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<br />S'uvm iJ- f 10 .W . ^ '. - 'IOrl.{l-ee, <br />f(,tyak It +0 Wf ~J.nJ:u (,4)j,+ <br />APPLICATION FOR A LOCAL PERMIT OR CHARITY LOCAL PERMIT Wi+n Co1"!1fl~ dpf)iarh <br />OFFICE OF ATTORNEY GENERAL . <br />SFN 9338 (07-2003) <br />Application for: 0 Local Permit .~ Charily Local Permit (one evenl per year) <br /> <br />rt;~i<1h <br />"~~'".'<:'< <br />1i~11~3~~~ <br />\\...'~r~':$i-.1 <br />'~\.f~""'" s. ',. <br />., , " ~"..... , <br />'. '1 ~~:" . <br /> <br />Name of Non-profit Organization ~ClJV~'1 ~uf' Date(s) of Acllvlty I <br />MINNKol'/\ AlttlrlH-rS lkf ,;()o8 to'])iCC. ~ODe <br />p(jon Responslb~~r the Gaming OperatIon. Including Disbursement of Net Income Tille Business Phone Number i <br />~'1 TALcc..H f~s I1>l.NT IOI-i~O'''''Ol <br />Business Address City State Zip Code <br />Mallfng Address (if dlfferen!) City - Slale Zip Code <br />1~Lj'3 1-lW'1 ~\ ~E UN(\' g.d.. --Jtl M{<)1bLoJN--:-~ N']) -l)~LjO\ <br />N.ame of SIte Where r~"7(S) wlll be Conducted Sjoiress fY)(1II~ I <br />L:\.lAfF€f. f'E 51 I <br />City Stale 1~7c1-Lf300 ti.51 I <br />-',.,\J&f'Ft<O: N1J i <br />Check the Game(s) 10 be Conducted: . Poker, Twenty-one, and Paddlewheels may be Conducted only by a Charity Local Permit. . <br />o Bingo DRaffJe l'l Calendar Raffle o Sports Pool o Poker. o Twenty.one. o Paddlew~eels. <br /> <br />DESCRIPTION AND RETAIL VALUE OF PRIZES TO BE AWARDED <br /> <br /> <br />Game Type <br /> <br />Description of Prize <br /> <br />Game Type Description of Prize Retail Value of <br /> Prize <br /> I <br /> , <br /> , <br />. <br />, <br /> , <br /> , <br /> I <br /> , <br /> , <br /> (Urril$12,COOperyear) <br /> Total: $ , 0.00 <br /> <br />Intend.du.eeorgamlngproc.ed.:5\)N'/)~\~ot fffi CUR 1011\ Af'\NWt"AA~'1 KUN-r 1/11 ~'" <br />I <br />, <br />I <br />Does the organization presently have a slate gaming license? a No 0 Yes ~ If "Yes," the organization Is not eligible for a local permit or charily local <br />permit and should call the Office of Attomey Ganeral a11-800-326~9240, ! <br /> <br />Has 1heorganlzatlon received a charity local permIt from 'his or another dtj or county 101 'he fiscal)'earJuly 1 through June 301 'iil No 0 Yes- If''Ye5,'' <br />Ihe organlzallon does not qualify for a local permit or charity local permit. <br />. . i <br />Has the organization received a local permit from this or another city or county for the fiscal year July 1 through June 301 ...81 No 0 Yes - If ''Yes,'' <br />indicate the lotal value of all prizes previously awarded: S . ThIs amounf Is part oflhe lo./s/ prize limit of $12,000 per yeer. <br /> <br />~ <br /> <br /> <br /> <br />