Laserfiche WebLink
CG220 Minnesota Lawful Gambling <br />(Rev. went Application for Exemption from <br />Lawful Gambling License <br />Fill in the unshaded portions of this application for exemption and send it in at /east 45 days before your gambling activity for processing. <br />Name and Address of Organization <br />For Office Use Only <br />Organization current/previous exempt number <br />eoj tJ c- /oS / r1L 3 <br />beet City State Zip code County <br />%'d d'4X /74/II srif7 <br />2/94 Litt/ <br />Chief executive officer phone Manager phone <br />/*kW E/na/Zy Zni; Y87.Jo37 Eue-ae chi'', $/07 ,nia43,rj2 <br />Type of Non-profit Organization <br />current/previous license number <br />Years in existence <br />Attach proof of three -years or more of existence. Number of active members <br />❑ Fraternal ❑ Religious ❑ Veterans Other non - profit <br />7? <br />H you checked box for other nonprofit, check one of the following and attach proof of nonprofit status <br />❑ IRS designation ❑ Incorporated with Secretary of State ❑ Affiliate of parent nonprofit organization (charter) <br />Gambling Site <br />Name of site where activity will take place <br />V5,16t /k4 /A/A) <br />Street City State Zip code <br />t P/ y )t c t sr id -tip �.n,,fvA 53712 <br />Date(s) of activity <br />Ss//A/OG y 0 CfaAM -3 / J? 90 <br />Tug <br />es of mss <br />ounSy ry� <br />Gams Yes <br />allies <br />Paddlewheels <br />11 <br />boards <br />Pull -tabs <br />Financial Retort <br />How will profit be used: <br />Pa FAG ,¢.2,;4 4 'L i jtu, <br />Co m rev vx�7Yy OA; <br />t!% y/J�Q dL 'r 7 <br />,egc / kr sof /f !` <br />I declare all inforfiation submitted to the Deportment of Gaming <br />is true, accuratt cnd comp <br />fiiamtaSn <br />ate, andcomplata: <br />P of exeruhve nfficar's sinnamrn Date £ htaf pvabi tiva n %ref d igneh ir r p'g <br />Local Government Acknowledgement <br />I have received a copy of this application. This application will be reviewed by the Department of Gaming and will become effective 30 days <br />from the date of receipt by the city or county, unless the local government passes a resolution to specifically prohibit the activity. A copy of that <br />resolution must be received by the Department of Gaming within 30 days of the date filled in below. Cities of the first class have 60 days in <br />which to olsallow the activity. <br />City or County <br />Township <br />Township name <br />Signature of person receiving application <br />Title <br />Date received <br />WHY-Bowl <br />Fink-agt a, Mall this application and fee of $25 (check made out to Commissioner of Revenue) to: <br />YMwv- orOshad QyrNL/mb Department of Gaming - Gambling Control Division <br />c <br />eotl —sty r q mo r��hONO U «s <br />Mail Station 3315 <br />St. Paul, MN 55146-3315 <br />Page 45 <br />