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Minnesota, Charitable Gaimbling Control Board LAWFUL, GAMBLINGEXEMPITION <br />�Room N�4,75 Griggs-Midway Building <br />FOR BOARD USE ONLY <br />=;70, i-ak, 1821 University, Ave�niule <br />St., Paiul, 1 55104-3383 <br />(612) 6142-0555 <br />IRISTRIUCTIONS:1 1. Su�bim�it requiest for exemption at least 30 days priorto the occasion. <br />Narne of Premises Where Activity Will Occur <br />Date(s) of ActivitV, drawing(s) <br />St,. Rose of Limes Churdh <br />Apr. 24, 1988 <br />City <br />�Premises Address <br />State <br />Zip <br />County <br />20148 N. Hamline <br />Roseville <br />'Minn <br />515113 <br />Ramsev <br />-Expensesiand <br />N ' t;41. <br />Market Value:­-'-` <br />Game <br />Yes <br />No <br />Gross Receipts <br />Cost of � Prizes <br />Profit <br />of Prize;.".. <br />Bin�go <br />-o. <br />Raff les <br />X <br />.N , <br />M ................... <br />y" <br />. ..... ..... <br />K24 <br />ti <br />Paddliewheels <br />P <br />'A 0,� <br />'k 5 K, <br />Tipboar,lds <br />• Vhl <br />.............. <br />Ne y <br />A ZZ <br />Pull�-Tabs <br />T.- x' � <br />7" <br />Jl 4M A., <br />2' 4-p <br />I of Profit <br />n <br />% i% <br />DEW* <br />"M cqu rei <br />L <br />�4;6 <br />A <br />bistiributor From Whom Gw**V, Equip <br />I affirm all it or io, submitted to th ard is true, actor- I affirm al1l fin�ancial information submitted to, the.. Board';' <br />_II5 <br />At <br />ate, and bi m true,, accurate, and complete <br />Cor- <br />t 4 <br />S: <br />­Q <br />k, <br />re NA4 <br />h <br />ON M NO �qmm I <br />V <br />'C"h—ie�Keclutil,ve officer Signature /;Date 0deflExecutivo 10"icer Signature Lq <br />Name of Local GioverninigoWdy I(Cily or County) i Towniship Name (Must be notified when County is the approving body) <br />Si Irxan¢ure of grion Rl e�c plication <br />It A A <br />Yr <br />its <br />Walm !7 <br />Signature of Person Receiving Application <br />111iii <br />CGI-01010201-01 16/87) White — Board Canairy — Board returns to Organization to complete shaded areas. <br />Pink — Organization Gold — City or County <br />M <br />