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LG230 <br />09/20/95 <br />Minnesota Gambling Control Board <br />Application for Authorization to Conduct <br />One-Day Off-Site Gambling <br />iffjyl. • ;K' <br />Organization Name <br />O/lohJo <br />Class of Organization License Base License Number <br />O'ic.S'i <br />License Expiration Date <br />ScV }o,/7iq. <br />Chief Executive Officer (CEO) Information ■,4: <br />Name of Chief Executive Officer (Cannot Be Gambling Manager) <br />yJ£7^)C <br />Daytime Phone Number <br />(OtL) V? 2. 52./ <br />Gambling Premises information <br />Name of Establishment where gambling activity will be conducted <br />6/totJo (4-t^ sc^oc CvH^ty-e-fLiA <br />■- /■■ ‘ . • l’/■ •• <br />t ».• • \£-■ t *V* * ' *, r . •' ‘ I ' <br />>-m, * »• . . . ' i • .1 <br />4*- <br />Street Address City <br />. 0/d t O/Zo/Jo <br />Does you*" crganizalipn own the gambling premises? Yes No <br />If no, a lease agreement must be submitted with this application. (See instructions) <br />Activity Date V *4 .. f. <br />Date of One-Day OfT-Site Activity / <br />The gambling activity conducted on this day may not exceed 12 hours <br />Type of Gambling Activity <br />Check the box or boxes which indicate the type of gambling activity your organization will be conducting <br />for this one-day off-site activity. <br />I I Bingo \}^\ Raffles I I Paddlewheels I I Pull-tabs Tipboards