Agenda Packets - 1992/06/22 - Laserfiche WebLink

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r. Minnesota Lawful Gambling LG230 (8/2/91) Application for One-Day For Board use only Off-Site Lawful Gambling Base License# wrguattzat ton::::;<:>::>i::<:::>:<:g::>:::::::>:::>:;:::::;<:::>:;::::;::?:<>;?::< :;:;<:<<::;:.ti:: m <:>:n::: :<::?::;:;:::;:::;:> .;::;;:�<:::;;>:.>:'.:: :::::?: Name of Organization Phone Number License number Expiration Date th gear ear .htke yicns ex,A (4/2 ) 4 — O /5)-0.2378 4/-30-92 Address(street or post office box number) lirl32toa FavtU4vt 'Rd 2 <3 City State Zip code Vartvt.atc I-lecq 4 4-5 rnn Ss'1 1 O Name of Chief Executive Officer(pleade print) Phone Number 16,4 C iarK 'Pric,e (1012) 417-9-52.18 .......... ... ............ :••r•:.•:.v.•::.•r+:xm:rr:.vxx:.•.•:rr:r.•rr.•.v.•???{?:.�?:.•}:??•'•:?nr.?{r•.,v,.,vi.,vr,.;r,;}??:fx;?r?r,?j$i{x?iq?r<?n:vnvy?r,:;{?r,•::�????{�;r,•;.:;Y•• .. ...... .... .............. .•.................... ....x.v:::::::.v:::......... .......:;w:r::::::•:::::.........n...........•. f.•::4:J:::,?:v?w;:x:::?•:•:•:i:?6'•i:•.......:.'...?.::•:F.•.ii:�:::::..::::::.....::: Qi::i. - tio#:�':•7:_i:::.'•:ii?:':tii i:�'ii:::.:::i:::yiiC:{:::::ii v?F:ti:;{:::,:::i:::?::t::+.•,:::•.:S v?::1:.'•:::::•::'v::!?:jYr$.rii'ir:iv:?:S:i1i.'•:::::i�::i>.i<::::G::si:::i ii}:;::<?ti'�'..........................rr......:..............n.. 1. Name of location where off-site gambling will be held VYIe -mat a 5,,pp,ey- e(L) b 2. Address of off-site location City or township State Zip Code ..2-OO 14 wy I() f�ov s VI e w orf 5S' 112_ one-day event 3. Date of Oe-.. ) (oto, Z 4. Has your organization conducted off-site gambling this calendar year? 0 Yes ;21 No If yes,what was the date of the event? / — / ._ OC 4.1:15: :::. ....E ....,...:::>.:.:,.S:r'•' ': :.:.. $<:::::%::d;: :is :::::: .SF`?':}•`::::i:{%`'•'.•'`2: :S i ::: : ;:: :ii8:`•s::M:t:;>%: < N: f i'':*: i:i:K.'::i:i:M:1;::: t :i: :: `':::Nti:::: I affirm that the above information is true and correct Signature of Chief E;wp.JAve Office - Date 4., 6 y 90•-- ':'.'iF:isiv::ii:>.::?i:i:jy::ii:,,,, Jt??::::i:;:;:{?:!;':;:;:;:•{;:.::.i:}:i;:;:i;:•:: }i:+:::?:?�:??;:':::.'?:5:::•'r::Fi:ii:ii?":':::;:;:? ;_soca:<:.::.:::.: ;emery.�.:::.::::::::.:: ::�::: :.:::. :.:: .:::::._.:.:..........................:............. ..:.:..........:......:....:.:........:.:::. 1. The city must sign this application if the gambling premises is located within city limits. 2. The county AND township must sign this application if the gambling premises is located within a township. 3. The local unit of government(city or county)must pass a resolution specifically approving or denying this application. 4. P coov of the local unit of government's resolution approving this application must be attached to this application. 6. If this application is denied by the local unit of government,it should not be submitted to the Gambling Control Board. City or County Township City or ; my name Township name ON .. Afie,..) Signature' .• =cewing a••ica.on -Signature of-person-receiving-appheahon Title (?.,4 Date received Title Date received Ci/,/' ,te (r -C- / 2 Is township: _Organized Unorganized_Unincorporated Attach a copy of the lease for the off-site location and a copy of the approving resolution from the local unit of government Mail this application to: Gambling Control Board Rosewood Plaza South,3rd Floor 1711 W.County Road B Roseville, MN 55113 •>;:.>.;.;i.:.::;;;.; .;:: :::�:.::.;;;:;:;::;::;;:-;:;..i;:.ii>: :.;::•iii>:.;;:;;:.::::::::: :.;:::•:::•::; ::;g>:;.i::. .::.::.;:>:?:; .;:::.::;. a .USS .h •:i•:xis:>:::•:::;i:>::»:•:i::>:•:i:i:•i:<i:: • • • •:r.i•:::::•:.:::r•::::?•:::.:::..::•: bll •.C� oe tf.:::::::::r::•::::•:::•:.�::::.:::•.:. .;.#1.mt4:::r:::•:•r:::::::?.:.....:::. •::•ii:•i:;.::?<•ii:•;:•:i:•;:•:>i:.;:?•;:.i:?•::•;:?•.:+•;:•i:..........:........................:.. Ivf�.t]Isoeteir•X3a .....tl .....-f?IY'Al:�....r.............:....:...:............ 0:5::::•:?.:;::iii:•... ..r:....