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V o 0* m" Gambling License kcw Application 23. |o gambling s located oc^ted within city limits? imhs/ `-//�`,"a' / "�# ^ _ , o , ` -' ' o oNaicativnh`,eooh preniseo hsv*Ptmfflos>osaseparvt*|i:enooioroquira1fo/oachummisex. 25. Does organization own the gambling premises? If no, attach copy of the lease with terms of at least one year. 26. 27. Amount of Monthly Rent OClanoC Class D Page 2 Does the organization lease the entire premises? ° no, attach --t—~ f the premises indicating what portion is beihg Ieased. A lease is required for applications. ----- ~ Yes 0,No |$ � / 28. Do you plan on conducting bingo with this license? If yes, give days and times of bingo occasions: Days Times / : Niles EiNe 29. Has the S10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained? Attach copy of bond. 30. |nou�ninoCompvoy N a m� ' 31. Bond N h* ~ ' 32. Losyn Name, w ' 35. :Gambling No �^ /'}/ /} y,)„, ;/ ,^ / �� .( ' / " - 08. Gambling Manager f‘hono ( / ) GAMBLING SITE AUTHORIZATION By my signature below, local law enforcement officers or agents of the Board are hereby to enter upon the site at any time, gambling is being conducted, to observe the gambling and to enforce the law for any unauthorized game o p r ractice. 33. Address / '��t��'�`- 36. Address / /. //g � /11 �- 39. Da e gambling manager became member of organization: 34. City, State,Zip ° 37. City,-State, Z�_ ( //�v^YJ/'Y .,x/ / /7 � ' p� re� m_^ �i/ � v' — � of this `7 =" ap .x . ' . ^ . -' -`'�` / .` ^complete e t e-'^ a' � ^ separate o y a n' ` ` � t'` ! 'x BANK RECORDS AUTHORIZATION " vro' signature below, the Board in hereby authorized 1v inspect thobank,000"dscdtheGonorn|Ganb|ingB"nkA ""«unt , whenever necessary to fulfill requirements of current gambling rules and law. OATH |horebydon|an»that: 1. | have read this application and all information aubnit<*dtothoRoan|; Z . All information submitted io true, accurate and complete; ]. All other required information has been fully disclosed 4. |an the chief executive officer f th i t ' 5. I assume full responsibility for the fair and lawful operation of all activities to be conducted; 6. k will familiarize myself viththo|aysofthoStato of Minnesota rao'` ot gambling and rules of the Board and agree, |f licensed, tu abide by those laws and rules, inv|udin " amendments thereto. 40. U/�dv|'Lono|Nanao/0mao�bu�on � | \ |� ( / 41. ci.." °./ '.`-'. signed f~ �-! -/ / / ' «� �/'/��'/�,// / �' .> /r /' /\ X - x ,4^~,�/�e^�./ /4/%{49-�„o/��,: Title ' (i ,..:7' //, < /\^t.^ Date / , // 7, " NOTICE BY LOCAL GOVERNING BODY ACKNOWLEDGEMENT I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, will beconie effective 30 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that res.olution is received by the Charitable Gambling Control Board within 30 days of the below noted date. 41 Name cf City or County (Local Governing Body) City of Little Canada If site is Iocated within a township, item 43 must be completed, in addition to the county signature. e� Signature of person receiving application / 43. Narne of Township - _^+," � �' �/'�'-/ Title i Date received (30 day period C/crk-/cc:o"ccr begins from this date) k/ky^/ Signature of person rcceiving application ' 24` Are all gambling activities conducted ot the premises ^ X 44. Name d Person ddiyering application ^y Local Governing Body Title CG-0001-02 White Copy-Board- Canary-Applicant � w Pink-Local Governing Body