Date: ______/______/______
The following is a lawful request for financial assistance from the Big Lake Sno-Cruisers Snowmobile Club under the guidelines set down by the Charitable Gambling Control Board of the State of Minnesota.
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Requesting Organization or Individual: |
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Address: |
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ZIP: |
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Day Phone: |
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Evening Phone: |
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Name of person submitting request: |
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Address: |
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City: |
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ZIP: |
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Purpose |
Education: |
Health Services: |
Parks and Recreation: |
Other |
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(Circle One): |
Disabled Persons: |
Youth Activities: |
Community Project: |
(Describe): |
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Reason for Request: Use back if you need more space. |
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What is the total amount needed? |
$ |
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How much have you raised so far? |
$ |
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How much are you requesting from our club? |
$ |
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What is your area of service? |
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What other organizations have been approached? |
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Which will help you? |
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Is approval also needed from another governing body (school board, city council, etc.? |
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If so, have you received approval? |
Yes: |
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No: |
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Explanation: |
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From Whom? |
Name: |
Title: |
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Make Check payable to: |
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Date Needed: |
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Account Number: |
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Address: |
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City: |
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State: |
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ZIP: |
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Name of Big Lake Sno-Cruisers |
Day Phone: |
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Member investigating request: |
Evening Phone: |
Name of Committee:
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Committee Findings: Use back if you need more space. |
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Committee recommendation: |
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Date: |
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Board of Directors action: |
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Club Action: |
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Date: |
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Date Paid: |
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Check Number: |
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Signature: |
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6/8/97