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itable Gambling Con l Bd <br />Char d,wa,y B 1, d g <br />-M <br />Rm N 475 Griggs I <br />t <br />1,821 Universi y Avenue <br />Paulg MN 5,5104,--13383 <br />INSTRUCTIONS: 1. Submit to above address. <br />211., PRINT or'TYPE., <br />REQUEST FOR MORE THAN <br />TWO BINGO OCCASIONS PER WEEK <br />State how additional occasions are Consistent with: a. Preventing Commercialization of gambling <br />b. Insuring integrity of operations <br />c. Providing for the use of the net profits only for lawful purposes. <br />d. Attach additional sheet if necessary. <br />-xF1WW9PW% <br />;U7o,�-4; 71.771q <br />Bign <br />Chief Executive Officer, Date of Request <br />7 ". <br />ACKNOWLEDGEMENT OF NOTICE IBY LOCAL GOVERNING BODY % <br />I hereby acknowledge receipt of a copy of th'i's application for reqluest for more, than two Bingo occasions per week. By acknowledging receipt, I admit <br />having, been served with notice that this application willl be reviewed by the Charitable Gamblin�g Control Board and if approved by the Board, will become <br />effective 160, days from, the date of receipt (noted below),, unless a resolution of the local governing body is passed which specifically disallows such <br />activity and a copy, of that resolution is received by the Charitable Gambling Control Board within 60 days of the below noted date. <br />LOCAL GOVERNING BODY <br />N�aime of Locai-Gloverning IBod <br />1^ <br />;zF <br />Sig�natu�re of Erngw-Receiwing Application <br />S. K <br />Date Received (This is date from which the 60 day <br />approval begins) <br />ORGANIZATION <br />Name of Representative for Gambling License Applicant <br />(serving noti�c�e,) <br />PetAWSM, TWS & SQUitVar PeAa <br />W <br />CG-00008-1011 0 2/84) White — Board Pink — Applicant G011denrod — Goveming Body <br />