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X'Yes, 0 No 3. Have Internal Controls been subrmitted previously? Ifnio, please attach copy. <br />4. Aippilicant(',Offilcial,ille�igalna�2eoflorganizaiti,on) <br />rop <br />jKj:5Z'6 V=4 4X VA, W., 7�-rrr <br />61. City, State,, Zip <br />�5. Business, Address of Organization <br />7'. Coluntly <br />Awsoc_ <br />1. Business Phone Number <br />15. Number of active members 116., Number of years in existence <br />32, <br />17'. Name of Chief Executive Officer <br />Fff:1 <br />Note: If less than four years, attach <br />evidence cif three years <br />existence. <br />18. N�a�mielof treasurer err person who accounts for other revenues <br />of the organization. <br />"M <br />2M <br />I 4J_1_AAW <br />Business Phone liumber I <br />I Business Phone Number <br />19. Name of establishment where gambling will be, 201. Street address (not RO. Box Number) <br />Coniducted <br />ffe)5eil-z-1cZE ilioc� IrYr 1� <br />2 1. City, State, Zip <br />22. County (where gambling premises is located) <br />Canary-,Appilicant <br />Pink-Local Governing Body <br />FOR BOARD USE ONLY <br />■ <br />License Number <br />all <br />oil <br />PAID <br />AMT <br />CHECK# <br />DATE <br />X'Yes, 0 No 3. Have Internal Controls been subrmitted previously? Ifnio, please attach copy. <br />4. Aippilicant(',Offilcial,ille�igalna�2eoflorganizaiti,on) <br />rop <br />jKj:5Z'6 V=4 4X VA, W., 7�-rrr <br />61. City, State,, Zip <br />�5. Business, Address of Organization <br />7'. Coluntly <br />Awsoc_ <br />1. Business Phone Number <br />15. Number of active members 116., Number of years in existence <br />32, <br />17'. Name of Chief Executive Officer <br />Fff:1 <br />Note: If less than four years, attach <br />evidence cif three years <br />existence. <br />18. N�a�mielof treasurer err person who accounts for other revenues <br />of the organization. <br />"M <br />2M <br />I 4J_1_AAW <br />Business Phone liumber I <br />I Business Phone Number <br />19. Name of establishment where gambling will be, 201. Street address (not RO. Box Number) <br />Coniducted <br />ffe)5eil-z-1cZE ilioc� IrYr 1� <br />2 1. City, State, Zip <br />22. County (where gambling premises is located) <br />Canary-,Appilicant <br />Pink-Local Governing Body <br />