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r .41 <br />GIM- I <br />4 <br />FOR BOARD USE ONIL <br />a. <br />th. MAP. oil, <br />WEiN <br />PP 8 <br />4 V X.."J tAl 91 tic# <br />*Q <br />r 6= <br />FEE <br />No 4. IT -4� <br />Ov <br />Lawful UMI <br />Gamb <br />CHECK <br />MIR <br />les, Pie Ap..cation =.Part IL of 74 <br />A Alzk Ull I <br />WTAI <br />_ 4�L 17W 0I <br />DATE <br />Ck" of ISO <br />�.rwqq' — 6 permit <br />IF. __ .__ op <br />4 V <br />Rfltzp 14 1 Mq c k o n 6) - I 'W <br />RAI-tabs, tip - boards, dkwAwelse g bingo <br />IMMMA Pao <br />AY .; .-* .., Re� •�. _ • � . ^T• ,�, •� �'� r,�.l A��, .��'sA 9V <br />�outh, Hoidkev Assoiciaiton <br />625 Trans it <br />-C " -, .' 7 -�* - . 4.. %RUMMU - .1 <br />Roseville <br />MN <br />%=6 of GhWif executive e er (camot be your gambUng manager) <br />Lee Blorash <br />Daytime phone number <br />Daytime phone numbw <br />(612 )378-1003 <br />Bingo Occasions <br />111 applyMg for a claw A or, C permit IM in days and, be & ending hours of b—in-10 occasions: <br />No more than seven bujo occastom =y be conductecd by your, orr!a=jj n DCr,& WCek., <br />4h <br />nig/Ending Hours Ending Hours Day FEtuling Hours <br />Da Dw <br />y <br />5PQ cz:)o <br />9109 x.11'eccA42 18 <br />MMIN" to <br />• 9IIII.PeIII A 40 'r-W -VAW& -r "11PjW"rWVW*'&- <br />""404K h 71ft. A. A <br />to to <br />4 <br />W."t Iiiix -0, a_ <br />A-w <br />IT# MWO <br />2 <br />MOW Ubl"a -wM not, be conducted, check here <br />.1% <br />AO%W <br />� R.I.A <br />of esab—lisent, where, gamblin wilill conducted 1dress (do not use a post office box numbier) <br />4_4 9 <br />Knigbts o f Columbus B' Hall 25,55 Snelling Ave. No. <br />c:3 unorganized 1:3 unincorporated <br />16,te prierni'ses located within cfty'Jimlts? Yes M No If no, "s toviiiinship orgrptzed <br />MW and County, where gambling prdMises Is located OR Towns,hiip and County, wh3rS gambfieng premises is located if outside of city limits <br />Roseville/Ramsey <br />I land address at legal owner of promises City State Zip Code <br />Nazareth Building, Assoici*ation Rosev"i'lle Minnesota W55113 <br />Does your arganimbon own the buildnig where the gambling will be conducted? r= YES MO <br />If no, attach the following: <br />a copy of the lease (kx LG202) with terms for at least one year. <br />a copy of a sketch of to floor, plan wM dimensions, showing what porfion is being teased. <br />,A lease and sketch are not required for CLI Di applications. <br />st�t) <br />l '�--Is rr': <br />jwdr'e'" s''is'ovf" lel. I 12ac,e, LF eq p,m <br />WIN <br />Address City btate Zip code <br />Ift <br />255r5 Snelling Ave. No. RoseVJ-11e Mignne'sota 55113 <br />