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W200 Minnesota Lawful Gambling <br /> Rev. (2128/90) Gambling License Application - Part 1 <br /> Organization In ormation . <br /> Legal name of organization <br /> SAINT ANTHONY VILLAGE SPORTS BOOSTERS • <br /> Business address of organization-Street or P.O Box (Do t use address of gambling manager) <br /> 33o ( Sic vex 44 r-e Ko A b <br /> City State Zip Code County Business phone number <br /> E7. 14,d 7i'O-V /��✓. S_�-4/F AWA/W/l✓ (.-/4) 78/-.Sa 2_ <br /> Name of chief exec, e officer(cannot be gambling manager) Title Business phone number <br /> 7),4-,) 4,,Her_ (G/z ) Vl11W''z/-7/�'f <br /> Address of chief executive officer-Street or P.O.ssy�hx <br /> 4- 3 `vc /V C, <br /> City /� State Zip Code County 9-r• 4"1-e 117A) 5-154/00 h"A)jP/A) <br /> Name of treasurer or person responsible for organization's other revenues(cannot be gambling manager) Title Business phone number <br /> NIS F,-4 a cm I- (6i2 ) 788-M4¢ <br /> Type of organization: ❑ fraternal ❑ veterans ❑ religious other nonprofit <br /> Number of years organization has been in existence as a nonprofit organization 24— <br /> Attach a copy of nonprofit incorporation from the Minnesota Secretary of State or a letter tram the IRS declaring income tax <br /> exemption. (Do not send a sales tax permit or Federal employer identification information)) <br /> Number of active members (must be age 18 and older) <br /> Fi&rW 4 <br /> v-ffV2)A`, <br /> When does the organization hold regular meetings? Day(s) or- &-4cH /Nc�+Tl+Hours S:oogoof- //.oo Atw- <br /> Have internal controls been submitted on the form provided by the board? yes ❑ If no--Attach a copy. <br /> Type f Application o • <br /> Class of License <br /> ❑ Class A—Fee$200(bingo, raffles, paddlewheels,tipboards,pull-tabs) <br /> Class B—Fee$125 (raffles, paddlewheels,tipboards,pull-tabs) <br /> ❑ Class C—Fee$100(bingo only) <br /> ❑ Class D—Fee$75 (raffles only) <br /> Bingo Occasions <br /> It Class A or C, fill In days and hours of bingo occasions: <br /> No more than six bingo occasions may be conducted by an graan/zatlon per week <br /> Day Beginning/Ending Hours Day Beginning/Ending Hours Day Beginning/EndingHours <br /> to to to <br /> to to to <br /> to to to <br /> If bingo will not be conducted,check here <br /> Status of license-check one: <br /> ❑ Organization has never been licensed. <br /> New site—Fill in jog license number -0 2-24-5 106>/ <br /> ❑ Renewal of existing license—Fill in complete license number <br /> ❑ Change in class of existing license—Fill in complete license number <br /> ❑ Previously expired license-Fill in complete license number <br /> • <br />