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Minnesiota, Charitable Gambling Control Board <br />900 Summit State Bank Building <br />310 4th Aveinu�e South <br />Minneapolis,, MN 554,1,5 <br />612' 341 -676 <br />GAMBLING LICENSE APPLICATION <br />(Class <br />FOR BOARD USE ONLY <br />fa <br />II NSTRU'CT IONS lei PRINT OR TY PIE <br />NI <br />21. Bring completed application to local governing body, obtain signature and date on all copies, <br />and leave goldenrod copy* Applicant keeps pink copy and sends remaining copies to above <br />adldress. <br />3. Chan cties in applic;a,tion information must bie submitted within 10 days after the chanae. <br />;vof Application: <br />class A, Fee, $100.00 (Bingo,, Raffles, Paddlewheels, Tipboardsq Pull-Tabs) <br />:1 Class B Fee $ 50.00 (Raffles, IPad'idliewheels, Tipboardsq Pull-Tabs) <br />D Class C Fee $ 50.00 (Bingo, only <br />lake checks payable to Minnesota Charitable Gambling Control Board. <br />Applicant (Off , <br />Business, Address <br />.0 Lt.4161% <br />City State Zip <br />glal name, of organization) <br />ti <br />A <br />Location Wheire Articles are, Filed <br />L <br />M-00001-01 <br />Name of Organization's Officers and Titles <br />A C If, <br />71 F <br />Coiniti,n�u,ed on Page-' <br />