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05/12/2010 07:28 FAX 7634418066 <br />Minnesota Lawful Gambling <br />Schedule C/D - LG1010 <br />G®neral Information <br />RIKE-LEE ELECTRIC <br />f~ 010 <br />Orpanrzation Name wganrcaw„ ,~„~, ,.~,,,~, <br />Zimm®rntan Fine Relief Assn 02221 <br />Monbr an0 yearreported <br />5 / 2009 Page 1 of 7 pages !s this an amended SchedWe GD? Y N <br />Schedule C: Lawful Pumose Expenditures <br />Member <br />Approval <br />Date <br />Date of <br />Check <br />Check <br />Number Check made out to_ <br />Description <br />(Purpose) T <br />R <br />C <br />A <br />Code Code <br />A-7 <br />M F <br /> <br />Amount <br />5/19/2009 5/19/2009 8038 SHELLY HAUGLAND MEDICAL X A- 2 500.00 <br />5/19/2009 5/19/2009 6039 ZIMMERMAN CIVIC CLUB CITY CELEBRA X A-1 2000,00 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />~o7E: check me rRC oorumn dike expendiJyre is rrom the Tex Refund Total Schedule C Lawful Purpose Expenditures <br />and croetr (fRC) amount Your organiraeon may not expend nroney Aom for this month. <br />this amount fo-la~Ku! purposes Ate, A-9, and A-72 ar ter arlewaDle expenses. Enter on line 41 of Schedule G-1 2500.00 <br />•hs+rlnlA r)• Rnarrl - Approved Expenditures <br />l Member <br />Approval <br />Date <br />Date of <br />Check' <br />Check <br />Number Check made out to. R <br /> <br />C 8 <br /> <br />Cod® <br /> <br />Amount Ap roomed <br /> <br />Date <br /> <br /> <br /> <br />Board Approved t_xpendiEures for.Recr+eational. Community. & M F <br />Athletic Facilities Intended Primanly fpr Persons Under Aye 21 <br />' 7'o(al schedule D Boarn- Aporoved Expenditures• <br /> <br />0.00 <br />I d®clsre tAet all information on this ,summary and tax return is tn/e, correct, and cornplefe. <br />SignatUle ord7iefexeCUbYC otlJoer Date <br />manager <br />Mail To: <br />Gamblinsl Control Board <br />Suite 300 South <br />1711 West County Road B <br />`osevflle MN 55113 <br />Data <br />If You use a TTY, you can call the Board by usinl7 the Minnesota Relay Service at 1-8Q0-627-3529 and <br />ask to places a cell to (612)639-4000. This form will be made available in eltemative format (i_e_ lathe <br />print, Bral/le) upon n?auest. The Information on this form will be used by the Gambling Control 13oerd <br />to detemlln~e Your comp)+ance w-7h stafutes and rules ooveminp lawful Qamblini7 activfies. All <br />(Rev, 03,pa) <br />YG48:98 Hr162009 Mi»neeo~ Oamok, <br />