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STATE OF XXXXES'OTA FOR r BOARD USE ONLY OAMBLZNG CONTROL BOARD � # ORGANXZATZON LXC SS RE AL PZICAT r ON LG 210OR PRINTED t07/13/93 LICENSE NUHBERsAmw00070 EFFECTIVE DATE s D 1 f O1 f EXPIRATION DATE:12/31/f4' .QRGANIZATION IMPORKATION Skating RosevUle Midway Club MN SALES & USE TAE PERMIT Ot 5670670 1101 Willow Cir Roseville MN 55113 COUNTY:maser PHONE NUMBER t 612-633m3326 CRIZIE ZXECUT13M OFFICER INFORK&TION lure Dauer DATE OF BIRTH 5789 Lake Av;a white Bear Lake NN 55110 PHONE NUMBER: 4 TREASUREROH r 91 Z40147r- DATE OF BIRTH PHONE NUMBER: 1 ORGANIZATIONS REGULARLY SCHEDULED MEETINGS ARE: 2nd TUBS AT 700 Ply NUMBER OF ACTIVE MEMBERS OVER THE AGE OF 18t 186 LAST MONTH/YEAR OF EXPENSE CALCULATIONS: 10/92 WITH AN ENDING BALANCE OF: -9 S 3*S I ACRNOWLEDGMENT I DECLARE TMM: *I HAVE BEAD THIS APPLICATION AND -ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; BALL INFORMATION IS TRUES ACCURATE AND COMPLETE; *THE COMPENSATION SCHEDULE IS CURRENT AND ON F I L'E WITH THE BOARD; *THE PROOF OF NONPROFIT 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 Ir IF APPLE I CABLE j, OUR CHARTER REMAINS IN GOOD STANDING WITH OUR NATIONAL ORGANIZATION; *THE INTERNAL CONTROLS ARE CURRENT AND ON FILE WITH THE BOARD; *ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; ;T AN THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; *I ASSUME FDM RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; I WILL FAMILIARIZE MYSELF WITH THE LASTS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF THE GAMBLING OMqTROL BOARD AND AGREEjy IF LICENSED# TO ABIDE BY THOSE LAWS AND RULES# INCLUDING AMENDMENTS TO THEM; *A. IP LIST OF THE ORGANIZATION WILL BE AVAILABLE WITHIN SEVEN DAYS AFTER IT IS REQUESTED BY TM GAMBLING CONTROL BOARDT *ANY CHANGES IN APPLICATION INFORMATION WILL BE SHITTED TO THE GAMBLING CONTROL BOARD AND THE LOCAL UNIT OF GOVERNMENT WITHIN iC DAYS OF THE CAGE; *A LICENSE TERMINATION PLAN WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD WITHIN 15 DAYS OF TERMINATION 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 THE DENIAL OR REVOCATION OF THE-LICENSE &IGNATLTRL OF CHIEF EXECUTIVE OFFICER DATE V:� �.�