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Long <br />0.00 1/11123) <br />Minnesota Laced Gambling <br />Application for Authorization for <br />Exemption from Lawful Gambling Licensee <br />RN in tns unshaded portions of Wb appRniton fbrexempfn and <br />sand Ilk at battik; dgte bias ywwganrbflhgasin ' P.r <br />vhrocen S <br />. .'R11C1. lu .e, .r "a: �d'••:kG. 2'. .. .. ^ttrkyy,dUa:.a: at:w.... <br />St. John `s Church of Little Canada <br />Haws moo <br />FEE <br />PAGE 02 <br />R WORD 1WSEotaY <br />CHK <br />DATE <br />Cvnettfpfealms same bather <br />x- 62005 -94 -005 <br />stmt Shy orrn EP owls <br />380 Little Canada Road St. Paul Ma, 65117 <br />Cfaaf Emma a ONkat Wass Phan !fumble Team <br />ne+!. _Rebery p ;r. .atrick ( 611 484 -2708 _Sates <br />Cheek tha box below *ads intRo*tn yaw type et«wdntlen <br />© <br />ratans <br />❑ <br />Veteran <br />7 RaUybuo <br />❑ Oftwrnonpn*ft <br />W gaakt <br />Noss of de ohs oath* wleWm ,,, i,: ,. q:eo:.;.'�d��'t`<•F,a'vs,�,'s j a..;'r <br />pat o .• <br />The Venetian Inn <br />C.rnN <br />Ramsey <br />Moms tTapNUhWr <br />Chink the h wt@ratlndleatnyaurproetotnonprof t <br />stoto old ;Meth o copy aline proofto the sppKoaren. <br />r) IRS designation <br />© CoMfioa tionot good 'standing immthoAgmnsota <br />Ssmstnty or Stab's ottos <br />51 gMiliw oetp mmmmtprot otg gran (thmta9 <br />Strut <br />2814 Rice Street St. Pau. <br />Das(s) of awtrny (to maws. Piaoq. ths dais of ths draetngi <br />1 <br />I declare all information submitted to the <br />Gambling Control Board is true, accurate, <br />and complete. <br />Into* Wotan acOpyorHO rpPMotlton. Mkt apybgtarwane mriewaaby tot eangmiCark08eartio r lb000nwaawh®8odays#omtnoWaa <br />twat/ by Ho arty to county. QM* at.Woe unit Ofoweta eopmaaentowtatta apaof0Oany orthintatawMb• A wawa t M tUWOtbn tatMbO taaatrw <br />by ms eaatSiil Co bolSutrawANn Be drys of the daw butt befog CtO.0Rp mscauhaysgoWayom wtsdtto Maslow thea . <br />(My orcounty Tswhah(p Townohip'ie <br />City or county name TowmMpname <br />o organized' <br />❑ unorganized' <br />Q unincorporated* <br />Attach loiter <br />Anton' of parson me/ft wakoatian <br />TAk <br />Mamas 01 peaaarooamffgappaselon <br />DM. recokn <br />Tale <br />OMa Naestrsd <br />This form will be made available <br />in alternative foment (1.. large <br />prku, braille) upon request, <br />Mall with 824 pemdefee meson of <br />proof of nonprofit *dee to:. <br />Gambling Control IMAM <br />1711 W. County Rd. &.Suite 300 S. <br />Rosevilie, PAN 55113 <br />Page 18 <br />White - Qrigleal <br />Yellow:- Board returns to <br />orgsnitation to complete <br />shaded areas <br />