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M �y <br />CITE ' OF ROSEVILLE. <br />ui} <br />GAMBLING LICENSE APPLICATION' <br />FOR ORGANIZATIONS APPL `I FOR EXEMPTION FROM STATE LICENSING) <br />NAME OF ORGANIZATION <br />ADDRESS, " 'ORGANIZATIO <br />o 76 <br />" <br />DATE' (S), OF GAMBLING ACTIVITY <br />?o <br />DOLLAR ° <br />, <br />e, M1 <br />r <br />AMOUNT- OF. TOTAL PRIZES TO BE AWARDED <br />..1.��1°..�1 -' � • ° <br />n <br />.mra <br />7I' , e. � •°J . Are . . - . . , <br />n a ,e , , ^ R -a a ° T ; e ,. .w.. � • n. • ° • s • a R w. ..s .° + y - f <br />A <br />{ <br />• t <br />w <br />I • • <br />a <br />�. . e��` � .,5 �' a if'.w. .. e e ,r • .. ' f ' r- � , ° <br />" <br />"- <br />r .y <br />t ' a <br />m , <br />n . <br />, <br />NAME OF HERS i ' APPLYING FOR LICENSE'. <br />SIGNATURE OF APPLICANT <br />• R <br />- A L <br />'w "nom a �, I • v. s b y..�. °. <br />' i!ti ¢. ,i M i #' � W *Vi'� N r K ee • �" a ` Ta • � Y ° A <br />Y <br />, <br />P r <br />r t <br />•r S <br />, <br />' r n <br />Ri 911 " •r,'w° ry eA �* � � °• A 1 i .,�"n,� ° m:, °. L .. • { � • P 1. r Pry A IR� � •�� <br />DATE OF "PLlCATION' 0 C>l Ir t-, - <br />e � <br />a ' <br />k , <br />pAl- <br />gk <br />• +f . •. <br />�r•- <br />s <br />� a <br />. R <br />T <br />• e „ 'IIN?'k � ° vii °R A � i 4, w A R. � � ,..` . - r A � ��, r d• °.. it .. e1R +�, <br />4 ..., :. <br />w <br />r <br />w � - <br />�,y � . _. m �. 'a f ". m , a. ° � , " ., - ,. • • , n k e mom. F� r <br />v <br />- <br />a <br />LICENSE FEE 5 0 <br />a <br />a . e ..ter, • k r.. � . "+ ®.. '� <br />, <br />• <br />WITHIN (10) FILING .� •y }` <br />Te, <br />GAMBLING CONTROL BOARD, THE ORGANIZATION SHALL FI L COPY OF <br />• <br />SUCH REPORTS I WITH THE CITY OF ROSEVILLE, AS REQUIRED SECTION <br />THE IT CODE' 0 <br />