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CITY OF ROSEVILLE <br />APPLT,CATION FOR GAMBLING PREMISES PERMIT BINGO HALL <br />DATE <br />ORGANIZATION <br />yv% riz 0 <br />I'P BOARDS <br />PADDLE WHEEL <br />ADDRESS <br />PERMIT EXPIRATION (IF <br />RENEWAL) <br />RAM Is lc;� rk-,IIIIIIIII� <br />LAST FIRST M 1 DDLE NAME <br />1% <br />DATE OF B I RTH <br />O.Wip!i 0I I 4i h I 0 <br />BINGO <br />PULL T'AB,<Z]RAFEFLES <br />I'P BOARDS <br />PADDLE WHEEL <br />DATE OF <br />PERMIT EXPIRATION (IF <br />RENEWAL) <br />COMPLETED FORM IS CRITICAL TO A THOROUGH APPLICATION AND TIMELY <br />COUNCIL ACTIONG <br />I <br />