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Mi�nnellsota Charitable Ga�mbl�ing 1 Control B,oia�r� <br />Rolom N4,75 Griggs-Mildway Biul�ld�ing <br />1821 University Avenue <br />St. Plau�l, MNII 5i511,0�4-33i83 <br />(612) 6421-05,55 <br />A B BLING EXEMPTION <br />F'OR BOARD USE ONLY <br />Pa�d�d�lewheelilsil <br />I M <br />ma <br />99 <br />am FZI <br />Township Name (!"� ust be niotif iied when County is the approving bloidy) <br />Signature of Person Receiving Application <br />Im <br />m <br />9 L"I 11116# 11 U k I ............... <br />VAU# <br />or <br />it <br />ITA <br />A <br />Altl <br />A0 <br />............................ <br />I'l I <br />He w <br />00 <br />_74 <br />N <br />WI <br />Pa�d�d�lewheelilsil <br />I M <br />ma <br />99 <br />am FZI <br />Township Name (!"� ust be niotif iied when County is the approving bloidy) <br />Signature of Person Receiving Application <br />Im <br />m <br />