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STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />GAMBLING MANAGER LICENSE RENEWAL APPLICATION <br />4IRPRINTED: 12/09/97 <br />FOR BOARD USE ONLY <br />AMT. PAID <br />CHECK # <br />DATE <br />INITIALS <br />lete, false, or misleading application information may result in denial of a license. <br />LICENSE NUMBER: G-03074 001 EFFECTIVE DATE:06 /01/96 EXPIRATION DATE: 05/31/98 <br />ORGANIZATION INFORMATION <br />OF ORGANIZATION: Wrestling Minneapolis Minn/USA <br />AME: William Hinchley <br />tie Chandler <br />E 22n' ve <br />polls MN 55418 <br />ME PHONE NUMBER: 612 - 374 -9626 <br />ER SINCE: 04/01/84 <br />GAMBLING MANAGER INFORMATION <br />OF BIRTH <br />SOCIAL SECURITY NUMBER:' <br />EDUCATION INFORMATION <br />RECENT CONTINUING EDUCATION CLASS YOU ATTENDED: 11/21/97 <br />BOND INFORMATION <br />COMPANY NAME: United Fire & Casual BOND NUMBER: 5180767 <br />GAMBLING MANAGER CHANGE <br />to change its gambling manager, complete one of the following sections: <br />Other Change - Allow up to ten weeks for processing <br />The new gambling manager's license should become <br />effective (check one iA <br />e,W <br />/hen your organization is using this renewal application <br />mergency Change - Allow up to five working <br />days for processing <br />he chief executive officer, by signing below, <br />ffirms that the emergency application is due <br />the following reason (Check one and fill in date): <br />Death of gambling manager on / / <br />Disability of gambling manager on / <br />Termination of employment of gambling <br />manager on <br />Note: A New gambling manager may not assu <br />Gambling Control Board. <br />is complete <br />When the application has been processed by the Gambling <br />Control Board —the effective date will be the first day of <br />the month. <br />me duties until he /she has received the gambling manager's license from the <br />fr 3• piing. manager's license expires <br />'i'1` `` _ m manager's license expires <br />ee t • ager's license becomes <br />t •� d that all application information <br />urrent chief executive officer of your organization must sign this application in the presence of a notary <br />IATURE OF CHIEF EXECUTIVE OFFICER (CEO) <br />Notary Public Information. Notary Public Seal <br />must be current and correct; seal may not be altered. <br />,19 y g <br />rized Signature of CEO <br />Subscribed and sworn to before me this <br />day of R- b r w r, <br />Q. lt- <br />SANDRA J. LATHROP <br />- MINNESOTA <br />My Comm. Exp. ,Nn. 91, 2000 <br />otary Public <br />1-• 11S1V1k) <br />