88-1112 -
N�HITE - C�TV CLERK COUIICIl
PINK - FINANrr E GITY OF SAINT PAUL
CANARY - DEPA�!TMENT �///�
BLUE - MAYO File NO.
oun il Resolution ``.`�, _
I'�
Presented By ��
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Refeqred To Committee: Date
Out of Committee By Date
RESOLVED: That the req�est for the transfer of location of a State Class
A Gambling License, applied for by Blessed Sacrament School
presently located at 1060 University Avenue to 1494 North Dale,
' be and the same is hereby approved/�s�wd.
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COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimo d
Long, [n Favor
Gosw tz /
Rettma�y B
Scheibel �__ A ga i n s t Y
Sonne�l/
�if�l�lr
_�+' _ � �Q�Q Form Ap roved by Ci Attr ney
Adopted by Cquncil: Date �— ' � G y�/�
/ (i
Certified Pas ed by Council Secretary BY
By�
Approved b l4lav : a ' �L 1 1 1�p Approved by Mayor for Submission to Council
B(_==c��� . ��r-�.---- By
Y
', PtJ9�13NED �;�! 16 198$
_ � I �►►,��,�„� �►►,�� . ��'�i�'�
. , _ ±Q��:�� ��EEfi �: 0 420 41
� Mr. �}. Carchedi
o��r ort�ctoA _ .uww ron�GtMm
Ch stine Rozek "saa" — �.��� ��«�
. . vHO►�ra. , "uN�EA FOF' . - _
- ; naun� �� � Counci 1 Research
, ; : ' 8- 5 _ : o�a: —�- �,,,�,, . —
Ap ication for transfe � o� location of a State Class A Gar�ling License.
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No 'fication ate: 6-2 88 Hearing Date:`"
_ T10116a Acprove(A)«�(pl) - � _ _
REBEARp1 REPli�i':
. . �RJ1l1iRNi . � CML 6ERVICE OATE MI � . MTE OU� � .. .. . - � � �PFqlE Np:� � . . . �-
.. mNNiO �D 878 SCH�.BWWD . � . � � � ��
_ . .. : .STAFF � . .. � (�i�fER�1. �..I` . �MRElE AS IS � . ADD1 _ • .BbT'D FQ CONTA�'.I �. . .4�►i6111UENT . �
_ . _FOR AODi NitD. .. _.,._FE�p(ADO�•
. � . ��(�UNATlON: � - . � . . . , .� � , .
� - � SIR�OR'TE lMIIp1 061ECTVE9 . .. . . , . . . . . � _ . . .-. � . . . . .
.� � �-_. . .. . . � , ; . . . :: . '� �. . . . . � . . � . . � . . . . .
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Ma y Sei:dl , on behalf o Blessed Sacrament School, requests Council •
. ap roval of her requestl or;a change of locatio�n, from 1fl�0 University Avenu�
_ to 1494 N, .�ale Street„ f a �State Class. A Gamb7ing �.icense. The gaimbling :
se sions will be held days between the hours of 1:00 PM and 5:0� PM.
P eeds are donated to ' he school .
_ :�►�+oN �e�rnw.a�: ; . . :
A1 applications a�nd fe' � have been submitted,
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c�oa� rrn.�..�,a To w�,o�r. ,: , . � . : .
If Ct3uncil approval is ven, Blessed Sacrament will sponsor a weekly
. ga bling session at 14 N. Dale St. . If� Council approval::is not given,
th sessions wil'! not held. � ' ' �
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� G ` �
- oa.tasw►n� , I vnos ,�,s
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ine�raar .
� 14 4 N: Dale was recen ;l�y approved for the addition af two new bingo sessions.
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UIVISZON OF LICENSE ANI) P� IT ADMINISTRATION DATE (D ZZ OD / � �'Z a �
INTERDF.PARTMENTAL REVIEW CI�ECKLIST Appn P oc ssed/Received by
Lic Enf Aud
Applicant ��e$5� ..�RC��M� ��ome Address /Z(!(,p Q I(/I�►
Ausine�s Name Home Phone �5 7 "� SD�
Busine��s Address ��7 4 �0 ��Q,�� Type of License(s) �`Q,.SS �
Businei�s Phone �QI'1'� ! �' L,D 0 ��a h �(.,J
g 5
Public Hearing Date � '�,� � License I.D. 4{ ���a�(
at 9:00 a.m. in the �ounci ' C ambers,
3rd floor City Hall and Co rthouse State Tax I.D. 4� N '/4
Date Notice Sent• G / Dealer �l N � /�
to Applicant �6 � ��
Federal F3xearms �� ��'�
Public Hearing -�
DATE INSPECTION
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
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Bldg'; I & D �
N �� ;
:
Heal!�h Divn.
N`�, �
,
Fire Dept. j ' �
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Police Dept.
l
a���� � �
Lice�ise Divn. �
��Z�, g�� C��L
Cityi Attorney �
��a���, o�.
Date Received:
Site lan � �Z.'.
To Council Research � ��` �
Lease 'or Letter � '� a Date
from Landlord
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� �. .��: . _ ��//�a
� Charitable Gambi ng Control Board FOR BOARD USf ONLY
Roam N-475 Gri gs-Midway Building
� 1821 University venue� �°'�""�""
_ St Paul, Minnesdta 55104-3383 AMT
, • _
� ' � •�` (612)642 055a .
{� . -..: CHECK#
�:` t:'. . , �. ... . DATE -
� GAMBLING LICENSEaePUCAT101Y: ,, �,,�- ..-
R ����f��,.�,. .��„r,''�,�:- :'., .:
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E INSTRUCTI�DNS. � '
; A. Typeor',printinink. •
f B. Take co1!npleted application to local go�eming body,obtain signature and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with a check.. ` '
C: InCOmpliete application�will be retumed.
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� Type of Application:
E �IClass A — Fee 3100.001Bingo,Raffles;.Paddlewheels,Tipboards.Pull-tabs)
� ❑Class B— Fee S 50.00(Raffles,Paddl�wheels,Tipboards,Pull-tabsl ��snar•b�•�:
� �Class C — Fee S 50.00(aingoonly) , � t . M�^""a'p"�'a'�"g�O"10�� -�.
,....:,,F;�.,. CJass..Ot.--_-,Fee�S.�25.Q0�IRaffles�or�iy):, �...,:, � .�:'�a� - _ _x:: � ,_.. . _ _
� ❑Ye o 1. Is this application for a re ewal? If yes,give complete license number � - � - �
� �Yes�No 2. If this is not an applicatio for a renewal,has o� anization been licensed by the Board befo�e? If yes,give base
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` license number(middle fi�e digits)
� yZlYeaONo 3. Have Internal Controls b �submitted previouslyl lf no,please attach copy.
� 4: ApplicamtlOfficiel,legal name of orgarlization) 5. Business Address of Organization
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� 6: City.St�te,Zip, 7. unty_ 8. BusinessPhone�Number
.r �' 1 ) — �
� 9. Typeo brganization: ❑Fratemal C]Veterans �Religious: OOthernonprofit"� _.
i 'If organ�Zetion is-an"other nonprofiY'organization,answer question�l0 through 13.Jf not,go to question 14."Other nonprofit"organizations
� mustda�cument its tax-exempt status.
� DYe�❑Natr 10. Is,organizatiortincor oratedasanonprofitorganizedonZlf�yes,givenumberassignedtoArticlesorpageand ,r,..
�� book number: Attach copy of certificate.
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OYes�Na� 11. Arearticles filed with the Secretary of State7
�Yss�Na 12 A�e articles filed with the County7
� QYea�i Na 13. Is organization exempt ffom Minnesota or Federal inc�ne tax?If yes,please attach letter frorrr IRS�or Department of
Revenuedeclaring exemjption orcopy:of 990 or990T.
! ❑Yes�N� 14.. Haslicenseeverbeen d nied,suspended orrevoked7lfiyes,checkatl thata ly:
� ❑Deniect ❑Suspen ect ❑Revoked Givedate: - -
�` 15. NumbeROfactivemembers 16. Numberofiyearsinexistence Note:. Iflessthanfouryears,attach
� evidenc�of thre�,years^ j � ��-,,�,
� �rz:s _,�;�� --�� -��.. . �;- �:_-�_ . � �=.. <,-_�. �-��-��- ''� -exisfertce: '. f a--.." , . . ._
1 T._ Name o Chief Executive Officer ' ' 18. Name of treasurer or person who accouMS for other revenues
', of ihe organization..
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� rt e. rtie� , �, _
, _._ � _ ':.
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` Busine"s Phone Number_ B'usiness�Phone� mber
f _
( ) 7/ �* �)."._- .. ,,,' t f_` � 1 �"- �' /
19. Name o establishment where gambling will be�: 20.. Stceet address(not P.O.Box Number)
condu ed �;` 'f
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21. City,St e,Zip , 2 . County(where gambling premises is located! �
; �„ ) ' �� l � --�
CG-0001-02(8/861 White+C'oPY-Board anary-Applicent P'ink-Local Goveming Body
• �- ; ' � . ����_����
GambHng Vicense Applicatiort Paga Z
Type of Appilication_ �Class/� ❑Ctasa B OClass C ❑Ciass D
j�lfes�No ��23. Is gambling premisesioca ed within city limits?
�1fes�Nof 24. Are all gambling activitie conducted atthepremises listed in�19 of thi�application?If not,complete a separate
application for each prem�ises(excepi raffles)as a separate license is required for each premises.
❑Yea�J110 '�5. Does organization�owrt the gambli�g premises?If no,attach copy of the lease with terms of at least onayear.
j$Yes�No 26. does the organization lea e.the entire premisesl If no,attach a sketch of 27. Amount of Mo�thl Renr
the premises indicating w�at ponion is being leased.A lease a�d sketch $
is notrequired forClass D applications. �°�
�lfes�No 28. Do you plan on conductin bingo with this license?If yes,give days a�d times of bingo.occasions:
� �Y� � �d�rt .� �� Tim�s y .
Yes O No 9. Has the S 10,000 fidelity ond required by Minnesota Statutes 349.20 been obtained?Attach copy of bond.
30. Insurance Company Name 31. Bond Number
7� ", � � � - - �,►�
32. Lessor Neme� 33. Address 34. City,State,Zip
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. � J �f I . I ���.� .�; � w�. -.✓.�C� .°., r�e''�J"
. :..�. . . � _ � .� __� �- .. ._..� _._ •- -- -� -� ' ' _. �. � . . . . _.. . . +_. - .. ... _
`�' ''�"35: Gam lin�Manager Name: �6: Address 37: City,State,Zip
3; i i" � — .- ,, .�.-!/�_
38. Gambl' Manager Business Phone 39. Date gambling manager became �
( � ^ � member of organization: , �•;�
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GAMBLING SITE AUTHORIZATION
By my signature below,local lavu�eFlforc mentofficers.or agents of the Board are hereby authorized to enter upon the site,
at any time,;�ambling is being conduct ;t�oliser"vg the gambling and to enforce the law for any unauthorized game or
practice. '
BANK_RECORD�AUTHORIZATION-
By my signa�ure below,.the Board is hereby authorized to inspectthe bank records of the General Gambling:Bank Account
whenever n�tcessary tQ fulfill requirements of current gambling rules and law.
- OATH�
_ I hereby declare that:
1. I have read this applicatiort and.all ir�formatioR submitted to the Board;
Z. All information submitted is true,:ac�curate and complete;.
3. All othe�r required information has beert fully disclosed-
4. I am the chief executiv�officer of t e organization;
5. I assume full responsibility for the f�irand lawful operation of all activities to be�conducted;
6. I will far�ilia�ize myself with thelawsof theState of Minnesota respecting gambling and rules of the Board and ag�ee�,
if licensed,to abide b those laws a d rules, includin amendments thereto.
40� Official,Legal Name of Organizatiort ' 41. nature(must be�signed by Chief Executive Officer)
�r "�J � �'►� X r��F7 �� ���� � �'�--r,-� .,.f. f ,�..i
itle of Signer. , te �,`
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ACKNOWLE[�GEMENTOF NOTICE BY LQCAL G�VERNING.BODY
I hereby ack�owledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with
notice that tMis application will be reviewed by the Charitable Gambling CoMrol Board and if approved hy the board,will
become effective 30 days from the date pf receipt(noted belowl,unless a resolution of the local governing body is passed
which specifically disallows:such activity and a copy of thai resolution is received by the Charitable Gambling Control
Board withir�'�30 da s of the below noted date.
42. Name of City o�County(Local Govemir}g Body) If site isJocated within a township,item 43 must be completed,in
!� -•- �. ; � addition to the county signature.
+,_:.. `�• � :.y�`"'"�' .; � ��./
Signature of p�e�n reeeiving application i 43. Name of Township.
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X �,: `'- . _ �.;_, ,'t 7-;
Title Date received(30 day period ; Signatureof person receiving application
begins from this date) ! �r' ;
_ _:,.� �-:•=i -�-� i / ' {4'�, �� X
44.,Name of ,�/ elivering applicati�dn,to I Goveming Body Title
� !`J�. ..-T � ./t.� �! � � �
CG-0001-02� (8/86) White�opy-Board Canary-Applicant Pink-Loca!Goveming BodY'
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' City of Saint Paul ���/��
� De�artment of Finance and Management Services � �'1 �
Licensa a�d Permit Divisiorr � � 0�
' 203 CJty Hall
I St. Paul. Minnesota 55102-298-5058
. • I APPLICATION FOR LICENSE
CASH CHECtC CLASS NO. ' New fienew
� a Q �� ���� �o o � � /�
� Date �� I -` � 19� ")
Code No. Title of Ucense I � ' �(
From �� _ o Z_19�+ �
a�� -, ►<,�- ; ��, .. ��, �,� � � = �J--� �-
�oo i<i, c � —��' .� �� � .�f ��_�c
��� ,� ^ � APWIcanUCanpany Nams
�W \�
� � �I U�7 �-i �..i 'J - `�'!' -/
100 euainess Name
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100 � � '
' Business Addtess PhonrNa
100
, 100 Mail to Address PAon�Na
� I 100 L • �:"' . i
i ; j !� � �� 1� : �► �
L
, ManapenOwnsr•Name : ..�- '• �
I 100 , �'� - -
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i � ��� �. i`� �-i + t1� �� � ��.i �,
' 100 AlanegaNGwnK•Homs AddtesS PIfOM N0.
. 4098 AppliCation Fee -•.
2. � , • ( _ -
' Recelved the Sum of � � .� 10Q � .�l _ `j i � Til �� � � ��') %^ J ,� ��•�
f .,i i�� �V
Manager/Owner•Ciry,State&Zip Cods
100 Total 100
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, � ' i� �y'I� „�_%�. ✓ /' �-� �..:�C��
, License InspBCtor �--% � By: � `�' ' �ignature of Applicant
�
Bond•
Company N Policy No. Exqintion Date�
insurance• '
Company Nam Policy No. Expiration Oate
Minnesota State Identificatlon No. , Social Security No
� Vehicie Information:
Serfal Nu ber ate umDet
Other.
ITHIS IS A RECEIPT FOR APPUCATION
THIS IS NOT A UCENSE TO OPERATE Yo�application for license will either be granted or rejected subject to the provisiona of the zoning
' ordinance and completion of the inspectio a by the Health, Fire, Zoning andlor License Inspectors.
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$15.p0 CHARGE FOR ALL RETURNED CHECKS
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I "' O� '�' F� "�/�--,�
. , Cit;r oc Sainc ?aui ������
� . DeoarL:aenc oi r'inance and Maaagemenc Services
� Division oi License and Permic Regisc�acion
INF4RMATIDN REOUIREJ ��iITH �P°f ICaTION :OR ?�3PiIT TO CONDU� C�ARI?'�BLE G�t�BLZ`iG G� T_:�
� SaINT P9UL
1. Fu1Z and compleca name o organizacion •.rhich is applyiag Eor license
/'';,�� �� S�e cf� �c �2�bzle k f �-�-� D d �-
2. Address where games will 'be held ��{�1 L/ //d f,� � ��, ��. ��tJ�
- yumber Screec Cicy Zic SS%r7
3. Name of manager sigaing �his aaplicazion vao will conduc�, apezace and aianage
Gamb�.iag Gaates �-/'Ly �,�_/ D L- Dace of Birti �j � � v -�}�
T
(a) Length of time manag r has beaa me�ber oi aoolicaaL orgaai�acion ��/ � 1 `� .��
4. Address of ;�faaager b2( � , � ,�h �f• �z L� � S� I
,Yumcer Screac Cic;� Zip
5. Day, I' dates, aad 'nours chls applicac�on is cor ���� /��� 0 - i` od p/=-/
6. Is the applicanc or orgar�izacion organized under t�e laws at c�e �tace oi ;!PI? �
7. Date cf i.ucorporacion __
8. Daze', wEtea registered with the Stace. at 2�taesoca
9. Hew long has organizatioa beea. ia e_ciscaacs? 3� � P�K.�
-� .. ',
10. How long has o=ganizatio� bes� ia �Y�caac_ ia St. �au�? � a- �/�Z <Z C
11. What is the purpose af che organT�:ation? `�� �� � :��� � ( �? 7�z d �� �, ��dC''�/%�a �,
� -
� o �YL r�i e C`° �� ��YC.e �/ --
I2. Officers of aopiicanc or�an:zac;orc
Naase ���tir d t l �. I��rl �c3 Va�e �_�a P � �Q �'1 f'/� r��c
Addrdess /7 ,�_� ��/1�J Z�P �t. S'�/d 6 :�ddrass ,�`� U.����c? �.�� G.Y'"
Title��� �-coe�t DqB g-//- Y�� L=='z - �OB (� d 3 's`L
Name �P o /�L� r� 5�i � 2 P Yame , c ��C c 1� � C -�
�'
Addr�ss � � � � � (�'�2.-� �i-e_ �d�rass �� � 07� .S-�2-
'ritlde ��(.e_,.e - �Z?/�•Z. DOB J '/ �'S�� ='=�=e /'.� - rZ 70B �'-�c^! _`�.:
i
13. Give names OL OLLfCerS, qr any OC�B� �ersar.s '7f1C 7d=: :0� S�'^'-C93 =:+ =:� �rS�^==°-�=�n•
�tame j �n� 1 1'1 �. Yame
Addr ss ��a=°=�
Ticla -=-= -
(,:��ac:^ sepz=_ca �:.a�- -. - �c:.---_..__ ..�=_ .
I
� , � ���"_0O ���
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14. �Ctached he:eco is a Iisc of naases aad addresses oi ali members oi :�e organizacion.
15, In whose c•sstody vill or�anization's records be kepc?
� NamQ r ��v ' p Address /;�U !� �'Tf?'! P �,
. ^
16. Per�oas who vill. be conduccing, assisting in conduct2ng, or oper�ring the games:
Name 2 � � (> �-� Date o= Birth 3 �30 �s
�ddress 1�(j, G� �-`3 2 'J i �� (st� �S� �zc/ �-
Name� oi Spouse � � �� � �� l ,Q L... Dace of 9irth ���P� " `f S
Daces vhen suc:: oerson v�,1.L conducc, assisc, or operace (,(J�1e „1 /�,� � �'�� r �
Name� �d � ,jC. Z d Da�e oi Birth y� 5'-' .�j 5�
�ddx�ess /�� �� V ��� �.�.1 ���'! P_
Naae o= Spouse �� � ���I ��� uv yL2. O� Dace of Birth
Daces :�zen suci �erson •.r�CI? concLCt, ass:s�, or ope_ate ��� p �,, �� c�SS Z�y
I7. Have ;►ou raad a�c �o ?au caarougal� uadezstand �he orovfsicas of a�l Iavs, ordinances,
_,
aad regulatior.s `eve:-t_^. cae operac;oa ct Char:tab_e Gaztb�'_^.g ��es? �'-�
18. Atta;c::ed herec� oa �::e :o:-= cur..i.shed 5�� c�te C�=7 oi St. ?aL1 :s a Finaac:a1 Report
whic':z :�z�izes a?'_ :ece_:cs, e�eas�s, and s;sbursemencs o' c:^.e agplicanc organization
� as �.rel� as ai= oraar._�a:;.ozs �ao aave :e___red :•suds �or tae grecec��.g ca?endar year
'w�1fC1 :d5 j2�.^. ���.^.8'�� _^��7$I'?1�� 8AG V2��..�OL' �7 ��It� �� `� L-'
tiame
/�� Ll �/��[ � � ` � / • .
!
�� �!:(�i��SJ'
�
vho is c:�e o� �:se aavlicanc Organizac'_on.
. V�e �= OL=_.:_ �
19. Operaco: or p-a�:,es �ae:a rames �.:�_ �e ae:a:
Namel
' �z l�o «d
B�Slness nddreSS I �P � �/
Home;, �ddress �q 1 j'// a!'t r�,7 c�f . J�� �, [, �S / C) (
2�. .�II1011�1C OL *er.c 7d�cZ JV d7D���3IIC i�tT3aiI.�3C_C:I :Ot �O_.^.0 �►' =�8 �73��; SDeC_i;� dIIOl1t1C
I �
paid'' ?er '+-hour se�_:aZ _S . L� �
_ _ ��/l/�
2l. The proceeds o: cze garaes vfll be disbursed aiter deducting prize Layouc costs and
� operacing expenses cor ck�e Lollowing purposes and uses:
, o . �
. ,, � �
� .
2Z. Has the preccises vnere c;�e games ara co be heid been certified Eor occupanc}• by che
Cicy oc Saiac °auI?
23. Eias �our or3ar.izac:on ,'��ed cederal �or� 9?0—T' � I� ansver is ves, please ac�aca
a copy vic� c:.is acol?ca :on. L: ansc:ar is ao, .c�Lain vhy:
Any changes desi:ec �? cae a��L:ca�c :ssoc:ac=on �a� be �aae onl.r vich c�e conser.c o� che
Cicy Cc+unc:L. ,
i � ��
'I Orgaa_zac:an
►�ate So � 3 "c� � By: �c.�C�.e �
� � e: ia cnarae ot game
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