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�G 23M(2M/901)), Minnesota Lawful Gambling <br />Application for OnemDay <br />OffeaSite Lawful Gambling <br />Sand In this application at least 60 days before your gambling adivity. <br />Name of chlersixecutive of (plea" <br />John Seward <br />4 9.is—jci�-r &�gargiidii cioindfud od off-she Qumbling Oils �year? Yes 0 N�o 91 it yes, what was date of event? <br />Loical Govemment Acknowledgement <br />I 'shave received a copy of thus application. This application Will be rovi,01wied by tho Gambling Control Board and will become effective 60 <br />days, from, the dato of recelpt by, the airy or county,, unless the local govoirnment passes, a, resolution to specifically forbid the activity. A copy <br />of that resolution must be receilved by Ithe Gambilling Control Board within 60 days of this date filled in below. <br />at or uounity k110 DO, 11116 <br />City or coluinty, name <br />UUUIfflyyy�I <br />r Township <br />Towinishiip, name, <br />41 <br />Signiature of porson re(vi1 ving application <br />Signialure otperson receiving application <br />Title Altol,91. Date received Z 7 - 9 Z Title <br />Affaclh a copy of the lease, for the off-site location <br />41 <br />Mlaid this application and a copy of the lease to: <br />Department of Gaming - Gambfingi Control Division <br />Mail Staflon 33,15 <br />St. Paul, MN 5514,6-3315 <br />