Laserfiche WebLink
Orgag4ation Name <br />No <br />MNAM60111M <br />)5 <br />City, County, State, Zip code <br />li K;0614 , a 00 <br />Phone Number I Manager's Name <br />V-7��3 -^I <br />El Fraternall El Veterans, <br />0 Religion t <br />" Oher I Nonprofit Organization <br />Al <br />I Premises, Where Acfivity Will Occur <br />Promises, Aiddr,ess, <br />Games Ye s N 0 <br />Raf f lIes <br />MRSOMM <br />MA <br />r,or. <br />Lxx-nse Number (if currently or previously fi ) <br />Phone Number <br />WAN'" <br />if Other Nonprofit Organization (Check One) <br />E-1 IRIIS �Designa�tion <br />[1, Incorporated with Secretary of State <br />.2�Affillatie of Parent Nonprofit Organization <br />Gross Receipts Value I Prizes Expenses <br />letets) of Activity <br />s <br />,M® <br />I affirm all Information submi <br />i <br />rate, and completie. 1�0 , <br />MA=A�& �AbMMWA I <br />[111111M A 47MOTITIMM-4- <br />to the Board is true,, accu-, II affirm all financial Information submitted to the Board is <br />true, accurate, and complete. <br />Date Chief Executive Officer Signature Onto <br />ACKNOWLEDGMENT OF NOTICE BY LOCAL GOVERNING BODY <br />ell <br />S on, Rikeivin liication <br />Title <br />ft <br />CG-100,020-01 (4/86) Whiit,e — Board <br />Pinik — Organization, <br />Signature of Person Receiving Applif -, 11 It <br />Dat Recl;d Title <br />81 j 4 '"1 <br />Canary — Board returns to <br />Gold — City or County <br />f, <br />Date � <br />