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<br />Minnesota �' i Gambling
<br />` License APPE'r-ationiiii, '.r
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<br />L99W name Of orgnantaatian
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<br />Business amress al or nizatien - Street or P. 0 Box (Do not use address of garnbling manager)
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<br />stag Zips C minty Business l number
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<br />Address of w� f five ® Street, or P. 0. Box
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<br />Name of treasurer or per am respo nsible for organization's s otter revenues (cannot be giarr tWing ) Title Business phone number
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<br />Ty of organization,: El fraternal) El veterans 0 relig10 lls other ncnprof ,_:, r
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<br />(Number of years organization has, been nn existence as a nonp►iroff organization
<br />Attach a copy of nonprofit incorporaition from the (Minnesota Secretory of State or a letter from ft IRS nng income tax
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<br />exempt .l (Do not send a sales tax plermit or Federal employer identification Mnforrmabon)) '
<br />Number of active (members must be age 18 and older) r
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<br />When does the organization hold regular meetings? Day(s) T ) Tv4i . _ . .
<br />Have internal l nitrols been l sublmifted on, the form Provided by the board yes "" If no — Attach a copy.
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<br />Class 7
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<br />Glass Fee $200 (bingo, raflest, paddlewheels, t+pbY rd N pull-tabs) .4 ..r 4F
<br />Class, B Feel $125 (raffles, pladdl'ewh,eelsN ttipbcards, pull® tab s) . ` � -
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<br />Class c — Fee $100, (bingo only)
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<br />0 Class Fee 7 (raffles only,) +f ,. af'+y ore. ..
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<br />Bingo Occasions 1
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<br />ff Chas A or c fill in days and hours of bIngo o iallclnar
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<br />No, more than laix bid [� occasions may a conducteld week
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<br />ay Beginning/Ending . Day �lli ours . , . Da ° I�ti a innin ndirt 11 urs
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<br />check here
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<br />It 1n ill not e, conducted, .. � rgyAer . r. 1. �.. �..' � ,�.r,.r.Ap.�..v'�r� °°�r-N'��rT� I+�i�- � +4+A+*,r � ;• N �.�Y :..r �r 1. � ..�
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<br />Status I If license - check one
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<br />Organization hr a,s never been licensed. ""`wl • .: .: - •. .. , . ,,
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<br />Now, site —•- Fill in license number 1 • r ®� � y �
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<br />El Renewal of existing license F'illl in m 1 license number
<br />13 han17IP *n class of existing license — Fill in comp!We ficense number ...
<br />Q Previously expired license - Fill in I , _ le FI license number
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