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net rn to,: Charitable Gambiling Contro']. Board ONE DAY OFF --SITE <br />0 <br />1,8,21 Uni"Versity Avenue - Rm. N475 LAIJIML GAERLING APPLIUMON <br />W <br />St. Pa,ul, MN 551014-3383 <br />Phone: 612/642--wOI5,55 <br />■ <br />dM <br />OU—SITILE IFFOPMMT10111 <br />ACTIG1,11016111 M—GEM 71 OF 1410TIC117a BY L AL GYMMMIG LODY <br />I bere�by ackinowledale having been served with notice that this application will be reviewed by the Charitable <br />Gembiling Control Board and, if appro�ved, will become effect,iv,e 60 days from the date of receipt <br />(noted bielow) un),ess a relsolut,ion of the liccal governing biody is, Ipassed that 5pecifically di5allows such <br />activity and a cloply of that resolutilion 'is received by thet. Charitable Gamrblinq Control Board within 60 days of <br />the be'loi-i noted date. The, city oir count � may choose to walve the 60-day acknowledgenient period by resolution. <br />Y <br />Attach the written waiver to this, request. <br />w <br />71. Name, of city or county (local govpj:4Jng body) <br />0- <br />ts� DIE: <br />N- <br />8. Signature of person r-erevving app'lilciation Ti t'11 el Date received <br />- � NNW-- <br />If site i1s, located within a township, itees 9 and 10 must be completed in addition to the. county signature. <br />9 1. Name of township <br />Signature of person receiving application I Tit,le <br />17CR VWMD USE M�LY <br />Approved L_j Den, i edEl <br />Executive Secretary Date <br />Charitable Gambling Control Board <br />f o f f s i tia. doic 1(7 / 2 5 <br />