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LG220 <br />Rev06/95 <br />Minnesota Lawful Gambling <br />Application for Authorization for an <br />Exemption from Lawful Gambling License <br />For Board Use Only <br />Fee Paid <br />Check # <br />Initals <br />Date Recd <br />Organization Information <br />Organization Name <br />Aloej-h Euha,ehoiv' Cu en, ,r Lions (/j, <br />Previous lawful gambling exemption number <br />d (II 93 <br />Street ( City / S <br />/ <br />/ p o9./ i3z,O�p 4u e /16. AV/Jo u' ,7 ighl /7,V' <br />ate Zip Code County <br />5-6113-53:21 /earn S <br />Name of Chief Executive Officer <br />First Name <br />ghe la, w//✓ <br />of organization (CEO) r <br />Last Name <br />1/4C/ntsaas <br />Daytime Phone number of CEO <br />(Ida LD4l[o —S73" Y <br />Name of Organization Treasu <br />First Name <br />Ia' K <br />er <br />Last Name <br />.6unc0 lu/1- <br />Daytime Phone Number of Treasurer <br />(&/z �9a -3413 <br />Type of Nonprofit Organization <br />Check the box below which best <br />your organization <br />describes <br />Check the box that indicates <br />by your organization: <br />l%t.®4RS letter indicating <br />� EjCertificate of good <br />++,,of State's office <br />the type of proof attached to this application <br />income tax exempt status <br />standing from the Minnesota Secretary <br />you're an affiliate of a parent <br />submitted and on file with the Gambling Control <br />Fraternal <br />Veterans <br />A.- charter showing <br />Religious <br />nonprofit organization <br />I vl Other nonprofit <br />%C <br />roof previously <br />oard <br />Gambling Premises Information <br />Name of Establishment where gambling activity will be conducted <br />"TAJ e. Y e ii eie aid -7r1 n <br />Street City �nI State Zip Code County <br />vJ /mil le, ee S1/6.7 tit 4iT1 /e e4rno4 /tit/ 6.5713 eq.rl.fec-/ <br />Date(s) of activity (for raffles, indicate the date of the drawing) <br />Oe` -ob2,t 76 igq& <br />Check the box or boxes which indicate the type <br />of gambling activity your <br />0 Pull -tabs <br />organization <br />will be conducting <br />Bingo RFT Raffles Paddlewheels <br />a Tipboards <br />Be sure the Local Unit of Govemment and the <br />the reverse side of this application. <br />CEO of your organization <br />Pane 58 <br />sign <br />For Board Use Only <br />Date & Initials of Specialist <br />/ / <br />