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minnesota Laulful GambEM <br />LG230 Application for One"Day <br />(Sr2mi) OffwSite L 11 : Gam ling <br />-Tor Board use only <br />IL <br />Addrew (1111*41,11 Or POSt ORM b" numbw) <br />C. <br />M,071 0 01 LO 1-:1 15" zw Code <br />Ow ESPW 1 1 .3 <br />ifa� do L) Of. w <br />a <br />pro Nu mbow <br />Name, all ChiGfEX4=fW* PW I PMQ <br />4 A' ISO Ad IFTV o <br />--------------- <br />N=* of k)IInwhmi Off-SiO 98mWft WHI b4i Wd <br />Res d /tom of /Q <br />I <br />S�S1!? <br />w wwanip 1w. __w_ - <br />VF I A#_.f&P..jU '911L,:- -- lz & Oyw fj-// <br />'Y' <br />U— y" Nd N yu, whid wu ft daft Of the ~0 <br />Ku your wganizalbni cOnduOW Off•sitq pmWift tA Wend yew? <br />--------- z.E <br />j a1fArm that ft SbO" infOrMation Is true SM =WrOwt <br />isignature of <br />ANSIOISION <br />12=% <br />�LZTI'1,71 . a within ciV Omits. <br />1. The, C4� must'sign this application if the, giam�bl�ing PrOMIS83 is l0c&W� SHIP. <br />2. Tne WM= AND townshi2 must sign this applicafm if to gambling pmmlsn is lkxgftd win a Uwn <br />*fie* apprwAng or denying this applicaton <br />I The kmW unit of govemment (C4 Cw wurI must mss a resokidion SPW d "is md 20- <br />an mud he luds <br />4. A co- ofth", 19011 W011 Of 90-MMMOds Elsolu ab='Ing <br />4L If 111is apprication iS denied by 0* kx;a! urdt of'govornment, it sihoulI d not, be subMwd to ft Gambring Control Board. <br />City or courq nww <br />iL <br />Is jxMgWp : .,OrI;zW....UnorgaNz9d ,.,.Urf1nOOrPOMt9d <br />