|
LC;31
<br /> R ■{ `^'�IMF Bingo all P r o nn l
<br /> �'y■7�..�yJti�. �`y}�+'� �•t•'.��'}•�ti ��}{;'�{��; r��{+�}ti{J�+•S zr{}�"{-.:•�}:�{-••.}rti r�,�r}7•,.4 s�{ti-��ti�'h�f.�'�:y�,s.:'hl.rti'{r{:�.r!...r�*+}•x��•}y��y• �'f�f•}.•..y'r f'ti C�ti•e��.}•ti��te�:-'S•'•f ti.�:Y}�:•'y}:•,'r•r r�'..'?..'.Y•k
<br /> ti"`�l.��F�:r{�•'.i}}.ti;}:'r�y={,r:4.;r•��i}ti}..ti�T�.ti{�`.,;r.�y}'�.,._j{hrr}.'4•i'}.}.vr.'.'�}'•.•.••Y fti•...'4y.•�t.'ti,N}.i}ti t y{y.:';��••;'1 wy Y ti.!?'�:•y't�y.}�titi:;•'?r.•VF�'��r�}�r�s'-.�{ti�..y y{r:,.•:�p}ti••.•Fy y..j;s.r{ti;..'r ti 1-.s-f1 l.,{,:}:-.•�Y�}i .�'S
<br /> ti= 7 .
<br /> '!m 74
<br /> d
<br /> �� { '
<br /> t r p
<br /> � �� R� i
<br /> ti:r•rr`rr�f:{r�.•ti.•'.}}}'.x�:ti v�t�..�ti'}�:i:�r;•w:;�;,.}?,f...-s:,it{!.':,v.r:.:.t'*ti:.•�+'+;►.{-
<br /> titi:`•}s'•�r:.L{.'•:•}:.}r�.,•,r..:..y}'r•`,�v:•tiK frs,{.p ti-f r},':r{•f.f{r.*r'}:�•r'•;:•z.;,.�;ti;�7.;-r{�.r'•;+�":ti.{�}•r;{?+s�s�ti�:p;.i:-�{:
<br /> .}:
<br /> •���
<br /> Phone
<br /> 1. Dame at bingo hall (612 )631-0538
<br /> KNIGIiTS OF COLUMBUS State Zip code
<br /> Address ��
<br /> 551;
<br /> WORTH 2555 � I�LLING AVENUE ROSE�TI�LLE MN
<br /> ?� "� *'� {,rx_'#r'ti�h r.• ' •r :-'•'•.} +C Z .r . y{ .' ty '4`r 1• {'11 .f - Y�.ffiffik~: •S,Y} , y. .•.,• 1• y 11i•;J:.{i•y} ti.k r
<br /> .?r ri� ti •p s •' •r,{ y} ti.� - :, } rr{.r,3' }11;.rti_,•ti+ �r.,�� titi rr •
<br /> •z �' .. �' ��}tti,: 1' .•:ti.r::. : } sti �s• r}.':-'y;r:�ti.•: t�•':. '}} 'W'•:r:.
<br /> ;� ti•: � ;,�} ��r ,'r� •*::rr {y'�•.s ��'�. •'{}-•r'��•-•}.''}t{�'.• :Q':'7:s.'.'}r.�4 i+:l.
<br /> ■ �� 'x � },,fir-;•���?,�:.s4'�.��`f.•:r�:':� :�:.��.�''.'},.�.�:. 'ti7::. :r•' ';} :�•: �'.. rte•i'l.'r. .ti. ' ■
<br /> � Full Middle 1�erne l�re�rlous or rn�aden Hems
<br /> �. Last��rne First dame
<br /> .. r1 �_r ERA-
<br /> re ss *city stale ./ Zip ode borne Phone 3. Home 5Z 14 e - f p�l� of use
<br /> 4, �r��e�s
<br /> 'dense Number State of Issue Date of Birth Birthplace- State dull Name
<br /> + r
<br /> T. � ,: � i '
<br /> �. i�rar �f��l�tar'y
<br /> i�er►�i� dates of woe L.S. �it��en Yes i�Ic Length of residence in Minnesota
<br /> . , __ It nok rin in re ei stration number: ears
<br /> - - - - -0 hh bin g6 Kall (ch&6 068 IJ Sole proprietorship � Diredor 0 a�,age>'�A L E � 6.dour posr�ion w � �
<br /> 0 Padner in Corp. facer 0 upervolsor
<br /> JSE TAX
<br /> hone Your duties: TUS)DiV
<br /> record for past I o years include perils of unemployment o r education) ,
<br /> �. Employment � �cs�t,an Held Date s ai Ernplaymerli
<br /> Emp`��er Address Type�t Business
<br /> P- 1 Z� n�Kzgy
<br /> f _
<br /> S. place ci residence for past 10 years State Zip cod a Dates-of Residence
<br /> Address '
<br /> r yq { PP FS
<br /> 71A"4P A) D e Sr�Vellf. A_1_)"r4l/V- J?
<br /> 9. Crirnirial history statement(except petty misderneanors). If none,write *none.".
<br /> fat_ Charge City and S Late
<br /> Y
<br /> e address and license or eXernption of any organzation you belong to which conducts lawful gambling,
<br /> if Mane,wrhe�F'none,' •
<br /> t Llaense or ExempLion lumber
<br /> organiza -
<br /> - ,
<br /> Address Cad* - State Zap Cade
<br /> f 4
<br /> License or Exemp�on lumber
<br /> r arur r'r
<br /> Slate Zip Cade
<br /> Address '
<br /> a■r►3a7ti whit tiY� ■mot�+a rp�w■■}�a■�r war �• � yn�tiu`}}';t •+w �''7. .:}:•w.•'.ti'.}�,-• tits-.;y1{}�,�t?.: s s;
<br /> ► z • y� •{r.�� ?ri��rz
<br /> .ti.,}}'+ t }?{.+y{.1{s•r r■:7-7 rvwr r.s rz ta„�t.:ti+,#•1.}}}��� �tir,''s•#4ti,s:ti v`},i:�f.}�'+±�y}* r',r.'*',�r- •7.��rr-��'•�;.+:�'•;}:'r.•r.r:■.!•'}••r 1}}~~•��:*•.}{•r~�vs Jyy'=s�Y ti Z�}}k`i�.}.'r•r:ti..?.•'}•f}.�:?�L',r'�r rt�?z}��{'r 1``7}':�,.;.*vr s sti:?..'ti{rtitti.k r•r•i r-*:•.._ti tti} y {rr'r�'r;}};.�r�}'t�'iv.ti::'�}ti+{';rti k-:{•';;�'-0:'r}�.:�ti}rr�'v r•�r ti'':�r�`•}'r?''•}f.�:' �r'�+��':ti:�,r.:.-s t.��':{,r
<br /> t ti ti s.i,��-...-ti.�f r�'y�•{�-::.}.;
<br /> --::.Y}'.;s:{.,�*};r.ti},••:.{.�:•r:r�'':•{•..,:'..{.•
<br /> :.:�:.:.'r..::ti.:.-':.'•}:.}.:�::.•}:r.s:..ti}.ti R
<br /> PIN' ”'A}
<br /> s:.tiL,ti.t:x t_•:'}r-�r`'.��ti'--
<br /> titi:,ti ti'.{•r;•''•-•.
<br /> I dedLre 1ha[this ricaeon is aarrect and wrap{ele to the bmt of my kr led,9e sand befiei.i urrdiwsta d Est
<br /> �p
<br /> false and misleadk?p awwers are pmrrds for■r denlaJ a#kv=or fi ic ce 66n c)!av licenses pranged.
<br /> Gale
<br /> Your siprstivre r
<br /> rr f
<br /> Attach This form to Bingo Hall Personnel Affidavh, LG316
<br /> Mail lo; Department of Gaming - Gambling Control Board
<br /> Flosewood plaza South,3rd Floor
<br /> 11711 W. unty Road B
<br />
|