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Minnesota Lawful Gambling
<br />Rev. (2/281 Gambling License Application, - Part
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<br />B"ness addlressl of orgwizamin - Street or P. 0 Box (Do not use addres3of garnbiing manager)
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<br />State Zip Code 1 County° Business phone number
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<br />Name cf' chief exeerub've, offer (cannot be Gambling manai 1'loa . Business phone number w
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<br />Address at chi el execudve, off Street or P. 01. Box - � , . �� - 1n � � r• � � r
<br />G-709 Lic"CiZ
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<br />Code County
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<br />!Marne of treasurer or persori res;*nsiNe twi lanization's other revenues (cannot be (gambling manager) Ti �� Business phone number
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<br />Number Iof years organization has (belay In existence as a nonprofit o I+ganlizatlwn � . � �;_;,�` . * � : :
<br />Aittachacopi of naxrnprofrnt incorporation from the Minnesota Secretary of State or a letter from the IRS deciaring income tax
<br />exernptii m. , i(Do not send a sales tax permit or Federal employer identification infcrmat cn)) .► �� ;� i��l �� � . �• ` � '� . `�
<br />Number of active members 19 CFDi ('must be age 18 and oldie r)
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<br />When doles the clrganilzatl oln hold regular meetings ?, i Days 'r Hou' ri
<br />Have internal controls, been submiftted on the form provided by the board L I yes U& If no -- Attach a.SpM. .
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<br />Type of pucation
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<br />Class License °
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<br />f5i Class —, eel 00 (bingo, raffles, paddlewheels, tipboards, Ipu 1 t abs ) •.. - .i l■®w+ � _ . .. te1rL. # *r ra*1wL Vna• +lr + .a.... +.s. �. ., ..ya . a M,rtera ,r L.+. *+f "* +F'�r1+ y � *-. � a.dF . .-sLn.adr�i r 1r 4.#r#LJd■ • • ;1+
<br />0 Class EI Fee $1,25 i(raff'les,,, paddlewheels, tipboards, pull-tabs)
<br />Class C, a<at ■ �, r r .•L. �,� - .. . r .. _ . ®,.�- ..���aF w� ..... r.� .... _- +- °�^+wt..�-- ,..�•.�•.a_,• -tir - a. .a..�_! _°°.ter• _._ .,a,. ®. „1, + :pL
<br />Fee 10 b'lllr�rrr. o clrtly
<br />Class D Fee I7 5 (
<br />rafflles only) ■ :; ', 1+: � -y l ��. � .aj f +,, °rl .r
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<br />hen el ir�_c� c existing license Fill lrr rn !e license number
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<br />(Previously expired 'license - (Fill in gomnlete license number Jam!! -
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