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CITY OF ROSEVILLE <br />GAMBLING LICENSE APPLICATION <br />(FOR ORGANIZATIONS APPLYING FOR EXEMPTION FROM STATE LICENSING) <br />ORGANIZATION INFORMATION <br />� � - <br />�am� _�'� ���+�f � ��i IK�.S ������,������ ������+��P ����� ��cf � �� <br />Telephone Number �� _� '" �� �� - � �� �� <br />Address �����4�--�������'.�/�j' �� � �l�- iD ����4� ��'� ��� <br />�r�arr��ti��t'� p�rpp� ��� � r ���J� cr�� �F �� �S�w 4 v� ��"� �"�r � �������r ��'E s :�� <br />GAMBLING EVENT INFORMATION <br />New Or Have Previously Applied j/'� <br />Location of Event in Roseville ��������� ��/�� �'�`�`���- <br />r� ���1� �f Ca�1t3b] i �}�, .��� i k•s� w �-��� � � � �.� ��' <br />ri� <br />Estimated Time of Activity �� ���� `� � ���- <br />Dollar Amount of Total Prizes to be Awarded �'�����'�� �'�:� � l'�C� <br />� ' <br />Funds Will be Used F�r �"��1.�'���<"�`�= � �� �� � ��' �� �� � f� , <br />APPLICANT INFORMATION <br />' �� <br />Na�e �'r � � � ,�r}? ���x��- <br />��--• - --. . <br />��'�����i�ne � um�eC <br />. ��- � <br />�4��a��r� � �T��. � i�r�r_�� �r��_-�� - — <br />�$�� - � � ����� ����'�� � <br />LICENSE FEE $25.00 <br />� <br />WITHiN TEN (10) DAYS OF FILING ANY REPORTS WITH THE CHARITABLE <br />GAMBLING CONTROL BOARD, THE ORGANIZATION SHALL FILE A COPY OF SUCH <br />REPORTS WITH THE CITY OF ROSEVILLE, AS REQUIRED BY SECTION 125.060 OF <br />THE CITY CODE. <br />�.,�rr�.��. � <br />