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7 <br />k <br />Minnesota Charitable Gambling Control Board <br />904 Summit State Bank Building <br />310 4th Avenue South <br />( Minneapolis, MN 55415 <br />(6121341-7676 <br />INSTRUCTIONS: 1. Form must be completed by owner of site. <br />2. Submit to above address at least 60 days prior to date of occasion. <br />3. PRINT or TYPE. <br />Name of Owner of Site <br />erearehouse,Inc <br />Business oss Address <br />a o.— _N.dtul i nP S Q <br />City, State, Zip <br />Business Telephone Number <br />1 <br />Oil aneriof Site License Number <br />Official, Legal Name <br />REQUEST FOR <br />MORE THAN FOUR BINGO OCCASIONS <br />Address of Site (for which waiver is requested; <br />444_Bice S.t.r_eet <br />City, State, Zip <br />le Canada• Mij <br />County <br />Is Site Located within City /Town Limit? <br />Yes ❑ No .. <br />Organization(s) for which Additional Occasions are Required <br />Emistry of the Inter reters of the <br />Address — City, State, Zip <br />Number of Additional <br />Requested Per Week <br />08 East 7th Street StPaul Minn. <br />55 00 <br />License No <br />lie_ d for_ <br />Official, Legal Name <br />ront Aven r BooS�Q <br />r an <br />f <br />r <br />Organ: agents) Leasing Site <br />License No. <br />I.1 •.11.1• <br />ve reasons for the necessity of more than four bingo occasions per week. <br />✓ both Federal and State, certain charitable organizations have indicated a desire to use <br />Due to anticipated cut backs to City Government <br />portion of their profits from lawful gambling or lessening he burdens borne b Little <br />Inada by initiating, performing and fostering worthy g <br />nting services normally rendered. Y public works and augmenting chars charitable <br />'1• - The balance of the funds h <br />1t-why allowing additional bin o Un S S dll be for lawful <br />Chdritd <br />g occasions is consistent with: a. Preventing commercialization of gambling; <br />rations; c. Providing for the use of the net profits only for lawful purposes. <br />The lessor of premises shall not, in b.lnsuringtheintegrityof <br />of charitable gambling. <br />The lessor <br />operations <br />The lessor <br />re of Representa <br />ring notice) <br />any manner whatsoever, <br />be <br />involved i <br />n the conduct <br />shall insure the integrity of operations by not being involved in an <br />and by maintaining a safe and secure premise. <br />any gambling <br />shall not in any way interfere with the organizations ability t• donate their <br />ib Gambling License jA'pplicant �. _ _ <br />l <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br />:reby acknowledge receipty a co ' �s.•t r L{ Al <br />'ing been served with nolide that this application will be reviewed by the Charitable Gambling Control Board and if approved by the Board, will become <br />copy of this application for request for more than four Bingo occasions per week. By acknowledging receipt, I admit <br />active 60 days from the date of receipt (noted below), unless a resolution of the local governin g body is passed which specifically disallows such <br />vity and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of the below noted date. <br />of Local Governing Body <br />Signature of Person Receiving Application <br />)9 y O F L ir7Y£ eA/✓r� opt <br />12/84) <br />White — Board <br />ry — Applican <br />Date Received (This is date from <br />which the 60 day approval begins) <br />Pink — Governing Body <br />