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06/25/2018 02:45PM 6512551434 <br />Hugo Legion Post 620 PAGE 01/01 <br />Consent Form <br />Organization A listed below consents to Organization B conducting <br />electronic gambling and/or bar bingo at the premises. <br />Orgenlzailon A: Organization B*: <br />t-; Ire,�o A� �,�, any L .o"i <br />J- <br />Name and Address of Permitted Premises_1 <br />f/k'7o <br />.53 83 / 40 S T i✓. <br />Premises Permit (dumber. Effective Date of Consent:* <br />Circle One or Both: <br />Electronic Pull -Tabs and/o Bar Bingo Pursue 8��� <br />4m <br />0 1— <br />L-44- 4�7:o <br />hief Execut ve Officer (CEO) Signature, Organization A <br />Date: <br />" Organization B: Provide the signed written consent to the Gambling Control Board with your premises permit application. <br />This form Is provided for convenience, but any written consent is accepted. Mlnnesoto Gambling Control awed <br />7/1/15.4 <br />Ii <br />