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<br />,'. FOR BOARD USE ONLY <br /> FEE <br /> CHECK <br /> INITIALS <br />'. LG214 DATE <br /> Minnesota Lawful Gambling <br /> (9/5/00) Premise Permit Application - Part 1 <br /> Org~rtl~~~9Pt~!9f;11~'t!9P:...........:'..!;.,.",??,.... ..i..i/...?\... ..................}........}...........................,......................................,.....\i.\?/\i.................... <br /> Legal Name of Organtzatlon . <br /> 5HOR;;V/~U/-A-JJ)E).J fI/i-!-f; L/P4l5- CL iI!3 <br /> Business Address of Organization. Street or P. 0 Box (Do not use address of gambling manager) <br /> 3,j) ~c.t7 L/l/I/6- <br /> City ///l/~5- State Zip Code County Business phone number <br /> L'/i'?CL6 //'/ A/ ,;7070/1/ fJ II fi fa:;. (iI]) L/LJ'6J-/'?93 <br /> Name of chief executive officer (cannot be gambling manager) Title Business phone number <br /> &;1:30 j} {;, r: FIf!2X/15 /!le9/~C;fl/ (4'1j ,/SV-070D <br /> Address of chief execuoven ~ Street 0( P. o. Box <br /> 7?iJ L/f 50/1/ Cott/( T <br /> City 7)hJ,{~;J; GW State Zip Code County <br /> /11/V 55/ .J-? d/17-1!:5c! Y <br /> / <br /> Class of Premise Permit <br />. o Class A - Bingo, Raffles, Paddlewheels, Tie""ards, Pull-tabs <br /> .s Class B - RaH!.s, Paddlewheels, Tipboards, Pull-tabs The class of premise permit <br /> o Class C - Bingo only must be reflected by class of <br /> o Class 0 - Raffles only the organization license. <br /> Bingo Occasions <br /> If class A Or C, fill in days and beginning and ending hours of bingo occasions: <br /> No more than seven bingo occasions may be conducted by an orlfanization per week. <br /> Day Beg1nnJng/Endlng Hours Day Bcg1nningJEnciing Hours Day Beginning lEnding Ho~s <br /> to - to - to <br /> to - to - to <br /> to <br /> Status of Premise Permit - check one: <br /> 0 New premise - Fill in ~ organization premise permit number <br />.~ Renewal of existing premise permIT - Fill in comDlete premise permIT number f3- 0;3 i /t9~OO;{ <br /> Previously expired premise permIT - Fill in comD'e!e premise permIT number <br /> , <br />