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FOR BOARD USE ONLY <br />Fi�Z200A Minnesota Lawful Crambling <br />Rev. (9/4W) Org zati,on License ApipUcation -o Part 1 <br />%V. fe.- <br />x <br />'g: WX,". <br />ME .......... <br />mldja�'Iii6 flo <br />Lagal Name, of 0ganizabori, Other nanes used <br />Saint Agnes Schools Sit. Agnes High School/ S-t -Agnes G School <br />NN manager) Business 10 Number(Sales &Tax Permit) <br />Dneliss, Address of Organizadon - Street or P*., 0 Box (Do rat use address, of gam�bl�i g <br /># 410694 737 <br />53 0 L o n d Avenue <br />i state Z,p Code, County Business phone number <br />cv 61 <br />S Paul HN 55103 Rams" 612 ) 228-1161 <br />Mmal Af Mirn -. -GIR FWst 96061 Maiden i TRW ats of Owne number <br />I. <br />Boone John, Ei 411 (a12+ 227-1886 <br />A�ftess of cNeil exegmthm offmir - Street or Pi., 0. EW <br />121,510 87th Place Worthq Maple Groves, M 55369 Hennopin <br />Irwity - Stare V - A. 3 - Aty <br />Na—me-of "asurer or person row <br />It Name F INar ne <br />Schuler IL,ich,arid <br />organizatIon's other, revenues <br />Midde Name Maiden <br />.Ioseph <br />to of birth I ausmess pnone numa <br />(612)293-1710 <br />Type, of Nonprofit Organization: [3 Fraternal 0 Vetwans D Refigious )(I other nonprofit <br />Number at years organizaton has been in existence as * nonprofit a rganization 10 2 y r s <br />Class, oif Organi=flan License <br />C] Class A — Bingo,,, Raffles, Paiddlewheals, 'ripboardsi,, Pull-tabs <br />I <br />Class B — Raffles, Paddlewheels,, Tipboards, Puil-tabs. <br />C1 Class C — Bingo only <br />0 Class D — Raffles, only <br />K* <br />-ech <br />Stibij of Ltd6n,se <br />C) Organization has never been licensed. <br />Ponewlaic�tioxisting�i�icansel�Fi�ilincom-niete,iicanisenium�be�r. Bi-102640-002-004 <br />Chanae-in classlot existing license — Fill in QOMQlete licensio number <br />Previously expired �liceinse — Fill in ggimpte e, license number <br />