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CITY � � RO�E���.,�,� <br />GAMBLING LICENSE APPLICATION <br />(FOR ORGANIZATIONS APPLYING FOR EXEMPTION FROM STATE LICENSING) <br />.ORGANIZATION INFORMATION <br />� �} � ���� �� <br />Name �� � � �'�'��� � ��r-.- <br />���� ���� � <br />� <br />� ���� <br />1�eJ�pht�vn� �f urr�b� r _ �� � ~ �� �� � ���- �� . � <br />�� � � ����� <br />�a��r��� �� � � _ ���_ �. , <br />� <br />�C�F'�Ii]�Cil� I{Flly S�Ll]'}�3C'�l� I r��� ��� ..���._.. r f� ��- J r � �� - f <br />C AT�1 �#y.1T�� F�'�Ih'F�?��� <br />New Or Have Previauslyr Applied _� <br />Location of Event in Roseville ��� �� ��� '� � f � �� ��� —� � <br />� ----- � . ..., <br />���. � �� ��� �F �I� ���_� � �'.�. � _� _ �.i.� <br />r��'.e t o-'� t ��,Y��]Ti� r�ct��� i k�� `� <br />� � r'���•— ���- ���� / � Ls I�+- � • � .�? �L—' � f��'_� � } � <br />� �r � <br />Estimated Time of Activity . � � � � - �� ��,�- � <br />�� � ' �' v�� .- � � ;�r'.��f ;i �'_� <br />Dn�lar Amount of Total Prizes to be Awarded �-�'� �' �•..��� �_ ' <br />, � �• <br />]=�_r.J� ��'i�l b� �J��L f�r ��i����� ��-� �_��� �.�� � . <br />, � <br />APPLICANT INFORMATION � <br />�` 1 � � �` '' r n .� � . - <br />Name __,_ <br />' ' � - � <br />Telephone Number � ... <br />���»id�Lr� � �r���, - � <br />�}A!� <br />LICENSE FEE $25.00 <br />WITHIN TEN (10) DAYS OF FILING ANY REPORTS WITH THE CHARITABLE <br />GAMBLING CONTROL BOARD, THE ORGANIZATION SHALL FILE A COPY OF SU��I <br />REPORTS WITH THE CITY OF ROSEVILLE, AS REQUIRED BY SECTION 125.060 OF <br />THE CITY CODE. <br />t',.R►ad�.�r,4AP►,�• WPd <br />� <br />��. <br />