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_Minnesota Lawful Gambling COW .d (LG200R) Lawful Gambling license Renewal Application Corrections should be made dimly on this application Submit one dheck for the combined total of renewal fees, payable to State of Minnesota requirements: 1. An organisation lioer'h9e fee of $3S0 paid annually. Current license term: 4/1/2007 to 3/31/2009 Authorization #: 32235 ® r c�ecic ki; i�-K i your i organization: Church of St:. Marco (612)379-2755 IMW&OW ft ft,ter or the O I .600 University Ave NE, Minneapolis, MN 55413 County: Hennepin OVWWftn ax I aehr„ed m. rah shau�,ee I CEO: Sharbel Maroun L ; 3-49_ %64,6 — J 600 University Ave NE, Minneapolis, MN 55401 (612)379-2758 Thu surer: Michad Simon Annual Goal for 36615 3rd St NE, Minneapolis, MN 55418 Charitable (612)781-7345 Contributions °Na Gambling Manager Requirements: L A gambling manager license fee of $100 paid annually. Gambling Manager Audwization: GM -32235 -Mi Current License Term: 4/1/2007 to 3/31/2009 f:dward Theodore Rice ® The bxNv dual listed Is not raw** flak license. We have enclosed a LG212 627 Quincy St NE, Minneapolis, MN 55413 applicad0° for the new applicant (612)379-8595 Note: The gmt naww duties may not he ashamed by an Bond: # CCP0050396 indwlduai until they are soensed by the Mir>nesota Company: Fidelity & Deposit mfg CO*d Board. Gambling Mwu4W Affidavit and Consent S.bftnm* 1. I harm never been convicted of a Many or a dime JMWWWng gambling. . I have never committed a violation of law or Board rude that resulted In the my anion of a Kamm issued by the Board within five years before the date of the license appikation. 3. I have new been convicted of a criminal violation involving fraud, theft, taut evasion, mtstepresentation, or gambling. 4. I have never been convicted of (1) assa4 01) a criminal violation invol ft the use of a firearm, or (III) making terroristic threats. S. I Have newer been, or am I now, connected with or engaged in an.11legal business. 6. I have newer had a sales and use tax permit revoked by the commhsloner of revenue within the past two years. 7. I have never, after demand, failed to file tax returns required by the commissioner of revenue. 8. I do not owe $500 or more in delinquent taxes as defined In section 270.72-. 9. I have been an active member of the organization fsor at least two years at the tine of our organization's initial license application, or have beak an active member for at least the most recent sic monft prior to the of kcd ve date of our organization's license renewal. 10. I am not a gambling manager or an assistant gambling manager for anther organhation.. 11. I am not a lessor, a member of the lessor's immediate family or a person residing in the same household as the r, or an employee of a lessor of a premises where this anization has a permit issued from the Board to conduct lawful gambling. 12. I am not involved directly or indirectly as a bingo hall owner, manufk2urer. or distributor. 13. I am not the chief awcutiwe oMcw of this organizatIon. 14. I am not the treasurer of this organkation. 1S. I was not an officer of an organization at a time when an offense occurred which Caused that organbatiion's license to be revoked. ea ftround Check. BY signature of this document, the undersigned adKxtm the Departments of Public Safety and Revenue to a nduct a criminal and tan background check or review and to share the resuits with the Gambling Control Board. Further, I understand, agree, and hereby Irrevocably consent that suits and actions relating to the subject matter of this gambling manager Ream application, or acts or omissions arising from such application, may be commenced against me or my organization and I will accept the service of process in any court of aompethnt jurisdiction in Minnesota by service on the Minnesota Secretary of State of any summons, process, or pleading authorized by the laws Of Minnesota. Failure to provide required Irfiorrnation or prrovkWV false or misleading Information may result In the denial lir revocation of the Ikp" Changes In the ir><nm>ation submitted In this application will be sutmitted in writirhg no later than 10 days after the change has taken effect. I have read this application and declare tthat all information► submitted and nature, in nit, of gambling manager applicant Date:.