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Cczti {�}f Y1 <br /> City of Falcon Heights <br /> LAWFUL GAMBLING REGISTRATION <br /> To: City of Falcon Heights <br /> Date: P hO 3 <br /> 2077 West Larpenteur <br /> Falcon Heights, MN 55113 <br /> Name of Organization: Oaat fy BOWL Ci9 ,ei 1 <br /> Address: PO E W4<.iGt <br /> City, State, Zip: r?9-4//kAto PI S6"/ <br /> Telephone: .5-07-3V-r- 83l0 <br /> Name of Gambling Manager: /ZDC L- aerfa <br /> Address: Vs E. Ct <br /> City, State, Zip P7WPWW 41A 4.IN s'a'7S1 <br /> Telephone: 6/ S.fSS' <br /> Location of Intended Gambling: "c',t) BOWL <br /> Days Hours of Operation: WlOVE ✓e'R ESM-01 ;N/sie iS er`E4) to 7 <br /> Is the Organization licensed by the Charitable Gambling Board? <br /> No RI Yes If Yes, license number: 8 0ad`s <br /> Has the organization applied for a premises permit from the <br /> Gambling Board? CM No Yes <br /> ITEMS REQUIRED FOR REGISTRATION: <br /> A copy of the organization's gambling license application- asctCJ. <br /> exemption permit. <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 />