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jr <br />ILMG210Afl <br />11 e. <br />gambling your, organt"I'lation will be conduedng: <br />CWss A - Pull-tabs., tipbowds, paddlewtwls. raffles. bingo <br />Class C - Bingo only <br />RA3"ss et cniet exe=tivei otticer - <br />203 West, Skillman <br />73 <br />�_=7_ <br />Rosevillip. Mnnesota 515113 --Ramsey <br />-R <br />Full 13ame of arganizatan's tmasurer <br />Last Nam Rmt, Name Mime N=e, Maideri Tide Date of birth Daytime phom nun't <br />Warner James Lee Treasurer 16-4-69 1(612) 296-7333 <br />144ben does th organization hold regular meetings? <br />f4umber of AcIfive, Members • (must be age 18 and older) Moriday f ollowinz <br />Day of vveek 3ra St ay ti 0 TeMOO-E&MO <br />I dedlare, thar., <br />o, 11, have read thio. application. &-.A allll informfi on submitted lo <br />V* board- <br />a all ii i;r;;afion is trvtol a=urate and corrijAete; <br />aft.c=pensation sched7ile is current aW on file With dw <br />board; <br />wt* intemal oantrols are current and loin file with The board; <br />• aV other required information has been fully disciosed; <br />• I am the chlef execuWei officer of the organizabon-, <br />• I assume full Ire sponsibility for the fair, and Lawful operaven of <br />ag activities to be conducted; <br />A I willl familiarize myself with the, laws of Unnesot"a goveming <br />UnOul gambling and Irides of the board and agree, if licensed, <br />%a, abide by those laws and rules, including amendments to <br />Ov"; <br />Signature q hiet � ixecutive Date <br />3 <br />Mail with required attachments to-, <br />Gambling Control Board <br />'.Rosewood Plaza, South,, 3rd Floor <br />171 ` W. County Fload B <br />R'Osieville, MN 55113 <br />