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Attachment A <br /> City of Falcon Heights <br /> LAWFUL GAMBLING REGISTRATION <br /> To: City of Falcon Heights Date: <br /> 2077 West Larpenteur <br /> Falcon Heights, MN 55113 <br /> Name of Organization: l ikh=,e, \\\e •NC-pCA- 004 46 k L <br /> Address: a 3 l,O <br /> City, State, Zip: <br /> Telephone: e 1,° <br /> Name of Gambling Manager: r <br /> Address: 7 .i,.= i <br /> City, State, Zip c:. !_x tt '�•_t�; <br /> Telephone: t: vae <br /> Location of Intended Gambling: rcA-\ \-\-e, a R.%464,:;1 a+. L <br /> Days Hours of Operation: <br /> Is the Organization licensed by the Charitable Gambling Board? <br /> No Yes If Yes, license number: t k a <br /> Has the organization applied for a premises permit from the <br /> Gambling Board? LIZ No Yes i Cref- 1.0•2r i <br /> ITEMS REQUIRED FOR REGISTRATION: <br /> A copy of the organization's gambling license application and <br /> exemption permit. we vrt; <br /> A copy of any lease agreements, executed by the organization <br /> in regard to premises leased for the conduct of gambling. <br /> A copy of the bond or certificate of insurance which meets the <br /> requirements of Minnesota Statutes. <br />