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<br />. <br />--~-~~-~~--- .-----".-- <br /> <br />Feo Dnlc' <br />Chk Inil;al <br />CG300 <br />(Rov.10126189) l Liconso# <br /> <br />~ Minnesota Lawful Gambling --------------- <br />Bingo Hall License Application - Part 1 <br /> <br />(See instructions for completion of this application) <br /> <br />Is this application for a new license, or a renewal? 0 New C><i Renewal (J.;tSr 15SU~{J IN 1'16'0 <br /> <br />Bingo Hall Information <br />1. Name of bingo hall j , Bingo Hall Phone counk (where hall is located) <br />J?_Q I . 0' C;; 0 \ ~_ ....____=____._.J..(, t C!J~3L.1.~~___CI..rl'..fL'"'_L________ <br />Street address of hall _ L City or Township whore hall is locatod State Zip code <br />377C, CO.AJ_M_J::1_'L___ ......_J.l.rtD_c;;.v l:hLL~_____(rLA!._. __$$//~.___ <br />2. Mailing address of bingo hall City State Zip code <br />c:.~1YI ~ <br />_._--~---_. <br />3_ Is lhe bingo halll~;~ed within cl;;;i;;';:;-~~s [21-~o- C~ 1-;;-:~-::~;;;~:-a~;;~:~~;'I~-i~~hIGh~;;9~~~~~cated ___u_ <br /> <br />__.._.____________~._.___________________________ ________n.____________________ <br />Owne11s) Information (Attach additional sheets, if necessary) <br />4. Name olloga~'l"r:dOI bict~all PbQ':Y t:+- It:.\. ST ?Av L ~~o/n~ 4s B. 8~-- <br />'-"--~rr~ ress _s________ ----------------..------CifY------------ ...------State- -. ------Zip-code----"-~.- <br />. I 0 l3 l=" ....Ro".!\'. __ s.-r_~~_______s i_8:J.:::':..L____Ii1./../ ._66 /O-3~ <br />Type of Business <br />L_~_-.J Sole proprietorship C---] Partnership [-l?:.<'fZo rpor at ion <br />~ . I <br />~ ~--'--. . - ,. --.---- -----_.._----,---~.------:------------ ------_._._-~-----_.-- <br />48. Names 01 ail owners, ol1lcors, dlr&clors, partners, ill10 rnanagersisllp(;lvlsors <br />(each person named must fill out a separate Bingo Hall Personnel Information form, CG315) <br /> <br /> <br />.~.L..ou l b -.W~ k.s.l:L____~__~_ ~ Q e.o.01_~I~~---_-=------ . .. .._____~_____ <br />_ b-:!O,,",AJ _ Lu r.:j lS L+ ___8________. ....___"-_______ _____ <br />~ ~.91d lC-; S l <=.~Q'_<.!___~_______________________ i___________ <br /> <br />Lessor(s) Information (Attach additional slwe:s il necessary) <br /> <br />5 ~~'hessorl~ f'n4tU moVl ~t.J) -'I g 8 8.,)~0~ <br />~~ail~~..--~--~dL21------------ " CitY- --------------------STafe--------------- ----ZipCoae <br />_LOB rg9fo.J.~_____ ~TPA vl________lll~.L ... __,-5S:~O 3 <br /> <br />Type of Business <br />[ -- 1 Sole proprietorship r.=:::::] fJartnership [~poration <br /> <br />Sa. Names of all owners, olficers. directors, partner's, and managers/supervisors <br />(each person named must lill out a separate Bingo Hail Personnellnlormation form. CG315) <br /> <br />a. ~ OVI.<5. W A L'i::,JL d m________.. g ____m_____ <br />b. e. h. <br />--c.--'--~ --..---..------- -j---------m------------------------i. .,,--..------------------------ <br /> <br />~ --. ----.--.-. p-----..-..-------- <br />