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<br /> . <br /> - <br /> LG214 <br /> Minnesota Lawful Gambling <br /> . " , ' . .' Pre~s.e Permit Application - Pm:t2 <br /> j,tt'-@/dJ;;.A/1>>/73 ' " <br /> nliWlijU.~~!'t,~~lfW(dfm.t11drl!11m:!l,l!li!liilllllllllIII llllllillllli!ili!mlll!!ill!.III!II!III'!!11111111 i!M I11I <br /> Name of establishment where gambling will be conducted Street Address (do not use a post office box number) , . <br /> ~0';';'-~S~ -- P", IJ,() \ W (I O<J>\ \<.. Rc\ f- Aa/ 'et\ f{.,'II.:S trJ n 6sJ;<A <br /> Is the premises located within city limits? q(yes Onc \ <br /> City and County where gambling premises is located OR Township and County where gambiing premises is located if outside of city limits <br /> 1'4c:-d'fA'\ 1\: \ ( 5 I Q ~ S'-<.~ I City State Zip Code <br /> Name and Address of Legal Owner of Premises <br /> ~-dX'\C<.:J m0- 0\\\0 11001 \:2,'I\,.-1'e\r ad ~ "'fJco( l0 Rr//J1 /?xo.Gh ~) 3,5 L,{)" <br /> Does the organization own the building where the gambling will be conducted? 0 YES txl NO <br /> NOTE: Organizations may not pay themselves rent ~ they own the building or have a holding company. A letter must be sub- <br /> mitted showing rent payments as Zero from gambling funds ~ the organization's holding company owns the premises, The <br /> letter must be signed by the chief executive officer.) <br /> If NO, attach the following: <br /> . a copy of the le'ase with terms for one year. <br /> . a copy of a skelch of the floor plan wtlh dimensions, showing what portion is being leased. <br /> A lease and sketch are not required for Class D applicantions. <br /> . Rent: <br /> For gambling wtlh bingo $ Tolal square footage leased <br /> For gambling wtlhout bingo $ leOO-OD Total square footage leased <..50 <br /> Address of storage space of gambling equipment <br /> Address C~y State Zip code <br /> *See Attached <br /> IGlii.mIfF!~f~~!gJ!imillllillllllI111111-ll!!!lllllilllilillillili!llllIIII11Ilillllillllll;111111!!::;flll'1IIIII'7!:I.;..1 <br /> (ellCh p.m;Jtted g.f!1b1ing p,..mJ... mu.t.h..V........".r.te cheCiiing"""ccOunt) .. . <br /> Bank Name . l Bank A~unt Number <br /> YtJon.0'<.:S--\- 13'4fJ ;)0 <66 "7 ~ <br /> Bank Address City State Zip Code <br /> lA--{'rl~ ,\\\ \\5 Yhn 55 II d <br /> Name, adaess; and title 01 p6rsons 'authorized to sign checks and make deposits and withdrawals, <br /> Name Address Ti~e <br /> - ----- <br /> Dennis Brandanger 2344 Nicollet Avenue. Suite 280 Board of Directors <br /> Garv Thalhuber 2344 Nicollet Avenue. Suite 280 Rn~Yn of nir~~rnr~ <br /> Tom Trisko 2344 Nicollet Avenue. Suite LBO Director of Finance <br /> T~np Tvpr~()n /'-{44 Nirnllpt" AvpnllP ~llit"p 7RO nirpf't()r ()f <::O"l""'lT:iCP.~ <br /> . Carol Cramer 2344 Nicollet Avenue, Suite 280 Director of Administration <br /> Fillgrg M'mggr 231, '" Hicgll..t: _^"QHU". Suite.. nQ E:reeuti:r:C DiJ:"C-.-etsY <br /> , <br /> .-.---.---.- . :i'Jr.-'--' <br />