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/ A ` L0230 Minnesota Lawful OambUng <br />1p AppBcation for Oae -Day <br />d Off -Site Lawful Qrambllng <br />NWm of <br />LZ Y <br />ALAAma ItrM or bD <br />For Board use- oinly <br />Base License # <br />Non of Eowda OMW (008" <br />ct <br />r <br />V 9 FWM mr 0 � , <br />I <br />V1 <br />S rd <br />OEM', i <br />--------- <br />WYATT 17 <br />0� .......... <br />NMM 7 ;whKe CM. ng will W hold <br />alls <br />0 M tLL� � <br />J� J�n <br />11 1 <br />L .00 <br />3. DIM Of Onsm"Y O"M 4cjq�4je 14 /J:�L 2nI tj�3 <br />4, H YCLO sand off-so ganISW9 As =WMdW YON? V" <br />It yn, who wu ft daW Of 00 Omnt? <br />H, <br />R m <br />R.>0 x�- a- ME -, L. M.- a <br />V-)Nd , Zm-a" <br />m <br />T I a affi that inkrmdan w "o and =WL <br />F <br />of Ofter <br />V-.., <br />006 <br />, U. 5 , I cl,:,: <br />e <br />11-0gof�blrnp 0 <br />A."""'k 14 <br />wfthin Imb. <br />i. The c4 must sign 1hir, applicadon it tw PrOmim is k=90d <br />2. The ewnti AND =xhia must sign this wOk"M If to Vorbing p W" is kxawd wtWn a xwmhip. <br />madort <br />3. The bOW unit Of govemment (dty or CCU*) nW$t WSS & MOMW 3POd5O* or denong this. appr <br />4. A japy the 10011 unit Of 09ME02013 ing Ws <br />a. if dais appicagon is denied by the b= Urit of ffmn% it WwM not be subained to ft Gambfing C*nW Board. <br />Olty of County <br />C* or county nww <br />el y� <br />Signature of person .4 <br />Tide <br />Township <br />F� <br />TowrddMp nam* <br />Signatm of Wman racemling <br />Tift Daft romived <br />1111 VPNr*Np : ,..Orqwhe9d ..0 anted U ninwMow <br />Attach & OM of the, Me" fW the off4b kication and m COPY <br />of the approving resolution from the local unk of govemment <br />Mail this applin 110: <br />Gambling Go, rd <br />Rosewood Plaza SOt9h, 3rd Floor <br />1711 W. County RDad B <br />PawAss MN 55113 <br />