1989_0109_packet - Laserfiche WebLink

Home

Charitable, Gambling Controll Board R m N 5 -47 Griggs-Midway Bldg. 182111 University Ave. It lPlaul, MN 5151104-3�383 (612) 1642-0555 GAMBLING LICENSE RENEWAL APPLICATION For Board Use Only Paid Amt Check No. Date- LICENSE NUMBER: 8_111113-1111 /'EFF. DATE. AMOUNT OF FEE-. 1. Applicant—Legal Name, of Organization 2. Street Address ANERI'CAN LEGION IPOST 54121, ROSEVILLE 701 W Co Rd C 3., 01ty, State,, Zip, 4. County 5. Business Phone Rosevillie, NN 55113 Ramsey ( 612 ) 483-3535 6. Namie of Chief Exiecutivie Officer 7. Business Phone TUOMfg.— James L Tis�l,and do 8. Name of Treasurer or Person Wh�o Accounts for Revenues 9. Business Phone Anne, Harl"I Eildt ( 612 ) 483-3535 10. Name of Gambling Manager 11. Bond Number 12. Business Phone J3ft0Cd0bx John W Kriispin L 13. Name of Establishment 'Wlh�ere Gambling Wilil Take Place, 14. County 15. No. of Active Members Ain legit Post 542 IRtlselville IRuse y 811 116. Lessor Name 17. Monthly Rent: 18. If Bingo will be, conducted with this license, please specify days and times of Bingo, Tim�es [days Times Days Times I hereby declare that: 1. 11 have read this application andl all information submitted to the Board; 2. All information submitted is true,, accurate andl complete; 3. All other reqluired information has been fully disclosed; 4,. 1 am the chief executive officer lof the organization; 5. 1 assume full responsibility ,for the fair and lawful operation of all activities to be conducted-, 6. 1 will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the board and agree, if licensed, to abide by those laws and rules,, including amendments thereto. 23., Official Legal Name, of Organization S' ature (Chief Executive Officer) American Leglion R,ols�etown, Memorial Post 5,42 or 9 ACKNOWLEDGEMENT OF NOTICE BY' LOCAL GOVERNING BODY I he�ireby acknowledge receipt of copy of this application- By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and it approved by the Bo,ardl, will become, effective 60 days from the date of receipt (noted below), unless a resolution of the llocal governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Boarrdi within 60 days of the below noted date., 24. CitylCouin Name �(Local verning Body) Township: if site is located within a township, please complete items 24 h L 40" A Am, w 111 J f r 0-- 1 and �25: Signature of Person Mceiving Application: ti Title Date Received ate begins 60 day period) Name of n Del 7 Ong Apiplicat .4o Local Governing Body: -, 1 r 106-7 1, CG-000122-02 (818�8) 251. Signature of Person Receiving Application am- Township Name White Copy —Board Canary —Applicant Pink—Local Governing Body