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s <br />CITY OF ROSEVI <br />GAMBLING LICENSE APPI+ICATION <br />(FOR ORGANIZATIONS APPLYING FOR ION FROM BTATE LICENSING) <br />NAME OF ORGANIZATION <br />TELBPHONS NMCBER OF ORGANIZATION <br />ADDRESS OF ORGANIZATION a G ��t,v <br />�?_. -,�/• .337 �.3 ". <br />LOCATION OF NG ACTIVITY � jq ,�L,? �� <br />DATE (S) OF GAMBLING ACTIVITY ! qflk f q �� 3 1 � 3• <br />DOLLAR AMOUNT OF TOTAL PRIZES TO BE AWARDED <br />S <br />NAME OF PERSON APPLYING FOR LICENSE , <br />TELEPHONE NUMBER OF APPLICANT �4� � <br />SIGNATURE OF APPLICANT /r Ad <br />DATE OF APPLICATION <br />0 <br />rnQ..1 <br />LICENSE FEE 50e00 <br />(10) i�ITHIN TEN DAYS OY FILING ANY REPORTS WITH THE CHARITABLE <br />-GALLING CONTROL EDAR.D I THE ORGANIZATION SHALL FILE A COPY OF <br />SUCH REPORTS WITH THE CITY OF RD E I AS REQUIRED BY SECTION <br />125 * 060 OF THE CI'T'Y. CODES <br />