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i-Rt -14.;1N �Min,niesota Charitablie Gambling Control Board LAWFUL GAMBLING EXEMPTION.
<br />'A
<br />Room 17' I Griggilsi-Midway Bu�ilding
<br />FOR BOARD USE ONLY
<br />1821 University, Avienue
<br />St. Paulp, MN 55,104-3,383
<br />(612),642-05515
<br />"NSTRUCTIONS': 1. Su�brnit relquest for exemption at least 30 days pirior,to the occasion
<br />City I State' I zip I County
<br />Naime of �Premises Whier,e Activity W'illl Occur
<br />Roseville VFW Post 7555
<br />-71tremises, Aiddress city,
<br />1145 'Holodhilill Drive Roseville
<br />NEW
<br />Tipboards
<br />Date(s) of Activity, drawing(sl
<br />January 16, 1989
<br />State dip County
<br />MN 55113 Ramsey
<br />Use of Prolit
<br />- Fund-rallisier to offset expen,siies for ice time and equipment
<br />L%
<br />2
<br />0 ---
<br />_41
<br />7 41W7 Z,`4r_7,? 'r�'s Lice
<br />Distfibutor Fr m Whom Gambling Equipment Acquired Disin nse
<br />"rx LS4
<br />it
<br />Z rk
<br />as e
<br />affirM a 11 inf ormation, subm�itltled to, the Board is true, accor-
<br />vile, and complete.
<br />-a" OF
<br />'inaturie Date
<br />I affirm all financial information submitted to' the Board is,
<br />t al ccurate
<br />rue, a 1
<br />'6�
<br />and complete, e "rte K 4
<br />s
<br />V
<br />V-
<br />r
<br />-, Z-1
<br />-5 7 e�_Z, F�-- ie..- Z
<br />Chief x+eclutiiv e Officer Signature Date .
<br />I hereby acknowledge receipt of a copy of thii�s application. By acknowledging receipt I admit having been served with not'
<br />ice
<br />that this application will be reviewed by the Charitable Gambling Control Board and will become effective 30 days f rom the
<br />,late of receipt (noted below) by the City or County unless a resolution of the local governing body is passed which specif 1-
<br />cally d1sallowsi such activily and a copy of that resolution is received by the Charitable Gambling Control Board within 34
<br />fays of the I I I ted date,.
<br />CITY OR COUNTY TOWNSHIP
<br />�Niaime, of t.o all Governing Body (City or County)
<br />R9tseville -9
<br />Sin#re of Piorson IRecleivirng Appligrai/n,
<br />T'iltle
<br />Township, Flame (Must be notified when County is the approving body)
<br />Signature of Person Receiving Application
<br />Date Received I Title
<br />CG-0010210-01 (60'1817), White — Board Canary B od retns to Organization to complete shaded areas.
<br />ganization old — Ci or County
<br />Expenses and
<br />6
<br />Market Value,.,
<br />No,
<br />Gr�oss Receipts
<br />Cost P
<br />Profit'.
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<br />Use of Prolit
<br />- Fund-rallisier to offset expen,siies for ice time and equipment
<br />L%
<br />2
<br />0 ---
<br />_41
<br />7 41W7 Z,`4r_7,? 'r�'s Lice
<br />Distfibutor Fr m Whom Gambling Equipment Acquired Disin nse
<br />"rx LS4
<br />it
<br />Z rk
<br />as e
<br />affirM a 11 inf ormation, subm�itltled to, the Board is true, accor-
<br />vile, and complete.
<br />-a" OF
<br />'inaturie Date
<br />I affirm all financial information submitted to' the Board is,
<br />t al ccurate
<br />rue, a 1
<br />'6�
<br />and complete, e "rte K 4
<br />s
<br />V
<br />V-
<br />r
<br />-, Z-1
<br />-5 7 e�_Z, F�-- ie..- Z
<br />Chief x+eclutiiv e Officer Signature Date .
<br />I hereby acknowledge receipt of a copy of thii�s application. By acknowledging receipt I admit having been served with not'
<br />ice
<br />that this application will be reviewed by the Charitable Gambling Control Board and will become effective 30 days f rom the
<br />,late of receipt (noted below) by the City or County unless a resolution of the local governing body is passed which specif 1-
<br />cally d1sallowsi such activily and a copy of that resolution is received by the Charitable Gambling Control Board within 34
<br />fays of the I I I ted date,.
<br />CITY OR COUNTY TOWNSHIP
<br />�Niaime, of t.o all Governing Body (City or County)
<br />R9tseville -9
<br />Sin#re of Piorson IRecleivirng Appligrai/n,
<br />T'iltle
<br />Township, Flame (Must be notified when County is the approving body)
<br />Signature of Person Receiving Application
<br />Date Received I Title
<br />CG-0010210-01 (60'1817), White — Board Canary B od retns to Organization to complete shaded areas.
<br />ganization old — Ci or County
<br />
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