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f <br />LG503 <br />(R.v.taaiDq <br />Minnesota Lawful Gambiing <br />Request by a Government to Spend Gambling Funds <br />iverrirrtentIit}'orria:tivr« <br />...:.•.... fi ,l \ C ' ? +Si {'v3';i•: is <br />Name of Government Requesting Funds <br />City of Lino Lakes <br />Phone Number <br />612) 464 -5562 <br />Address <br />1189 Main Street <br />City <br />Lino Lakes <br />State <br />MN. <br />Zip Code <br />55014 <br />Check type of government making request: <br />X <br />1 <br />City <br />County <br />State of Minnesota, Department of <br />United States, Department of <br />Township n School District No. <br />Division of <br />, Division of <br />of <br />(l Other Govemmental Entity - specify <br />=Rt��•C =:f.« /'N.<!:�.�.- ::i «ri «« ..v. !::,�;!Y. ..$::.:.:.!; i< C%! R! ! = /.!t!!'/.!•: <!!ti..<• >i:!«•l.: :ti•:44..: <br />' .� i i<�Lwry f <br />Oganiza ... Y .¢..^.,!fyi R<aj•u K!<� <N'r.' .::i.t•' +- <br />:.:::.� }'l.•:...... ..L :.. :... v: ;::: r.•:i .. .. ..v:r.... r�vf• !- : >.�.; ::.�.!«< !!,�.<!<t <br />';$ytw .:C <br />r <br />• jf :. =::r:::::::::::...•.:::•: •. ;:::::: ..,......rr r.: w. :.:5: !.t: .. r r.Y =!r.v::r.:rYr:.v:::: H�'. <br />Organization Phone Number License Number <br />VFW Post #6583 ( 612) 784 -9313 <br />Address <br />7868 Lake Drive <br />City State <br />Lino Lakes MN. <br />Zip code <br />55014 <br />"VA.. :: 'er' ;!';% <« .M:.'••a =n :a :ti! -:.«r: <. <!t »: «.Vrr.« <.:xa ..u<y.rr <br />r (� s. <br />Y <br />:. :. a ues . . :: <br />........................ ...... : r..... ...............4ri/N .. rr/.y...O. r. M.. rw!...... S. v3 n.. r, <br />`the above -named government requests lawful gambling proTits for the following purpose: <br />(explain expenditure - attach additional sheets if necessary. <br />Purchase three (3) bikes needy family <br />Amount requested <br />$ 300.00 <br />By completing and signing this form, the government's agent confirms that the requested funds will be spent for a lavrful <br />purpose. This request expires one year from the date below and may be renewed at the request of the local governing body. <br />Signature of government agent <br />Print name • <br />jVA i Ltu <br />The <br />Clerk— Treasurer <br />Date <br />6/8/98 <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. lemma, of the Gambllna Control Board Is ■ot reaulred• <br />3. The form should be kept on file by the licensed organization. <br />4. Attach a copy of this for <br />11 • • <br />1:••• <br />1 = 11 • 1 1 1 . 1 1 1 : l 1 • - '•: 1 <br />