Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
114, FOR .130ARD USE ONLY <br />Charitable, Giambling Control Bd <br />67azl� <br />l�. 4 <br />d� I <br />Rm N"475 Griggs-Mi <br />X dway Bldg <br />1821 University Avenue <br />St. Paull MN 55104-3383 <br />GAMBLING LICENSE, APPLICATION <br />(Class A, B, or 0 <br />I NSTRUCT I DINS 1, PRINT OR TYPE. <br />2. Bring completed 8PPlication to local governing body, obtain signature and date on all copies, <br />and leave goldenrod copy. Applicant keeps pink copy and sends remaining cupies to above <br />addreiss. <br />3 Change5-in apglication information must be submitted within ill d aFter the ch-ange, <br />Typie of Applicationi-1 <br />C. Class A - Fee, $100.00 (Bingo, Raffles il Paddlewheels, Tip1bioarids, Pull-Tabs) <br />54 . ''lass's B, - Fee $ 50.00 i(Raiffles, Paididlewheels, Ts beards Pull-Tabs) <br />0 Class C - Fee $ 50-00 (Bingo, only ) <br />,Make checks payable too o- Minnesota Charitable Camblina Contral Bayard. <br />Apin-1 icant (Official., legal, name of organization) <br />B mess Address <br />[B <br />Ci Mate: , Zip, <br />letter declaring exemotion. <br />Wr ■ tow %w F-0 WA. %J CAN F.L A. CZ 6 J_%J& I %JMI I 41 1G Q4 %.0 WWI I CL U <br />gambling activity will be conducted? If <br />no, attach copy of the lease'for the <br />site. <br />MR <br />Name Of Orqanization's Officers and Titles <br />111 1 F <br />I <br />- <br />A 11111111 �j <br />A I <br />LO U wa Im WA d <br />I i FMAN V� <br />