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�Minnesota Charitable Gambling Control Board LAWFUL GAMBLING EXEMPT101V <br />-Mi�dway Building <br />Room N'4715 Griggs, <br />FOR BOARD USE ONLY <br />1821 University Aveinue <br />St. Paul, MN 55104-3383 <br />n. <br />(612) 642-0555 <br />INSTRUCTIONS: 1. Submit', request for exemption at leas�t 30 daysi pr,ioir to the occaslog <br />wJ811114AWTY am <br />�Premises Add si City, <br />MCIICIA,RRON BLVD "ROSEVILLE <br />Gamie Yes No ross Hei <br />■ <br />R'aff le, <br />Emil <br />;AUMNEW 1 <br />974=1 <br />lip �uIIII <br />5Z,5 113 �R MSEY. <br />TA <br />II <br />Pu�ll-�Tabs <br />Rcl�" <br />'Use of Piro,filt <br />SUPPORT UNIT ACTIVITIES i.e. picnics Chr-istmas party for unit members <br />Ali, jjjjPjq?-.]1j111 Ill -F1 <br />11 C311 11111 Ill C3111 11 11UF 1111410LIU1 I b1UU111tLkVU LUI 11-1t: 1310dl"E] is ixue, accor- <br />a�te, apid c9mplete, <br />Name of Local Governing Body (City or County) <br />R 0 EV I'LL E -11 MN <br />re of Person IRecei,vii pilic iti n <br />X- P <br />Title <br />Township Name (Must be notified when County is the approving body I <br />Signature of Person Recelving Application <br />Date Received a <br />Whitle — Board Canary, — Board returns to Organization to Complete shaded areas. <br />Pink — Organization Gold — City or, County <br />