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<br />I RECEIVED
<br />3 1995 FOR BOARD USE ONLY
<br />I LG214 . .. - APR. BASE #
<br />(7l21Wl1
<br />.'/'-'. ,. . art Of ARUEN. ~l~ :' " .~_.
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<br />.-!"~..::;:.:;.~~';. : '_<:':."_ . -- ... '0 .:-_::-~> ,...,_---~--;~..:'- CHECK'. .n-'--:-~.~~i~ ;T.;~:":
<br />,,',~_. .. ' ^ MfnnesomLawjidGambllng,_ ... .._, ~_='
<br />._'.';:~:~~~'~:':"-"_ .. ,-'" ... ~ ,'. .... -.-rt" ,5..~-:". _..:;.;;.~-.., . ~,..~ ~.INIT1ALS;}-.,,,ti'_.. '-'."":~
<br />'~,.> :.... ...,'. Premises PermitAppHcatiOIL-:-.PartTof;2y,::-7 -,.. ..'..'.,,_ > "4'
<br />1~~::;;S:iS.~4ij~&,~'!;~j!iA~~~~"4i~~ ~'t:~ ::;-;: =:~ .
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<br />I '-,~:';1~~;.:.:c ,c.;;;;_ '~~.~':~~;:;;:~~Z;;;~~1~~~:~~{:-~~~:~:;~"$~~~_~'-~~;:-~:-=~~:~r0~~ Class of ~-- permit":;~~~~':~;.?~l.1f
<br />O-_I'Ien~';':';:;~'number .,~",~ .. -::- ~.~T$400; ="~;;;~els.raItIes;lingo
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<br />I --~"-, PN"'-pemlil...- ,..._, . -0 8,($250) PuI-IeIl&.1ipIloerds.r~;~~~::;~:~";\;:~:;;
<br />~ 0 C($2Oll) BIngoanly, . ";.':"-".:;,..w;'"
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<br />I Earthstar. prOle~"$"rnC'..........,..... ,.,.,~ _.............,.~~..',.,~ .....~-_. '---'>+""-"'~-;?'~;::
<br />Business~. of<:lrganizalion -~ cr, P'o.O, Box (Do ~ use..... _. of your gambling manager);,....~ """I"-".c::::-- "",..;;::~?!:;c,
<br />-1* - ~_. ~.-. '."' ...~:.. ...."...,...'....--..:_' .1;,..- ~~...,..-;i._...... _ ".' . .,~, ' . .: _. " .::.:.-...-10':,'....-:,
<br />I .1885-..lJm:.vers~t JAvenue,.t,,SO>,.,.. ~. .' '~""',"u,l"{dJ"'z~"Jl;:wJ'B,.'.'.ii..~'.~
<br />. Ci11:t.~~~.1 .;:--:',:,,'" ;:,' ~,_- _ . .;:...~;~'"'..6~~!:'..-:.~~~-.: ZIp. ~ ~g~,_County ~F: .;J-:;.~::.;' ~~ ;;i.:0ayIime ~_~~:r_~?:;;:~~~;t
<br />i.:.~""St!Jil(pauJ::::"",;,.;.",.,,~.:!!';j;.,,""'''Mirinesota';c~,: 55 r04"';: Ramse .'.'"" ,,,. i61'2tt64~r-,.:~3'~~
<br />,. -;;;NamaotchiefelC8ClltiWOfficer(camotbe~~!'Il,_er)~,.,,,.,.~.Tode.~. .--....."" '.'-'-m
<br />.1. ..................... .....,.v<.. .. .',.. '. ,. '>~......'....'-.....'-.""..'~..- - ".~.. .'. """". .'.""" -...... "-. ,. '.' '." ..-...... ..<~ .. -. ......... ,......'..2'...::.0:.'. ...~... ..
<br />;~l'Betty:1 Gr-eencr6wi~'';''''J1'~4_~ "','Presiden:, '.~>::":~".,'P'>- "r Ii ';1"8 2't'1Y4::r5: .
<br />.. """B'~" Oc:c:as1o _.._...._.......jAp..~ .,. ,. '.'.". ,.,.. . "... , .. ~..., ~ .' ,...~......,....,.",.,........ . .. .
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<br />... .c'(;If"appIYtiigf"oriC..Ti..;,.~~~C'~7;'.il~iliCh.~".'~;iid~i1i&.'P::rlfT1li~urs'Of"bfiig()-""~~.-;, .. ... .. .
<br />"":;'.:,..3~, No morethaD.~tJh,""ci~<.T~<;?,,,,,;,;,cbe-cOriducted. '-~"",,':'m1saTifr..tlnnper~~' ..,.,.:,
<br />I ' ..... -, .~""J~-::-. . .,.. ....- .......~__,-_.4
<br />,. Dar:--.:....R.,g1n.....IIIEndIngHour-.,' ,.,.- , Oay'~~Hour- v; . Oay'___IYgl"-,'JEDdIng_'';;jO;<',,~;c
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<br />Sun 12:T5r.,. 4,lS. pm. _ "Tues'. .'6,00 to.9.:00i:l1n,-r'f)_~_' /", to,.. -,-. ,. ,-'
<br />I sun'-6~OOUto.'-~'00P~'~,'-TU~.~."".9~00 ,,:l~;~,O~~{-:' '--~,,:~-:.:. -'::~'~::::',;',:"
<br />Sun.._9:00 to '-1 ,,15 pm.~. If~b.gowillDOtbe.;....d...;t.,.(cb..dhe"'-"';D - ,-.:.,..::......:__.:..:.....;
<br />I "_'-;',","",-~~,_u_~,_~,"",-",.,,,.-,,-,-,-,-~._. .-,,'.....,..-.,','. ',- '-c.. . '...",.......'u._
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<br />0lUn.,.."',eJ.u,. ......... ...' . ... ... ...
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<br />Pot 0 Gold "Bi non H<=Il1-. 177fi -.~n>nnpl Ty. -A:v~nn~. '.:-... . :..r~>~.-;~! ~.:..--: . .
<br />I Is.... premises IoceI8dwilhincity limits? " CXl Yes'.i:c::lNo I'no, is _\II 'Clarganized Cl unorganized Cl unincorporalBd
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<br />City and County where gambling premises is Iocallld OR Township and County whent gembUIg pnomises is Ioca18d it outside of city limits
<br />I Arden Hills, Ramsey _.....'[".'''. '''',.... ....1'
<br />Name and_of legal ownerofprem_, -q,r.::,.Clty i' . SIal8. ".rZipCode.. -.~rt:::..
<br />. Gordi:" K"Siedow-3 00 4"-J'amrey-:--Lake~Elirio~ Mj,nn~~'- .55042'-'---:: .. '-:,'
<br />00.. your organization own the builcing where the gambling will be conduc18d1 CJ YES CCI NO
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<br />I" ~}"'!'~~;::'~~U:~~(IOmlLG202)wilhllln'nSloratleastone_.",-:..-::- . . =--:~~."C ;;.,-"~~.' ....
<br />.. -a copy of a _ of .... ftoor plan wilh dimensions. smw;ng _ portion is being leased.' , .. --
<br />-_ A lease and si<elCllllf8 not ~ lor Class 0 appIcalions..
<br />I ...,~.;o.~ , ~:;:1::;::W"~~'~~"'~:;>:{*WA-'AA~":W~1~'W~X"""lYxw-~::':'~~'::.<xtiR~~v.,':':,,-",""'~iM,~:::'~YW.;,~,>>:'X.':>;';.;'~:::~.;"~~,~{r<'~;';~'0:
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<br />.nu......ess~o .S o~e space'o ,~amu ,e pmen ..'"'!l'6'mf'_il'l'0!iO"''''""twl''^.''<F'''';'A: '.""'.y':
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<br />I - 3776 -c~nn:;;s A~~. Arde:ty ~'iii~ Mi::' ~5~~;>>"
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