Laserfiche WebLink
LG 230(2/28/90)) Minnesota Lawful Gambling <br />Application for One -Day <br />Off -Site Lawful Gambling <br />Send in this application at least 60 days before your gambling activity. <br />Organization <br />7w/^/ c l r, E5 '-/ E7 ° c Mf4Prwt- u wico <br />License number <br />Qooti n -003 <br />Address (street or post office box number) <br />C fO 7Dk Oet.✓LZc!/La <br />vt Alt Vt2' //y i9i/g.". <br />City <br />sr• eve <br />State Zip code Phone number <br />04A/ SS/it KP 7977 <br />Name of chief executive officer (please print) <br />srz1'C A-f/IN/44i <br />Signature of chief ezec�°ve officer Date Phone Number <br />1-11-ri / 5173 <br />Off -Site Information \ e\\ aEtZle �a\ ����a\ o�a�\\ �\\ ���` �\\ ��t� \w\�.`a�.� MENtettat�u\�l <br />1 Name of location where off -site gambling will be held <br />✓rt 174 / IA/A/ <br />2 Address of off -sire location City or township State Zip Code <br />2-W%' tote srztr urn-t c,r• 4 , h ,rr7/7 <br />3 Date of one -day event <br />4.o4it- 7//771 <br />4 Has your organization conducted oft -site gambling this year? Yes ❑ <br />No `t' If yes, what was date of event? <br />\a.\\\\\ \u\ rrn`..'nt\\mss \'\ <br />Local Government Acknowledgement <br />I have received a copy of this application. This application will be reviewed by the Gambling Control Board and will become effective 60 <br />days from the date of receipt by the city or county, unless the local government passes a resolution to specifically forbid the activity. A copy <br />of that resolution must be received by the Gambling Control Board within 60 days of the date filled in below, <br />City or County (to be fl :d in (.r =ants ) <br />City or county name- /t✓CL- yGCLc//GL./1 <br />Township <br />Township name <br />Si na ure of per n :ceiving applirati <br />Signature of person receiving application <br />Title Sv"'GL�f'ytCflJ dejDate received 5 -6- 9/ <br />Title <br />Date received <br />Attach a copy of the lease for the off -slte location <br />Mail this application and a copy of the lease to: <br />Department of Gaming - Gambling Control Division <br />Mail Station 3315 <br />St. Paul, MN 55146 -3315 <br />Director Gambling ;.Canvd. <br />gepaRmentaf Gaming...,._;. <br />Page 6 <br />