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LG�240 <br />V1119AP mfttnesota Zawfuli Gambling <br />Registration to Conduct, slim, Excluded Bingo or lRaffle <br />fl <br />Type of or"nizatloin (&a*, oney . 0 Fraternal ROJI18 0511 C3 Othm nonprolft, Organization <br />No [I Yes it yes, your organization may not apply <br />11 s your organization currently licensed by the GembUng OonW Board? to conduct exclu binao. <br />Chea lanio <br />C]Tbe bingo wig be, conducted, (up, to 12, Consecutive days) in connection with a* County Fair 0 Stwe Fair civic Celebration <br />E]'The bingo will 'be one of four or fewer bingoi events the organizaton will hold this year. <br />Dia*s) of bingo event" <br />How many tirrI has your organization hold <br />How many consecutive, days will bingo, be played? a Virago event in the current calendar year? <br />Narne of person in charge of bingo, Phone ( <br />�ai III I <br />61 <br />If <br />Ito <br />Total market value of raffle Prizes $ <br />A.ates of raffle, ftwing C <br />11 <br />Name of person in d IIiarge 'Of MMO <br />A is comp and accurate to -,the best of my knowledge. <br />The.-Wormationpmvided above <br />Date <br />Chiet Expoutive Officees signature Niamle (piease print) <br />91 <br />/T <br />Send the completed reglistration, form to: <br />Department, of Gaming - Gambling, Central DMI911011 <br />Riosewood Plaza South,, 3rd Floor, <br />17111 W. County, Road B <br />Rosevil�l�e,l MIN 5'5113 1 <br />