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W2001 Miennesota Lawful Ganthling <br />�R,ev. (212,M,O) G ambling License Application Part <br />1 <br />Organization Information <br />Legal name of organrzation <br />C> seu I LJLOC sc.-oci A-n OrN <br />usines,s aitscress of organization - S,treet or Pl. 0 Box (Do not use address of gambiiiIng manager) <br />city State Zip "Code County <br />Business phone number <br />ROS&IIIIII I L-Lc <br />I Z) Bfel- --- I M5 <br />If 9 of chief executive officer (=nol be gwibling manager) ride <br />Business phone number <br />L Gn <br />cc 1Z) 3:2ti.- I ZI I <br />Addriess, of chief execubve officaf, - Street or Pl. 10. Box <br />State Zip, Code County <br />yon 00top 5td <br />ame of treasurer or person responsible for organization's otner revenues jeannot be gambling manager) Title <br />Business phone number <br />MW ON <br />Type of organization-ki ED fraternal 0 veterans 1:3 religious CR other nonprot: <br />Number of years organization has been in existence as a nonprofit organization 12 141:2 - I <br />Amich a copy of nonpircifit incorporation from the Minnesiota %.=ltary iof State air a, letter from the IRS declaning income tax <br />. <br />exemption (Oo not send a, sales tax permit or Federal employer identificadon information)) <br />Number of aictivie members 450 (must be age 18 and olideir) <br />,41 rv%cw%o#4%4, ^-VUO. <br />Wh�en does the organizatilion hdId regular meetings? Day(s)i '5 Z I e% Q 4"hd Hours -1,,-%30 rno <br />Have internal controls bieensubrnitted on, the form provided by the, IYr oard?' yes Iff If no – Attach a copy. <br />Uwi,e oIf,APPU,cat,i,on <br />Class of License <br />19 Class, A — Fee $2,001 (binga. rafiles,, paddlewheels, tipbo and s, Ipull-tab si) <br />El Class B Fee $125 (raffles,, paddlewheels, tip boards, pull-tabis) <br />0 Class C Fee $100 (bingo only) <br />0 Class D Fee $75 (raffles only) <br />Status of 111cense - chieck one: <br />Organization has never been ficensed. <br />New site — Fillin license number <br />ng l Fii comUll in lete license number <br />0 Renewal of existii cense — <br />Changle in- cla2.2 of existing license, — Fill in gomglete license numbier <br />[3 Previously iexpired) license, - Fill in cgmpleje license number <br />