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1989_0109_packet
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1989_0109_packet
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Charitable, Gambling Controll Board <br />R m N 5 -47 Griggs-Midway Bldg. <br />182111 University Ave. <br />It lPlaul, MN 5151104-3�383 <br />(612) 1642-0555 <br />GAMBLING LICENSE RENEWAL APPLICATION <br />For Board Use Only <br />Paid Amt <br />Check No. <br />Date- <br />LICENSE NUMBER: 8_111113-1111 /'EFF. DATE. <br />AMOUNT OF FEE-. <br />1. Applicant—Legal Name, of Organization <br />2. Street Address <br />ANERI'CAN LEGION IPOST 54121, ROSEVILLE <br />701 W Co Rd C <br />3., 01ty, State,, Zip, <br />4. County <br />5. Business Phone <br />Rosevillie, NN 55113 <br />Ramsey <br />( 612 ) 483-3535 <br />6. Namie of Chief Exiecutivie Officer <br />7. Business Phone <br />TUOMfg.— James L Tis�l,and <br />do <br />8. Name of Treasurer or Person Wh�o Accounts for Revenues <br />9. Business Phone <br />Anne, Harl"I Eildt <br />( 612 ) 483-3535 <br />10. Name of Gambling Manager <br />11. Bond Number <br />12. Business Phone <br />J3ft0Cd0bx John W Kriispin <br />L <br />13. Name of Establishment 'Wlh�ere Gambling Wilil Take Place, <br />14. County <br />15. No. of Active Members <br />Ain legit Post 542 IRtlselville <br />IRuse y <br />811 <br />116. Lessor Name <br />17. Monthly Rent: <br />18. If Bingo will be, conducted with this license, please specify days and times of Bingo, <br />Tim�es [days Times Days Times <br />I hereby declare that: <br />1. 11 have read this application andl all information submitted to the Board; <br />2. All information submitted is true,, accurate andl complete; <br />3. All other reqluired information has been fully disclosed; <br />4,. 1 am the chief executive officer lof the organization; <br />5. 1 assume full responsibility ,for the fair and lawful operation of all activities to be conducted-, <br />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 <br />laws and rules,, including amendments thereto. <br />23., Official Legal Name, of Organization S' ature (Chief Executive Officer) <br />American Leglion <br />R,ols�etown, Memorial Post 5,42 <br />or 9 <br />ACKNOWLEDGEMENT OF NOTICE BY' LOCAL GOVERNING BODY <br />I he�ireby acknowledge receipt of copy of this application- By acknowledging receipt, I admit having been served with notice that this application will <br />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 <br />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 <br />the Charitable Gambling Control Boarrdi within 60 days of the below noted date., <br />24. CitylCouin Name �(Local verning Body) Township: if site is located within a township, please complete items 24 <br />h L 40" A Am, w 111 J f r 0-- 1 and �25: <br />Signature of Person Mceiving Application: <br />ti <br />Title Date Received ate begins 60 day period) <br />Name of <br />n Del 7 Ong Apiplicat .4o Local Governing Body: <br />-, 1 r 106-7 <br />1, <br />CG-000122-02 (818�8) <br />251. Signature of Person Receiving Application <br />am- <br />Township Name <br />White Copy —Board Canary —Applicant Pink—Local Governing Body <br />
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