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25. Amount of Rent Pler
<br />Month or Bing o Occasion
<br />$ 6 0 01
<br />B. Do you plan on conducting bingo with this license?' If yes, give days and time of bingo occasions.
<br />I Da,y Time Day Time Day Time
<br />Yes I©'' 2,7. Hiasthe $10,0100fildelity bond r �gquired by Minnesota Statutes 349�.20 been obtained?
<br />36., Gambling M�an�agier Business Phone 37. Date gambling manager became
<br />if 61 115,18 member of organization.: Month 8 Year 6
<br />ElYes,DlSla .381. Has the I i ce nisiie termination form, been completed? Attach cloply.,
<br />DYes,01%lo 39. Has the compensation schedule been approved by the organization? Attach copy.
<br />401. List the day and time of the regular meeting of the organization. Day Time
<br />41., Bank Name
<br />E, FA ff Z TITIT, =1# �
<br />43. Bank Account Number
<br />GAMBLING SITE AUTHORIZATION
<br />By my signature bielow, loical law enforcement officers or agents of the, IBoardl are hereby authorized to enter upon the site at any
<br />time gambling is being conducted to, observe the gambling and to, enforce the law for any unauthorized game or practice.
<br />BANK RECORDS, AUTHORIZATION 1%
<br />By my, signature bel ow, the Beam is Ihereby authorized to inspect the bank records of the gambling bank account whenev
<br />necessary to fuif ill requirements of current gambling rules and law,.
<br />II hereby declare that: OAT'H
<br />1. I have read this application and alll information submitted to the Board;
<br />2. All Irif ormation submitted is true, accurate and complete
<br />-
<br />I All other irequ ired linformation has been f u�llly, disclosed"
<br />4. 11 am the chief executive officer of the organization;
<br />5. 1 assume full responsibility for the fair and lawful operation of all activities to be conducted;
<br />6. 1 will farniliarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, if
<br />licensed, to a�blidle by those laws and rules, including arnenidments thereto;
<br />7. M�embers,h�ip, list of the, organization wiill be available within se'ven..1days, after it is requested by the board.
<br />44. Off,icia�ll, Legal INarne of Organization 45., Signature (must b 1 rrecHpkChief Executive Officer)
<br />N
<br />X
<br />SAINT AGNES SCHOOLS' I
<br />Title of Signer
<br />F6 =.� .1
<br />0,1/117/1989
<br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY
<br />I hereby acknowledge receipt of, a copy of this application. By a�ckno,wlledging receipt,, I admit having been served with notice that
<br />this application will be reviewed by the Charitable Gambling Control 'Board and if approved by the board, will become effective
<br />160 days frown the date of receipt ('noted below) unless a resolution of' the local governing body is passed which specifically
<br />disallows such activity and a copy of that resolution is received Iby the Charitable Gambling Control Board within 60 days of the
<br />below noted date.
<br />46. Name of' City or County (Local Governing Body) If site is located within a township, item 47 must be completed, in
<br />& addition to the county signature. If township is not organized,
<br />City of' Rosevi 11e 11 county m�ulst sign.
<br />Signature of person, re,cel�v' applicatiom 47. Name of, Township
<br />P-W 7) 1
<br />Title
<br />r ho'.1 tinr (p",
<br />Date received (60 dla�y period
<br />begins from this date,)
<br />07
<br />Signature of person receiving application
<br />Q
<br />48. =van tve ion to Local Governing Body Title
<br />r If I
<br />CG.100101 -03 (818'8') White Copy -Board canary - Applicant Pink-Local Governing Body
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