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M 0 0 <br />innesotia L4wful Gambling <br />ow <br />Organi ion License Application: -P Paft 2 <br />+.- ., " <br />�' 6Q - <br />L . d9 <br />N <br />Please list the lawful purpose expenditures for whicli your organization will expand gambling funds. (Refer to Minn. Statute <br />3419.1211 Subd.12.) Give spedific examples. <br />Benef 115ttiong, persons edu ca. tion ally,, dortributing tio their physical well—being a d <br />inc acing t sir col mpriehen,s,i,on----O-f--p—a-t—r o iic-- prince ples. <br />d ions to yogth gj:o,-1j2Z , and COT=i-inj <br />Onat t PT ce--"Vica ar <br />3 M=i OUDS <br />.06 <br />suppl,emen,t 11oical goverment wil th cash and El f ts of eoui-Qrwnt <br />,ft <br />gambling manager Address C4Y 8iiie Zip Code <br />John 'W Iri, aspin, 322i West Go Rd B Roseville M 5.c-5 -.1 .1.3- <br />Ust ot,her activities through which your organization raises funds. <br />!►a. mb 2 r: a h I �n . A31p- bar j <br />nna rig t,- <br />ts -rn i i rl nZ, + hall re rt <br />What percentage lot your organlization"s, funds are raised or will be raised through lawful gambling? 5c% <br />What other activiities dioesi your arganization engage in (not fundraising)? Veterans' aff,airs awareness <br />Social events flor 'rrembers. commiinit -%.rcler6eer ac-'-*v'-t-,r <br />-v serv*ce Ithrouah <br />XXO <br />Ad *D�agpme <br />ll declare that: <br />al have read this application andl all inforimation submitted to the board; <br />•All information is true, accuratie, and complete; <br />,►ll other required information has been fully, disciosed; <br />91 am the chief executive officer of the organization-, <br />,91 assume full respoinsibility for the fair andl lawful operatio'n of all ad'Aies to be conducted; <br />allwill farnilianize myself with the laws, of Minnesota governing llawful gambling and rules of the board and agree, if licensed, <br />to abide by those laws and rules, Including arnendibents to them; <br />*A mernbership list of the organization will be available within seven days, after it is requested by the board; <br />Any changes in application ' information will be submitted to the board and local government within 10 days of the change; and <br />wA, termination plan will be, submitted to the board within 15 days, of termination of all premise permit(s). <br />el certify that the gambling manager is bonded and licensed as required per Minnesota Statute. <br />*,Failure to provide requiired information or providing false or misleading informatiorf may result in the denial or revocation of the <br />license. <br />Signature of Chief Executive dicer Date <br />C Ai <br />:efor to the, InstrUbtlons for the required attachments. REMINDER: The organization's chief executive off licer and <br />.i <br />!asurer must complete the Organization I Officer Aff ldavit, formn LG 2DOBi. <br />Mail to Department of Gam,ing -Gambling Contrail Division <br />Rosewood Plaza South, 3rd F'lloor <br />1711 W. County Road B <br />Roseville., IVIN 551113 <br />