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~usines~IA~ress ut ~gani~[on - S~oet ~ P. O ~x (Do not use the address of your 9~bling ~nager) : ,':, . ~
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<br /> , .Qi~ ~ . ,,~-., S~te Zip Co~ ~unty Da~ime phone number
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<br /> Name ol ~ief axe.five offer (~nnot be your ghmbli~ m~agar) ~fle Daidme phone number
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<br /> Lr app~ng for a cla~ A or C pe~t, ~ m da~ ~d beg~ & en~g hou~ ofb~o occasiom:
<br /> ' ;". No mor~ ~ ~ven b~go ~casio~ may be conducted by your~i~ per week
<br />.~ ... ?Day -"; Be¢~End~g Houm .- - Day Ben.Bhang Houm ~. - , Day Berg/End~g Ho~s
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<br /> ..... · . Name ot es~blishmem where g~bling will ~ ~a~ed , . .. S~t Address (~ ~t use a ~st offi~ ~x. number) , ...
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<br />where gambling ~emises Js k~,.ated OR Township and County where gambling premises is located if outside of city limits
<br /> . . . . ..., . : . ...... : ........ ..:.., .... ,- . =- ...-- ~ .... .., ~.: .-'.r~-:,.-. : -L ~":' ~';':'"';"~":~':~'
<br /> .~"t ,%.'~r_~ I ,-.~.-....~..-.--~ .......... ~,;~:~ :~:: -,,~,.:=.-.~a~;?4.~?;?..:'.~,: ..;'::: ~-:%~.~£-k~a;;:~-.~.~' ~:;L~:.G:~;.~;;;: ! -
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<br /> owner of i .. City ...... ,;'.:.-,:..-:.. ,._.,' .-.: ,' Code
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<br /> ~Jc ~ o' vr t~e I~u cling w'here9am~---'~'g w II be ~ondgcted? . E~ YES :-.~. NO. ,,~-:,-~/-.:~,?./.~':' :~:,..-.;-: :,; r~~, ~-.,,;'.-~:.~-' ~,~._,.-.';~:'?..~?(-
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<br /> ,, . , . , ..... ..~ ,'.y~-,,.,~ .~:.,~'~: .~...... ~<. ~.-..
<br /> !'.' a oopy'ot a sketch of l~e fto~ plan w~th d~mensm~s showing what portion ~s being leased.:¥.-l~.~ ~.~.~:~d,~,.,~ ;.~..,.
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