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Fn R BOARD USE nNLY <br />Ch;airi Cable l Gambling Contrioll Board, <br />wd' % <br />'ggs-, I idway, Bldg, Rm. N-475 <br />Gri <br />df j <br />1 1821 Univeirsitiy Ave. <br />No.'M* St. Paull, MN 55104 -3383 <br />GAMBLING LICENSE APPLICATION <br />(Class A, B, or 0 <br />Applicant ( Off iciall, legail name of organization) <br />"OUN"IL 402,1, <br />KNIGHTS 0" "."10LUMBUS1 <br />laiusinelss, A,Wr,ess <br />H ONCE TUING A"'FEMM <br />25'5'5 NO <br />.i.ty. State Zi <br />v <br />MN 55113 <br />ir, <br />.-uunty <br />R- A M 3 1 bliff <br />Business Telephone Number, Federal, I.D. Number <br />6112) 6131-4206 123-?10'7497 <br />T)f )f' Organization <br />Site Address <br />255 5" NORIT "IG A%, ENUE <br />City,, State, Zip <br />ROS-23711LE, M <br />County <br />.E 'Y <br />Yes No Are all gambling activities conducted a ' t <br />the above site? If no, comp leLe a sepa- <br />x rate GDOliCation form for each site as a <br />seearalte license is issued for each site. <br />x 12* Is site located within city limits' <br />AMMICAN STATES INS a C 0 EX 519679 <br />INDIANAPOLIS, INDIANA <br />Nam�e of Omanizations Officers and Titles <br />Dip h J., Flo Knight <br />N=dPONOMMIMM <br />I q1'", <br />b., I[AlRoy H., Droddyt DeWt,y Graind Kaght I ,,, Iv ent D. Burke, Treasurer <br />cc-0=1-01 (12/84), Continued on Pop 2 <br />