Agenda - Council - 07/27/1993 - Laserfiche WebLink

Home

FOR BOARD USE ONLY FEE CHK INIT DATE ,, L6220 Minnesota Lawful Gambling Application for Authorization for Exemption from Lawful Gambling License Fill in ~he unshaded porl~ons of this apphcat)on tot exemphon and send it in ~f lees t 45 daym before you~ pa~nbhng activity ~or processing. Name and Address of Organization O,~anizalton Nan'~ Minnesota Bowhunters, Inc. Current/previous I~_,~nse number ~~o_u~enn~t ,umber {Fed. 41-1613741 $1met Cily State Zip code Counly Cl~ef Execulive OIl~ce, Dayhme Phone Number 1teas.ute, Dayhme Pinone Nur'rt:~r Lauren Hain 607) 775-6882 Art Sweeten ~12) 484-5010 Type of Non-proj~[t Organization Check tho box below which indicatea your type el organization Fraternal Veterans [] Religious [] Other non-profit Oamb[in!7 Site Check the box that indicatea your proof of nonprofit status and attach a copy of the proof to the application. [] IRS designation [] Oeddfica~ion of good standing from the Minnesota Secrat~ry of State's office [] Affiliate of parent nonprofit organization (charter) .. Name el slle where activity will take place Game Fair _._~pboards Sleet CI~ ................ '~ ovm~hip State Zip coda CounTy 8404 161 Ave. NW~ Ramsey M, 55303 Anoka Dale(s) el activlly (Ior raffles, Ind~ate the ~te el the drawing) Au~. 13,14,15 and 20~21,22 Drawin~ Au~. 24, 1993 " 'o Oa~rtes'" .... .- '. ....... · .... ' ..: .F~nc. nc~aZ'~e~or'¢ ...- .. - '~':' -..' ' ~.-.~a~a~a u. of P~'~ · ~p~ ~ ....~...:...:~, ,.-- .... .. :.. . . - . . ....... .::...., ...._.~..~:.::.:.. ....... ..; :._' ... ~ [':. '.:. : ~n~,-l~lu~hg':::']~ :!:.::~ . :...: '- ?~:.':. · ~..~.-:-:...';-:-':~:L']'L~.;::.'~L.:.:¥.(tncl~ng D~at~:.'::. Gam~) ..... L. :-::~"~celpl~ :'.. "?: ':. · :~-. - ~ of P~z~-':.'.': ::'-::-:.::' ;.:'.-:.;L.-:--;F.: Net Profit - ........... ::' ......... ~':;.:..;and ~h):.:-:~F: :: .':~.- Bingo ~ ";'' J':~::'""' ~ ':~'l'' R affl e s ~ ::-:' ' "';" :-;:::: ::"~::~:;('""-:-' ~):: ~:'?::~::';?::':-;~ :" Paddlewheeis ~ ; ~. Puli-tabs ~ ;: ~ I declare all information submitted to the · .."':.:~ :':'~:~[::~:~::FF:~.F.:~'~;::?:' :::-:f:':':-'-:' ::::::::::::::::::::::::::::: ]::::~:~:"Z ~.i::.[';:~ :::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Gambling Control Board is true, accurate, and complete, l~¢~e '¢l.fi~i~ I~oAi~ ~b ~1~ .lo':l~' ~1i ~ .6onlr~: :. :::~ :::::::::::::::::::::::::::::::: ........ Chief Ex~utlve Office~ Signatur~ ~ Date I have received a copy of this appbcation. This application will be reviewed by the Gambling Control BOaJ'~ ~'~ will become effective 30 days trom the date el receipt by the c~ or counTy, unless Ihe local unit el government passes a resolullon to spectfloaJly prohibl~ the activity. A copy of that resolullon must be received by the Gambling Control Board wilhin 30 days of the clare filled in below. Cities of the first ctas.s have 60 days in which Io clisallow 1he activity. City or County Town,,hlp C~ of county name Township r~ms ', City of ~ams. ey . . apphcalion Sigr~ture ct person retmMng appiicalion Title This form will be made available in alternative format (i.e. large print, braille) upon request. Dste received Date Received Mail with $25 permit fee and copy of proof of nonprofit status to: Gambling Control Board 1711 W. County Rd. B, Ste. 300 S. Roseville, MN 55113 Township is [] organized [] unorganized* [] unincorporated* * Attach letter White - Original Yellow - Board returns to Organization to complete shaded areas