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1990_0409_packet
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1990_0409_packet
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11/4/2011 11:08:27 AM
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R <br />ff you checked box for other nionprofft, chm* onel of the follombg r' proof of nonprofit status <br />19 IRS designatilon 0 Incorporated wfth Secretary of State ED Affiliate, of parent nonprofft organization (charter) <br />GambUng.1fte <br />Name of site where advity will take plaw <br />Street Cily.. state Zip code County <br />I <br />DIate�(s), of adivily <br />I 1 #1 F 0 1 - A r, f -116 1 1 U rr;Tr? Q111zjf <br />IN <br />MM= tt 400 IL <br />signature of person receiving application I Signature of person receiving application <br />Tilde D�ate rece ived I Tidle Date received <br />A D - Orowizam Mall this application and fee oIf $25 (chieck made out to commissioner of Revenue) tO: <br />YONOW — Bowdi rekm* W �OrW�mikm b <br />moplele shaded we", Depattment of Gaming - Gambling Control Division <br />&W - MY or CO."" Mail Statilon 33,15 <br />St. Paul, MN 55146-3315 <br />
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