|
innebsiota Charitable Gam Wing Control Board LAWFUL GAM�B,LING EXEMPIO
<br />TN
<br />M
<br />.. F;. N
<br />idway Bu
<br />LIM
<br />Room N475, Griggs-MI 11ding
<br />FOR BOARD USE ONLY
<br />'1821 Universitly Avenue
<br />-33831
<br />St. Paul, MN 55104
<br />.,,l -015551
<br />N., (�612)1642,
<br />-ASTRUCTIONS: 1. Su�bmit requiest for exe�mption at least 30 days prior to the occasion.
<br />Name of'Premises Where Activity Will Occur,
<br />Roseville VFW Post '75515
<br />Datels) of Activity, drawing(sl
<br />I _(110- 0
<br />City' State Zip County
<br />Roseville 1� M 1� 55113 1 Ramsey
<br />Use of Profit
<br />Fund rai,ser to offset expenses for ice time and equipment
<br />Distributor s; icen
<br />se W
<br />Distri&irl IF'rom Whom Gambling Equipment Acquired
<br />-.;*-z Jj
<br />J-r
<br />Al 46,
<br />I affirm all information submitted to, the Board is true,, accor-
<br />d compli te. I-EMNINEft-
<br />mom
<br />Chief Executive Officer Siginature Date
<br />1,. aff irm all fin a,nci.al information submits ed..to- the Board id
<br />'tr,ue�, ac�icurate, and complete.
<br />I
<br />t 16 l'
<br />4.
<br />Z " 74.
<br />, 5
<br />-.9 ... mp-
<br />iChief Executive Officer Signature Date
<br />it hereby acknowledge receipt olf a copy of this application. By acknowledging receipt, I admilt having been served with notice
<br />that this application will be reviewed by the, Charitable Gambling Control Board and will become effective 30 days from the
<br />date of �receipt
<br />J (noted bielow) by the City or County, unless
<br />■ resolution of the local governing body is passed which specif 1-
<br />I I
<br />cally disiallows, such activity and a copy of that resolution is recei , ved by the Charitable Gambling Control Board within 30
<br />days of the below notlied date. TOWNSHIP
<br />CIT'Y'OR, COUNTY
<br />Name of Local Governing IBodly (il or County)
<br />Roseville, A
<br />_SignatVe" of' Person Receiving A�Pvc)_tion
<br />Titie
<br />Township Name (Must be notified when County is the approving body)
<br />Signature of Person Receiving Application
<br />CG.0101020-01 116k87') White Sioard Canary — Board returns to Organization to complete shaded areas
<br />Pink, — Organization Gold — City or County
<br />AM
<br />-t - Explen�ses
<br />Market-Value
<br />No
<br />dross" Rec'elpts - - .'Cost of Prizes
<br />-:-'Profit 7.4, of Prizes rArJ
<br />x
<br />4ll'
<br />rJ6 Am
<br />P.
<br />nest
<br />C�
<br />-e
<br />-:3 -
<br />-p
<br />U N
<br />X
<br />All
<br />Z,�
<br />x
<br />P%X
<br />4'.
<br />x
<br />7
<br />s-Z ll -
<br />.9 jL
<br />- 7
<br />Use of Profit
<br />Fund rai,ser to offset expenses for ice time and equipment
<br />Distributor s; icen
<br />se W
<br />Distri&irl IF'rom Whom Gambling Equipment Acquired
<br />-.;*-z Jj
<br />J-r
<br />Al 46,
<br />I affirm all information submitted to, the Board is true,, accor-
<br />d compli te. I-EMNINEft-
<br />mom
<br />Chief Executive Officer Siginature Date
<br />1,. aff irm all fin a,nci.al information submits ed..to- the Board id
<br />'tr,ue�, ac�icurate, and complete.
<br />I
<br />t 16 l'
<br />4.
<br />Z " 74.
<br />, 5
<br />-.9 ... mp-
<br />iChief Executive Officer Signature Date
<br />it hereby acknowledge receipt olf a copy of this application. By acknowledging receipt, I admilt having been served with notice
<br />that this application will be reviewed by the, Charitable Gambling Control Board and will become effective 30 days from the
<br />date of �receipt
<br />J (noted bielow) by the City or County, unless
<br />■ resolution of the local governing body is passed which specif 1-
<br />I I
<br />cally disiallows, such activity and a copy of that resolution is recei , ved by the Charitable Gambling Control Board within 30
<br />days of the below notlied date. TOWNSHIP
<br />CIT'Y'OR, COUNTY
<br />Name of Local Governing IBodly (il or County)
<br />Roseville, A
<br />_SignatVe" of' Person Receiving A�Pvc)_tion
<br />Titie
<br />Township Name (Must be notified when County is the approving body)
<br />Signature of Person Receiving Application
<br />CG.0101020-01 116k87') White Sioard Canary — Board returns to Organization to complete shaded areas
<br />Pink, — Organization Gold — City or County
<br />AM
<br />
|