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1992_0928_packet
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1992_0928_packet
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10/28/2011 11:24:01 AM
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10/28/2011 11:10:44 AM
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('Pursuant to Minnesota Statute 349.164) <br />/FO ts Cei R '31 <br />is ir .5,C. di <br />I under, oath state that. <br />(type or print) <br />1. 1 have not been convicled of a, felony. <br />2. 1 have never been convicted of a crime 'Involving gamblinj <br />Subscribed and sworn to before me this, ignature ol'appilica,n a-rBing6` Hall Personnel) <br />Mein or I <br />z 4,4 <br />d4F (f C.7 A4 <br />N�ame of B • Hial,l <br />i 1111111 WWI <br />Bingo, Hall License N�umber <br />Notary Public <br />Jaw <br />RIC!'ATI A,. HOAG <br />R,,4VI--v COU;,;�yy <br />My COMM. Expires jors 2, 10491444 <br />d4F (f C.7 A4 <br />N�ame of B • Hial,l <br />i 1111111 WWI <br />Bingo, Hall License N�umber <br />
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