01/23/1995 Council Packet - Laserfiche WebLink

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LG503 tn.v.tae cot Minnesota Lawful Gambling Request by a Government to Spend "Gambling Funds CroDernrnent rr foirn atton Narne of Government Requesting Funds Lino Lakes Police Department Address 7731 Lake Drive Phone Number ( 612) 780-0605 Check type of government making request: Lxi City I1 Ciry Lino Lakes State Zip Code 550 i 4 County I Township l 1 School District No. of State of Minnesota, Department of ,Division of United States, Department of , Division of Other Governmental Entity - specify a rg nma Qui Ii> f �tJt`IttiCxfftort: Organization VFW Post #f6583 Phone Number ( 612 ) 784-9313 'cense Number Address 7868 Lake Drive City Lino Lakes State MN. Zip code 55014 re to u , . the agovernment requests lawful gam. Jng pro its or i e o lowing pu (explain expenditure - attach additional sheets if necessary. Support of the D.A.R.E. Program within Lino Lakes and Rice Lake Elementary Schools. Educational Materials used during the 17 week program. Wades for the D.A.R.E. Officer $4,300.00 $8,000.00 By completing and signing this form, the government's agent confirms that the requested funds will be spent for a lawful purpose. This request expires one year from the date below and may be renewed at the request of the local poveming body. Signature ofotvemment aorft Pri nt na A v 11, A-C..c./-/ -Tido r/ /_ Dau Use of Form: 1. If an organization wishes to contribute gambling funds to a goveming body, the governing body must complete this form. 2. Annrovel of the Gambling Control,Board Is not reaulred, 3. The form should be kept on file by the licensed organization. 4. Attach esooy of this for 11 • 1 '.• ••1 • 1; 11 • 1 1 1. 1 1 1,. 1. 1•` event.