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W • <br />FOR BOARD USE ONLY <br />xim <br />AP <br />& <br />Nauime of Premises Where Activity Will Occur <br />Dateis) of Activity, drawing(s) <br />Rosev. 101 le VFW Post, 7,55,51 <br />Premises Address <br />City State Zip County November 14, 1988 <br />1145 Wolof hill Drive <br />Roseville Im 55113 Ramsey <br />Expenses and Market Value <br />Garne Yes <br />No "Gross Receipts­4� Cost of'Prizes ""'Profit f Prizes <br />1 <br />Binglo, <br />gym - - _- I- <br />T .. !;;� . '0 0- ;fte­r <br />r• T N I NL <br />"t2' ­�;;%!.`.'. Ar if _z 1%�2FV. A� <br />X pw�x, <br />A*t <br />Riaff l�e S <br />-c"T -Aoc�-- rcrwik I _4 <br />_wk Ajl L <br />44 1 � T_ r'; <br />Y t.W 44; 7414 <br />X <br />P <br />Ve & <br />_Aia 4 <br />X R ON <br />PladidlIewheels <br />�45 -4 <br />PRO <br />Tipboarlds, <br />4 <br />4 �: tLi� dr <br />F <br />X <br />ki . .. ... ........... <br />........ .......................... . ........ <br />Pull abs <br />-T <br />q <br />�jwPr k RI■ 41�A I ik •4;:. 1 ■ <br />drAw <br />VAk <br />X NN <br />— L04 <br />Use of Profit <br />Fund,. r,a,il,ser to, iof f set, <br />expenses for ice time and equipment <br />Disidbufor Friom 'Whom Gamibiling Equipment Aicquired_.-r� 4k' Di��IbiAo -e-a Licen s e a <br />if <br />%: pf r, <br />kP A. s. <br />"b 3; <br />I af firm all information submitted to, t,hizBoard is true, accor- I affirm all financial information submitte-d to the Board <br />ate, and complet e. <br />IY P <br />t rue, accijfk6' and complete.77� r. <br />1;�2 4��,jj A- -1X4 <br />Chief Executive Officer signature <br />Date Chief Executive officer signature Date <br />mlp:_uyllig a k 0 , - - <br />Si re of fersion Reiceiving p, tlication _Ccd Signature of Person Receiving Application <br />I ''14• J_ I iajalp� CIO <br />Tiitle��, Date Received Title Date <br />CG,-010020-01 161/87) White — (Board Cainairy — Board returns to Organization to complete shaded areas. <br />Pink — Organization Gold — City or County <br />