My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
12-20-1995 Additions
>
City Council Packets
>
1990-1999
>
1995
>
12-20-1995 Additions
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
7/23/2014 12:53:40 PM
Creation date
1/10/2014 2:07:01 PM
Metadata
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
35
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
LG503 <br />(Rev.10/8190) <br />Minnesota Lawful Gambling <br />Request by a Government to Spend Gambling Funds ' <br />Government 7i%#ormation <br />Name of Govemment Requesting Funds <br />CITY OF LITTLE CANADA <br />Address <br />515 EAST LITTLE CANADA ROAD <br />City <br />LITTLE CANADA MN <br />State <br />Phone Number <br />( 612 ) 484 -2177 <br />Zip Code <br />55117 <br />Check type of government making request: <br />x <br />I <br />City County Township School District No. of <br />, Division of <br />United States, Department of , Division of <br />State of Minnesota, Department of <br />Other Govemmental Entity - specify <br />Orgcdi nation 7rcfarr cafxorc ;: <br />Organization Phone Number <br />L,fr ('.a- 44472,4 e4-4/412144,1 D4VS (OA) q4 i -/, fao <br />Address City State <br />T "lC�-1-t_ -C- C- PKcvq ,57 P,a-a 14.1J <br />License Number <br />43 aq-.2f9 <br />Zip code <br />ssfr7 <br />The above -named government requests lawful gambling profits for the following purpose: <br />(explain expenditure - attach additional sheets if necessary. <br />,4RK SNg.t i E.12 4A) a-t <br />Amount requested <br />SAC, coo. 00 <br />By completing and signing this form, the government's agent confirms that the requested funds w'll be spent for a lawful <br />purpose. This request expires one ear from the date below and may be renewed at the request of the focal governing body. <br />Si of government agen <br />Tine <br />loFG 71.9./do <br />oats <br />• i i iaz /qJ <br />Use of Form: <br />1. If an organization wishes to contribute gambling funds to a governing body, the governing body must complete this form. <br />2. Approval of the Gambling Control Board Is not recurred, <br />3. The form should be kept on file by the licensed organization. <br />4. Attach a copy of this form to your Schedule C Report for the month In which the funds are spent, <br />Page 41 <br />
The URL can be used to link to this page
Your browser does not support the video tag.