville <br /> Date of Actxv it - <br /> Estimated Time of Activit-�r � <br /> Dollar Amowit of Total Prizes to be Awarded <br /> Funds Will be Used for I Z-Z, ////-s /5 F- o[A Corn <br /> pR i "Zt;�y <br /> 'e�?)ItIlYL <br /> APP 1F T i <br /> Name <br /> Telephone Number <br /> j amturr, <br /> 6 <br /> Date <br /> LICENSE FEE S 25.00 <br /> -WITHIN TEN,(10) IAA <br /> OF FILING ANN ANNY REPORTS WITH THE CHARITABLE <br /> MBLIN+T CONTROL BOARD. THE ORGANIZATION SMALL FILE A COPS* OF SUCH <br /> REPORTS WITH THE CITY OF ROSEVILLE, AS REQUIRED BY SECTION 125.060 OF <br /> T CITY CODE. <br />