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<br />Minnesota Lawful Ganibling
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<br />t O ng License A pt , -Part 2 1
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<br />Nwe of establishment where ambling will be conducted Street address, (do not use a pot office bias number)
<br />'City AM County wtwe gamkWing pre en is atedl OR Township and County ire ding prernises.is located if outside of any city limits.*
<br />WY 4 COUNTY TOWNSHIP COUNTY
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<br />Legal oww of gambling pmm6ses � � Name of leswrl if not ft 199W owl A
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<br />Address of owner .. City, Mate Zip Code _
<br />Does the organization yawn the building where the gambling will be conducted? YES N (NOTE: Organizations
<br />may not spay themselves rent if they, owlet the building or have a holdingcompany. A hearse must be submitted showing rent.,
<br />pllayrnelnts as zero from gambling funds If the organization's Folding company, owns the premises, i
<br />If NO, attach the following:
<br />a copy of the, lease with tei rrns for one year.
<br />- a a copy of a sketch of the floor plan with dimensions, slhowllin l what portion is being leased.' �lL
<br />lease, and sketch am not required for Class D applications.
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<br />For bingo With other gambling � , RCO Total square footage leased q,31 0 � : e
<br />For garntding without Mingo Total square footage, leased
<br />Address of registered storage space:,,
<br />to CRY < . ... A State �.-•.`#,,, 44 ria•yA.'. Zip Code
<br />cR73-7 MAOCU6,111 SrY" s6VII a-elial plia"r •(
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<br />Mlimager InfGPir,mation
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<br />Gambling me ws naffm
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<br />Address,
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<br />.. �I -ty state ZP code ^6
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<br />+ e Fate that gambling manager became a member of the organization 74 `y
<br />Date that gambling manager seminar was tom pleted = � ! l' ��.,�.� � � w���� - ' � �� �� � r •�'
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<br />A $1 O�#1000 fidelity bond covering hI � � � na manager y Minnesota ta taw. Provide the following inform. ar
<br />tion X.M.
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<br />Name of insurance r a
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<br />IBond numbeir
<br />Banklnfo=ation
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<br />(e=h 1krrised ganobbling, ea must harp' a separate cIt -
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<br />*ern name, A I k 'Ate nuAI I A . •.`.^a'.rr� ►�.. i1 dY 'i�'�`.' v aar 'yea' 6 • AT ,f # t ber
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<br />Bank address i ' _ n p ..y
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<br />Name. addlri and ctie of members auttwiried to sign checks and make deposits, and wididlra+ alsl
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