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CITY OF ROSEVILLE <br />GAMBLING LICENSE APPLICATION <br />(FOR ORGANIZATIONS APPLYING FOR EXEMPTION FROM STATE LICENSING) <br />Telephone Number �� ` ' �D� 9 - �5 j� <br />Address t l0 ls1 � � �Q� ��'I�-�t �� ! � <br />Organization's Purpose �-f C�1 '�C � `C7�� ��� 'I�l1Ci �� � l `�r�� <br />C'TAMBLTNC'T EVENT TNFORMATTON <br />N e , Or Have Previously Applied _ <br />Locat�� Event in Roseville `�'�� �-� S <br />Date of Gambling Activity <br />u\� a�� <br />Estimated Time of Activity �' ����'�� <br />�u� �c.w� �,�W <br />Dollar Amount of Total Prizes to be Awarded IO �"�''� <br />Funds Will be Used for ���` <br />APPLICANT INFORMATION <br />Name � i� 1'�11 9�ILU�L���i� <br />Tele� <br />Sign�z <br />Date <br />i _ �. <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 SUCH <br />REPORTS WITH THE CITY OF ROSEVILLE, AS REQUIRED BY SECTION 125.060 OF <br />THE CITY CODE. <br />C:bfFa\wpwinkxmptgam wpd <br />