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License No. <br />APPLICATION FOR RAFFLE LICENSE - $10.00 fee <br />Organization <br />Address: <br />Representative: <br />Affiliation with <br />Address: -V 3 V4 <br />Date(s) of the Drawing <br />Date Received _ <br />Date Expires <br />Final Drawing Date <br />CITY OF ORONO <br />1335 BROWN ROAD SOUTH <br />BOX 66 <br />CRYSTAL BAY, MN 55323 <br />Phone _ <br />g <br />7 0 - <br />Z S d--V <br />Phone <br />70 <br />- / S dZ <br />e -5- <br />Location of Drawing /� _ 1M Al <br />Purpose of Raffle /C qiS E /71a -o . A9Ye O-717` <br />List Prizes to be Raffled and their value (fair market retail value) <br />Specify which of the prizes noted above were donated <br />Security (minimum amount $10,000.00) in the form of Bond <br />Insurance <br />Copy of security to be submitted with completed application. <br />THE ORONO POLICE CHIEF SHALL HAVE ONE HUNDRED EIGHTY DAYS (180) IN WHICH TO <br />INVESTIGATE AND MARE A RECOMMENDATION PURSUANT TO ORONO MUNICIPAL CODE SECTION <br />5.23, SUBDIVISION 3(D). <br />--------------------------------------------------------------"'--------- <br />The undersigned hereby agrees to the conditions quoted in Section 5.23 <br />Subdivision C of the Orono Municipal Code attached to this application and any <br />additional requirements the City staff may have. <br />Signature of Applicant: ---Date_ -' R, <br />--- --- - ------ <br />FOR CITY USB ONLY: After review of application, a at <br />recommends the following: <br />Approval of application __ Denial of application <br />Signature of City Official: <br />Date: <br />Signature of Police Chief:��-4,,(— /(cam, Date: <br />