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1987_0511_packet
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1987_0511_packet
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'.. "" , , I I -V <br />M�innesota, Charitable Gaim,ng Control Board LAWFUL GAMBLING EXEI 1PTION <br />• Room 1N475 Griggs-Midway B�u�ilding FOR BOARD USE ONLY <br />1 Un <br />8 iversity Avenue <br />• 2 <br />M - �83 33 <br />St. Paull, <br />�N 551,04 <br />1612)642-0555 <br />Narne of Premises Where Activity Will Occur <br />Premises Address <br />City, County, State. Zip Code, <br />St. Rolse of. Lima Church <br />Va[ue of Prizes I Expenses I Profit <br />usoof'proft General. Parish Revenue: MAintenance of C%urch,, Utilities, Benefit of Religious 2 F�.: <br />Education enefit of Ne,edy, Benefit of Sebool, <br />Distributor From Whom Gambilingi Equipment Acquired Distributor's License No. <br />N <br />I affirm all formation submitted tothd IBoard, is true,, accu- I affirm alll financial information submitted to the Board is <br />rate, a com a trine, , accurate and complete.- <br />4*-271-*87 <br />iff --ew <br />Date;, <br />Chief f4ecutive, Offifterr'Signature Date ChW'Exiemft W'd Offk*r Sidnaturo--- 7- <br />4C0j46j,1WLE'DGMENT OF NOTIC LOCAL GOVERNING BODY <br />I hereby, acknowledge receipt of a, copy of this application. By acknowledging receipt, I admit having been served with notice <br />that this applicatio'n will be reviewed, by the C'habitable Gambling Control Board and will become effective 30 days from the <br />date of receipt (noted below) by the City or Coulntyi unless a resolution of the local governing body is passed which specifi- <br />cally, disallows such activity and a copy of that resoiution is received by the Charitable Gambling Control Board within 30 <br />days of' the (below, noted date. <br />CITY OR COUNTY TOWNSHIP <br />Name of Lc ali overning Elc0004iity or Ciouinty) Township Name Must be notified when County is the approving body) <br />Si, nature o Person kecef=gi Applicatla Signature of Person Receiving Application <br />AL <br />name= <br />*:S�r ::: <br />Titte Date Received' Date' <br />Canary Board returns, to Organization 10 keep <br />Gold — ity or, County <br />
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