Agenda - Council - 06/26/2001 - Laserfiche WebLink

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6amblin9 Eontrol Board Fax:651~-659-4075 Jun 8 '01 13:48 P. O1 Minnesota La~ul Gambling LG220 - plication for Exempt Permit' Fee - $25- Organizafion Information, ~ - ~Ch~ Orga~i~name '~ ] ,' ~ ~ ~ ~[e~qus la~l ~b~ng e~fion Name of chi~ ~ecutiv~ o~er (cEO) ' I . First name ~ , Laoname ~ Da~mephone number ~~r / Da~mephone number Type of N~ofit Organi~fion " ~ Fraternal ~_ Religiou~ Chec~e box that indicates the ~e of proof your organi=tion a~ached to ~is __~ IRS la.er indicating ~me ~ exempt ~atus /~' ~/,~._ /~ Cedificate of Good S~nding *om the Minnesota SecretaW of State's 0~c¢~7 ~ ~, Proof prevbus~ submi~ed and on file wib the Gamb~ng Control Boa~ k¢~ Gamblin~ Premises Information ~ ~ Name~.p%remi~e~ wh~8 9~mb~ng .~ wa be ~u~ Cot m~, t~ ~e s~ where ~e d~wlng Aadress (~o hOC use PO bo~ I I ~tat~lp Code ~ Count, Da~(~f ~ (~r r~, ;nd~te the da~ of ~e d~win9)/ Ch~ ~e ~x or ~ t~t ~ ~e ~ of gamblng ad~ ~ur o~n~n ~11 be This fo~ will be mad~ av~b~ in Your ~me and ~d your orQm~t~n'~ . _~ ~rm~ (i.e.~me ¢~ n~a~d~~ubr~o~a~n Boa~ wnose work a~nment requi~ n r ~ ~eo~ that they h~ ~n ~u~. T~%~u~t~ ~n ~by d~t th ~ b · '~m~on(~l'Bo~rd~a~~uM~e~ ~ur the Minnesota Attorney ~eneral; the il t m t~th~u h~ am~n~n h~n~,ano Kev~ue the not e ~t yone pursuan[ to cou~ order, other ~ ayn ~ ~ni '~a~r ~ [ edh~e mdividua~ and agencies [hat are ~ ~ a~ ~-~OD~ ~, ~ '~ ~ ~ ~ur n~e law to ha~ acc~ to the Inflation; ~e .... ~bn ~r~ ~, ........ ~e B~d w]l~ ~ ~'~ ~nd~an~tbn's~meand~d~'-'~ ...... ~ ......... ~5S ind~ua~ and ~en~ ~r ~ ~w or be ab~ to ~ ~ur apDlbatbn, wh~h ~ m~in. pubt~ ~lo~au~o~s n~u~orsna~g ~ P~te dam a~ut ~u a~ ~ilable on~ to ~s~n.~¢ thb Mo~ w~ g~n: . 1% ~ ~ i /~ A~ ~ 2a~an~new~urconsent. I I I' I I I I I I