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J6 <br />+ <br />VP. <br />Charitable Ga ling Control Bd <br />Rm. N-475 Griggs-Mildway Bldg <br />1821 UI nIiver" sity Avenue <br />St. Paul. MN 55,1014-3383 <br />GAMBLING LICENSE APPLICATION <br />(aass A. Bi, or Q, <br />INSTRUCTIONS: 1, PRINT OR TY'P' E. <br />rOR anARD USr nNLY <br />2,. Brine g completed application to Jacal govierning body, obtain signature and date on all cWies, <br />and leave golidenrod copy, Applicant keeps pink copy and sends remaining cuples to above <br />adidress. <br />31 Changes in al2olication information must be submitted within 10 days after the rhanne <br />a <br />Type of Appl,i,cation: <br />CD Class A, - Fee $100.00 (Binigio, Raffles, Paddiewheels, Tipboards, Pull-Tabs) <br />CD Class B - Fee $ 50.00 (R,a�ff'lels,, Paddlewheels, Tipbofiirds, Pull-Tabs) <br />C9- Class C - Fee $, 50.00 (Binigo only) <br />Make, checks payable to Minnesota Charitable Gemblino Control Board, <br />-[Applicant kOiffirial, legal, name of organization) <br />Allexander & Alexander 3353235 <br />CC-00001-01 (12/84) Continued on Page 2 <br />