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<br /> :.lI.o <br /> , I,>: <br /> l;i <br /> " <br /> ~ <br /> F6RBOA.RO lJSEONlY. I <br /> BASE # <br /> '7l <br /> pp# ':1 <br />. FEE <br /> Minnesota Lawful Gambling CHECK <br /> Premises Permit Application - Part 1 of 2 INITIALS <br /> DATE <br /> IJ!lltfJI\:M:!I'llllillilJlflI1I1111i;1111l11Iiill'II!;jijIIIIIIIlliitl,;rJII~11111111Ii;11111Ilii1rl~lr.i'jt)llt[11IlltJJlllIllrillrllfllllll,II/;I;1111 <br /> rst Class of premises pennit <br /> Renewal COf'?f (check one) <br /> Organization base license number If ;:8J: A ($400) Pull-tabs, tipboards, paddiewheels. raffles, bingo <br /> Premises permit number OoG 0 B ($250) Pull-tabs, tipboards, padd1ewheels, raffles <br /> D New o C ($200) Bingo only <br /> 0 o ($150) Raffles only <br /> <br /> Name of Organization <br /> C-fluR.Ctf ",,p w:- H If e.t {:oHlhVfI!-P oR/; OjJo <br /> Business Address of Organization..; Street or . 0 Box (Do not use the address of your gambling manager) <br /> .,;-4 W=tJO <br /> City State Zip Code Daytime phone number <br /> ST- <)<;" II (enJ -4\" .. Sc;:(f <br /> Name of chief executiv officer (cannot be you'r gambling manager) Title Daytime phone number <br />. P-II-IL F:>Co tJiTA ~ f2 "-S. ( ClI...) G 1( .. <>>1.r1' <br /> Bingo Occasions <br /> If applying for a class A or C permit, fill In days and beginning & ending hours of bingo occasions: <br /> No more than seven bingo occasions may be conducted by your oIV"anization per week <br /> Day Beginning/Ending Hours Day BeglnnJng/Endlng Hours Day Beginning lEnding Hours <br /> (, j "-0 7;1<; P"tD 9'",,, ~1-1 - to - to <br /> w<V 7: /'>. l'lb 1/ : Pf' /'1-1 - to - to <br /> 51'9-1 m(~/\, /:= he" Ifbingo will not be conducted, check here CJ <br /> <br /> Name of establishment where gambling will be conducted Street Address (do not use a post office box number) <br /> IIt1J7,{/ I-I-,u, . D(,(/ G", ff/J-tL -:J77C Co,J;.Jc.LLt/ ~U) <br /> Is the premises located within city limits? DYes DNo If no, is township o organized CJ u~organjzed CJ unincorporated <br /> City and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits <br /> 1J~,u /..L N jr cP, <br /> Name and address of legal 0 oar of premises City State Zip Code <br /> U/lL.917 <I .4-r5o L, (0 17 F~4 /lu- 57- &vii HtU >SI <br /> Does your organization own the building where the gambling will be conducted? DYES 051 NO <br /> If no, attach the following: <br /> . a copy of the lease (form LG202) with terms for at least 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 applications. <br />. )77C Co;U'v<i.C-Lp /t' ,R./J f,J ffIU--f/ ItAJ STilL. <br /> 1ft/'\. <br /> I , <br /> , Q <br />