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(".11TY OF ROSEVILLE <br /> GAMBLING LICENSE APPLICATION <br /> (FOR ORGANIZATIONS APPLYING FOR EXEMPTION FROM STATE LICENSING) <br /> ORGANIZATION-INFORMAT I �1T <br /> Name t ,r 01 7 <br /> Telephone Number � <br /> Address n 9mtxrjh rntA <br /> Organization's Purpose J <br /> GAMBLffG EVENT I RM <br /> New Or Have Previously Applied <br /> Location of Evert in Roseville N4,--h <br /> Date of Gambling Activity <br /> Estimated Time of Activity <br /> Dollar Amount of Total Prizes to be Awarded J 0--LO <br /> Funds Will be Used for <br /> AULICANT INFORM <br /> Name <br /> Telephone Number <br /> Signature <br /> Date <br /> LICENSE FEE 25.00 <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 I E L E 7 AS REQUIRED BY SECTION 125.060 OF <br /> THE CITY CODE. <br /> C WFtcc%wpWLMexmpsgsm wpd <br />