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�y Iw <br />64, a <br />CnarllaWe Gamalinp <br />Rm NJy5 GrigOe MNway <br />Control Board <br />Bldg. <br />i., <br />1821 University Ave. <br />St. Paul, MN 55104-3383 <br />•ere <br />(612) 642-0555 <br />Far Boca Use <br />Paid Amer <br />Cloak No. <br />Date: _ <br />GAMBLING LICENSE RENEWAL APPLICATION <br />LICENSE NUMBER: S-OW-177 I EFF. DATE: 04/01/B7 1 AMOUNT <br />1. APpi"ol-Lop] Name of Orak "Wo <br />2. Seer /ddrba — --- <br />TUly Will FIN pill <br />3. City. Suite, Zip <br />4. County <br />5. asks. phooa <br />IlinesalMllg, >M 504 <br />Normal <br />1 612 1 M15M <br />B. NNne of GNeI EseculNe Offioar <br />7. Simferopol PhOU <br />Nlnatd h <br />( 612) M15M <br />B. Name of ron Treasurer or PerWho Aeoallns fro Remmers <br />g. Suferow Phwn <br />Eleans Mwek <br />611170.1300 <br />10. Name of Gambling Menagpr <br />11, Bona Number <br />12. Burrow Pawn <br />E S SociallyB.yf. Novak <br />lIIPLiB <br />6/ —Y <br />13. Name of EalaOtiehmenl Where Gambling Will Take PMce <br />14. County <br />15. No of Mire MetNwn <br />JI�If'f Loatge Nava <br />Nwnpin <br />L0000 <br />18. Lbew Name <br />17. Monthly Rbb <br />]1�INf LelMle <br />►)10 <br />le. It Bingo will be cOndmtW wife this ikon, pew ess ily days and times r Bingo. <br />DaYs ETIS I Date Times Days TYnas <br />f 8. Has, license war bean. ❑ Rewked DMc ❑ Suspended Dale: ❑ Dbred Dare: <br />N Hole Internal Controls bsen bOmided prerauely? fikyb ❑ No (it "I'll altwh COPY) <br />21. Hb Ci n i rot Ibse been find vita IN aord? 24 yore ❑ No (II'No; atuch copD <br />22. Has Cunenl skelCh Nan filed with IN boards? m yb ❑ No (11'No; anaan coot') <br />OAMWNO SITE AOTNOMZATION <br />By my 8lgNtu:e below, total law enku,ownent onion w agbts of the Board us hereby aufe vkdi to enter upon the bs. N salty verso. I,M^bSV M <br />being ow .ted. to oberve IN P. Wr,g ant t0 snfoNa th, W for env unrnhwlz.d game Or prbtloa. <br />BARN RECORDS AUTHORNZATION <br />By rely signature below, IN BUN le hereby aullroneW to Inspect tee bank records of fee Geloral Gambling Bank Accwnl wTerlwv nw/aaYy M <br />RWfill Ip ,redo sinui of currant gambling rules and law. <br />OATH <br />I hereby Were that. <br />1. I few read this applssfion rld all InlormetIon submitted to the Board; <br />2. All Information submitted Is tom. wawals ant coMplwS <br />3 All other required Information lea Men fully disclosed; <br />4. 1 em the chill eeeMlw off. of IN OrgCNeatkn: <br />e. 1 assume full res,Niblllty for'he ffer aN lawful operellrn of all Wtl lobe CondWi d; <br />B. 1 will familiarize myself with the Own of IN Slate of Minnesota respecting gambling and rules of IN boaN and agree. II liumed, to feaso by thaw <br />laws and ruses, Including amendments Inward. <br />23. Dahl Legal Name be Organization Signature (CI O. Olken) Dat T'IM <br />y41Tvt S �ca.ns Swa-'7 <br />Vildexl sYd. Cvlb7br it/i <br />ACKNOWLEDGEMENT OF RIOME 11111"L0(AL OOVERNINO BODY <br />I Marry ac in0wndge ...Pl be a CsVy of this apprltahon. 81 aCknoMedglog Warps, I submit hMn, been bawd wish all 21. that the apwl wron will <br />M nev OY the CNnteble Gambllag Control Board ant II approved by the Board. will bw0rtn eflectlw s0 dap m frothe date of recap Incur <br />Mhwl, Ipea a IIaPINIwt Pi aN IpPr gOvrtlalD body is PabW whlCh tWiW.fICrly disallows such aCIIN1Y .l a COPY of Nat reMdemon es rwatwd by <br />the C Ieble Gemblmp CMIM board w1th, dui r IN More, rioted date <br />L 'Co No (!- a ion YI I TcwNhkp II eN Is locatbhin Mi wa Iownp, passe comerN s some <br />4 I vj wel_ end 25 w0 <br />Sib .rest Poraqi gi w g Applltaben M $IgneNre of Person Rwrwr, Applltatnn <br />Ora "M m dui thi 1 Lae <br />Twrmmp Name <br />coo=41("T) sv WNls Casio, -Bore Canary -Altpwant Palk -Ever Oa.ermng Boar <br />