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P <br />• 14 Is A 11 <br />gap kk <br />,fill W W 0 <br />4, & 1 9 1 1 1 V M <br />A 1 1 I <br />th <br />AMT. PAID <br />CHECK # <br />JJDATE <br />PRINTED: 07'/02/97 <br />LICENSE NUMBERV* BH0126 EFFECTIVE DATE: 01/01/9'8 EXPIRATION DATE: 12/311/98 <br />41 <br />Avolicant Information <br />I &. NAZAR ETH' BUILDING ASSOCIATION INC. <br />Name of App,lic,ant.i 4W9h1tS-0f-G04 <br />RN kFBA, 1-fapplicablei-.1 KNIGHTS OF' COLUMBUS HALL <br />Main, Office Address (if different from above): <br />mi <br />Type of Business Corporation <br />Local Unit of Government Acknowledgement <br />if the Bl* located <br />o Hall is, wi, the city It'mits,, the *City must sign the,, application. <br />Ing <br />If the Bingo Hall, *is located outside me city 11mits,, Both, the **County and **Township must sign the application- <br />FOMM <br />Signature of'Persion receiving the app�l,ic�atioln <br />Date Application, Received <br />icati n, <br />Title of Person Signing the APP111 <br />By signature below, the, township acknowledges <br />that the legal owner of the bingo hall is applyin <br />for a bingo hall, license renewal within town-eshi 17 <br />linlits. <br />Signature of Person receiving the applicatiol <br />Date Application, Received <br />Title of Person, S,igni,ng the Application <br />01 <br />Township, is: 'Organized <br />'Unorganized <br />'Unincorporated <br />