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! <br />'l <br /> <br /> State of Minnesota <br /> Gambling Control Board <br />Organization License Renewal Application <br /> <br />For Board Use Only] <br /> <br />LG200OR Printed: 11/1/1999 <br />License Number: A-02926 Effective Date: 3/1/1998 Expiration Date: 2/29/2000 <br /> Organization Information <br /> <br />:l <br /> <br /> ! <br />,! <br /> <br />Ice Anoka Arena Assoc <br />4111 7th Ave N <br />Anoka, MN 55303 <br />County: Anoka <br /> <br />MN Sales & Use Tax permit #: 28329 <br /> <br />Phone Number: (612) 427-8163 <br /> <br />I <br /> <br />Rick W. esp <br />855 Jefferson St <br />Anoka, MN 55303 <br /> <br />Chief Executive Officer Information <br /> <br />Date of Birth: <br /> <br />Phone Number: <br /> <br />9/21/1954 <br /> <br />(612) 427-8187 <br /> <br />! <br />I <br /> <br />Treasurer Information <br /> <br />Dennis Sauer Date of Birth: 1/11/1946 <br />t~/~ ~c..~ /PTA) ,~'8'/3-7q Phone Number: (612) 428-7386 <br /> <br />Organization's regularly scheduled meetings are: <br /> <br />Number of active members over the age ofl 8: <br /> <br />4th Wednesday from 7:00 PM to 8:00 PM <br />6OO <br /> <br /> ACKNOWLEDGMENT <br />I DECLARE THAT: <br /> <br /> · I have read this application and ail information submitted to the Gambling Control Board; <br /> · All the information is true, accurate and complete; <br /> · The compensation schedule is current and on file with the board; <br /> · The proof of nonprofit status for the organization is on file with the board; <br /> * Our organization remains in good standing as a nonprofit corporation with the Minnesota Secretary of State's Office <br /> and/or continues to be recognized by the Internal Revenue Service as an income tax exempt organization and, if applicable, our <br /> charter remains in good standing with our national organization; <br /> ·All other required information has been fully disclosed; <br /> ·I am the Chief Executive Officer of the organization; <br /> ·I assume full responsibility for the fair and lawful opexation of all gambling activities to be conducted; <br /> · I will familiarize myself the the laws of Minnesota governing gambling and rules of the Gambling Control Board and agree, if <br /> licensed, to abide by those laws and rules, including amendments to them; <br /> · A membership list of the organization will be available within seven days M'ter it is requested by the Gambling Control Board; <br /> · Any changes in application information will be submitted to the Gambling Control Board and the local unit of government within <br /> 10 days of the change; <br /> · A license termination plan will be submitted to the Gambling Control Board within 30 days of termination of all Premises <br /> Permit(s); <br /> ·The gambling manager is bonded and licensed as required by Minnesota statute; and <br /> ·I understand that failure to provide required information or providing false or misleading information may remit in denial or <br /> <br /> Signature of Chief Executive Officer Irate / <br /> <br /> <br />