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CHARITABLE GAMBLING CONTROL BOARD <br />900-904 SUMMIT STATE BANK BUILDING <br />310 FOURTH AVENUE SOUTH <br />MINNEAPOLIS. MINNESOTA 55415 <br />(612) 341 -7676 <br />January 10, 1985 <br />Dear Applicant, <br />The "Acknowledgement of Notice" below is a required part of the application process. <br />Because the forms are not yet available, this form is provided separately. Please provide <br />all the information requested; copy this form and take it to your local governing body to <br />date and sign; mail one copy of the completed form to the address on the letterhead. Be <br />certain the form is signed and dated by the local governing body by January 28, 1985. This <br />step must be completed to meet the provision of the law which allows local governing bodies <br />30 days to notify the Board that the application is disapproved. No license will be issued <br />until the 30 day 7eriod expires. If you have questions, please call. <br />Roger rank <br />Execut've Secretary <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br />I hereby acknowledge receipt of this notice. By acknowledging receipt, I admit having been <br />served with notice that an application from the organization identified below will be <br />reviewed by the Charitable Gambling Control Board and if approved by the Board will become <br />effective 30 days from the date of receipt (noted below), unless a resolution of the local <br />governing body is passed which specifically disallows such activity and a copy of that <br />resolution is received by the Charitable Gambling Control Board within 30 days of the below <br />noted date. <br />LOCAL GOVERNING BODY <br />Name of /Local Governing Body <br />C4✓1cccJg2 C, or <br />Signature of Person Receiving Application <br />Date e d ep @ G::Chlebeck- lerk <br />/ /./ g <br />NOTE: This is not a formal application. <br />Before acting on this notice, the govern- <br />ing body may want to contact the applicant <br />to verify that an application has been <br />filed with the Board. <br />Krt 5ke`e__ Ir <br />se e.K c �-a (iv +14 <br />each cLet ss Mee ms. <br />ORGANIZATION , �1RC: <br />Applicant Organization: //l I2 CArleidiCa_ D J <br />Legal Name:J, f-t'fe CQnaeea Et&e t)ept _Lac. <br />Business Mailing Address: 1111) a. 1.1tiLe Coliee <br />/ I'-r -1-ke Celli q1 m,IVN'. s4717 <br />Phone: (6/01) zl 1 1/— �7 � <br />Proposed Gambling Site: rik e f{a L L <br />`i L{D -. L", ti-Le CceNUCPq Ad, <br />City or Town: �-(' f 1 Le CaNeldet� /Thv, <br />County: '/Yl 5Q/ <br />Class of License: A B C (circle one) <br />Name and Title of Represent : ' ` <br />ative, <br />//eNRy T !}(o iitJ> Buie, Taivndele <br />6 <br />AN EQUAL OPPORTUNITY EMPLOYER <br />O <br />