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<br />, . <br />LG214 <br />, Minnesota Lawful Gambling . <br /> Premise Permit Application - Part 2 <br />GiH*bnril!lliiiMi~a~Jflf6ii4ltfidfi;..I .....iti;'......tllul;...:......../;....iI!!i I;..;......;;!!;;.;;.......................... <br />Name of establishment where gambling will be conducted Street Address (00 not use'a post office box number) <br />~/C je)) 7/1//6'( CLH!J 1/7c'3' M ).)wI/, III /f,fJJ6AJ II/I-l?; /fl;v 5b I/;;? <br />Is the premises located witl1in city limits? o yes o no / , <br />City and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits <br />1t~J}e/J #/I-L5 I <br />Name and Address of L&g21 Cwr,er of Premise~ Ci'Y Stats Zip Code <br />-;J' (? fiJI:), v</G 1--;5(; H ;ell:? ll.ftiyt1 r7'f law J/7J; JJ!/j/ 7.?'/lS <br />Doe. the organization own the buildog where 1I1e gambling will t>e conducted? 0 YES ,0 NO <br />NOTE: Organizations may not pay themselves rent IT they own the building or have a holding company. A letter must be sub- <br />mitted showing rent paymen.ts as zero from gambling funds ~ the organization's holding company owns the premises. The <br />ietter 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 sketch of the floor plan with dimensions, showing what portion is being leased, . <br /> A lease and sketch are not required for Class 0 applicantions. <br />Rent: <br /> For gambling with bingo $ Total square footage leased <br /> For gambling without bingo $ 66!{)d)O Total square footage leased ;Y4i?O <br />Address of storage space of gambling <>quipment <br /> Address City State Zip code <br />/0'17 ;J;rY/f/t:! /lYe. :5; ,p,4-tf{. /1//1/ J7/07- <br />~~i~;gt9.t~.ii~~!pP::................';...;!'....:.;;;...;.....;I;.;I!................................................;;;;;;;;;!......!:; ......................!:!.......... ................:..................;... <br />(each permitted gamlJJJng prem'.... mu.thave II .~iir.'. ChttCj("ng "ccaunt) <br />Bank Name Bank Account Number <br />Fd?7TA/1. !l{)pe'{/;u6 f}/fA//( 1i/70y t?6 <br />Bank Address City State Zip Code <br />:?'/tJp ~ :3/Veul#G Ii vf€f!1 Ll!3 //,$' ..7'.:7// .7 <br /> Na.me, adaess, and title of persons authorizoo to sign checks and make oofX)sits and withdrawals. <br /> Name Address Title A <br />';;GtJ;[J6G F/ll;'(/i5 ~ .,;!I.I'l1ev/br/ <br /> 7?:;; 1+r/?.7t7/i/ c. 7 /iAJ 1,f67/ <br />j(/J/JI)JV 1/)..fCq- ~y :j~ C/hn&:C /.A. C/!2.c.LI! jJ/;j)~3 /Jt/l/ 7dv' <br /> , " ~ <br />G~tJ"t.0~ /3 tJ.o /77 G If. h.d <i1l-L.v/;tJ W, 91 ;JA-/{L /11JJ1 /!14 / <br /> . <br />