Agenda - Council - 05/14/1991 - Laserfiche WebLink

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· ' ' :~ .... 7:':,~,~;.::." '" ..i':?: :;: /;-. :. ~':: ':!: :.'. :-:~ ':?'' ..'" '" .':. ': '-:': ' CHECK '-:' '~ :'::~'~-- r:?: "' ' ' ''';~ .... :' '':": '~ :'' "' INITIALS DATE ' ~'~': ' Premf~e Permit AppLication - Part 1 l~J~iness Address of I:~ganiza~o~, Street or P, 0 Box (Do not use address of gambling manager) . :. · ,~, ~ . .... .. . .,::'~". '-- . . ~ , Name of chief exe~,'tive officer (cannot be gambling manager) .; Title ,: ~,~ .... E~usiness phone number Ad~'asI,:~'ct~ exe~utlv~ (~ca-r - ,~t or P. O. Box .?~,.:;:. ~ ...... ~ - -,. ..... .,~ . ' - '_-~,0" ,q~<~<A '-' ~'.'~:' Cl.~s of']>remt,~e Perm/t ' - [] Class A-- Bingo, Raffles, Paddlewheels, Tipboards, Pull-tabs II Class B -- Raffles, Paddlewheels, Tipboards, Pull-tabs [] Class C-- Bingo only· .:~'. ..... - [] Class D-- Raffles only ' ' Bingo Occasions $200 $125 $100 $75 If class A or C, iq1! in days and begi-~ing and ending hours of bingo occasions: ' · No more than seven bingo occasions may be conducted by an organization per week. Day Beglrming/Endlng Hours Day Beginning/Ending Hours Day Beginning/Ending Hours __.to .to. to, __,to .to. to, to__ ..-:~L~-m~ ~rman., ~ ~!~:~ a~t~ ~;.¢.:~ a~ ,~.~: ......... ~a>.~:~. ........ -...~-~.~. ......................... ~ ................. ~..-..:.-:~-~. ................... ~:~:::.~ ........... ============================================================================ Statms of Premise Permit - check one: [] New premise-- Fill in base organization premise permit number [] Renewal of existing premise permit -- Fill in comolete premise permit numb~)~3l~- [] Previously expired premise permit ~ Fill in comolete premise permit number I ! I i ! I ! I I I I' I I I .-: .?';i~: '-