|
<br />'" (
<br />.-, ",
<br />RECEIVED
<br />FOR BOARD USE ONLY
<br />LG214 ~, i', ,,;" ,. ... APR 3 1995 BASE #
<br />(1/2ll11l1) pp#
<br />. <''!''. 0lY 9f ARDEN HIlLS FEE
<br />");......,-, .-< ..
<br />
<br />";';,$~~0~~~~"Z,'~ . .... . .:~~i~:~ta t~~L ~Ung >.'> ..::~~ i', i.,.;~'*:'~;";rcJ
<br />.t4 ...Y"~.~",jP:~':?7.'.Premises P~tAppUcation':"Part 1.of2 . ."';~=~""_"C.,,, ~'i'>
<br />.::C- "'.~.~.:~':~:::~::~~} ~~;~~~~~i '~: .,:.:~:~~~~~~~~,,;~:: \~~~._~i~:~::i~':~~ ~~:~;~-~.~;~.! ~~$ ~.--. ~~ . ...;~e,~~-'~~- ~;'-",.:~ -,:" ':'-___~:t :~X:'-
<br />~~.....~~~~,::..~IF4."1~".:1;~~~:.c;~~~~~,i.~~;:;"":"-~...' ;to:",,_ ',__ _, .. .....;:::;.::,"-~
<br />;::f ~~~;
<br />:.: ,", ," ". ' '.."" .. . . ., ," .. ,C' .~~:'>. .. :~:
<br />;,.,. -', ........ '.. .. _.:f:',..~..~"c
<br />~"'C':o'.,,;>-:~ .~n::~.:f;'f':.;~?Y"k~f;i~i:'~';~!r~?:'4\:r'~>;"f:X;.~..~..pnIl1l-;,,:=~,,,,~P''''''''::'!''':;''..:!~~'.''i~,'~~'4'P
<br />.... Organization base license number -- . ...,.. ...... .... ~r A ($400) PulHabs, tipboards, pa_. rattles, bingo
<br />,-
<br />--..- ..~. -. . _ parmk oomber .... . 0 B ($2SO) Pull-labs, tipboanls, padclewheels, rallies
<br />
<br />.."'p;';?t;.~ ;;..... ..;.~,.,;<: "-r>' ... ;::..~;-,; :;:_~_._. g~::: -:::.: ~.:.- ..... --''''-' .....:...... .
<br />"j'$'~~
<br />
<br />EarthstarcPro ec ,j~ric~~~'~""" ,..,.".,.....".. ....... ,......, '. ,.....'......,.,... ....'r..,'.....:.,.;
<br />siness~S~,8'ganizalio,':{~n,et.ar,P...O~X(Ot>'.'!'.'"S'!,lhe adcnuofyour gambing manager)" " """''''''.'0 ;)('l,S:"" .($"', . .. "
<br />1 8 8 S:'"U ....... '''-''t.. ."~... ".., . "~JL"; SO. ..,..~.,.., "-. . .. .; '-,,' ..;...{..,....~ ~<f An"""
<br />_... n.l. ver SJ......nvenuer 11--. "'\..~.- ,< ._ . ,.J." -., _,_'" ,._, ", ,. -___-~,~.. _ ~'5"_"r,:,.~
<br />CilY.!*,}'Vi''I.:,/b. ...,......... ...;~~....;m";:""~~~~144''''''. ZIp Code,,,';;'H."Coun1y,, , "',.,. .;,Daytime phone~mber. . <Ef..@
<br />j,'-CStl~PauB'"";".'::;;'i'"';";"'ii.li,,,;;;...,,,, Minnesot.a",".. 55 T04 . f.!Ramse .,...,~ .,,:.c (,6l12"'64~1r...7'3:..';:'J,,:i;'
<br />,', ,':_:.,:.::7 N~~o~~f ~~~;.officerJ~ptb&~~bi!"9JI~~erl>J;i--;:?':(L-"~': Tille ;-,,~~~:j~;:,,~fi.;~:~~~.~?~ ~me' phonen~~,",?L:r~~-
<br />...~;i1l~Bet;;Yf'Gr~;;ncr()~';.~~!{i~...:;_a*1i!!,.;tpr'ksid~nt~'i1 .... >" (~Tl...82;T~~9~
<br />..~:~r!.'B.~..O'Oc:cas10D8"""!,"!I'ol~!I"......T'l~:;,><.rn:.<,:;;.i<...,> '.' ;.. ...., .'",. ...... i'.',;....~~:;."t~.:.....,l'.~~l't
<br />. ;;~~.i!'"~pIYmglo?a"rE~~~S'~!.r~,: ..~~.ai\d ~~~!&";;~g~O~.~fblnlO'~;.!~is~~~~lj
<br />. ",; "No more than. seven:blngo ()('(">sr()TlS m:iybeconductedbyyom:organ17<1tton perweek:.:;""",',~~j", ."...;'<".'.2',
<br />..Day.......... R.ogInnfng/Endlng~;;"';' Day~Beglnnlng/EndlaH~_.. Day.~..~/EndIng Hours. \ .,
<br />'~-''-'-' .',,"~,::I__., "'~'~"'_',' '____;;'~;~ _,', _: .'\t!f$Q.-'-~:">"~-_:__O'\' _:_/,.,~ ,T'0Y""- ,,' . -'~',:." '_~;-_1iht:: i'i..',.,,:.,,~~- rt.J;"-::?~';I-~',,;:''''''2 ,~.,'
<br />Sun. Ti-,TS'to;'4:l5 p~ ..,Tues . )'6~00 to 9:00 p~.?,; ~.L,;;;,' :'--.'.
<br />, - ".._ J '".._ __"_' ,.J,_'^
<br />Sun'"..6:00to..9:00.pm....,'..~.-".".9:00 to12:OO pm-' -=...:" "'to ..... '.
<br />
<br />Sun 9 : 00 to 1'T: l5 pm ... Ifblngo wll1 not be conducted, check he... D
<br />.. i~... ...,.,......~_,"~,..~..."k.~..
<br />
<br />ame 0 _ es ment g8mb ng WI
<br />PotO'Gold'Bingo Hall 1776 ..
<br />I Is the pnlmises located wllhin city Iimils? DO Yes. '. 0 No II no, Is -..ship 0 organized 0 unorganized 0 uninCOlJlorated
<br />
<br />City and County where gambling premises is located OR Township and County where gambling premises is locabld II outside 01 city limils
<br />
<br />. Arden Hills, Ramsey . ....., r' ....
<br />
<br />Name and address of legal owner of premise..., i' ....I'l;'1'7;Clty; StaIB ..,,.,Zlp Code, ", ,,:,;
<br />'Goldi'ICS'i'edow-:--3 0 04.Ja:iriley~~:.Lake:Elmo--...Mil1117.. 55042
<br />Does your otganizalion own 1I1e building where 1I1e gambling will be conducted? 0 YES IlCII NO
<br />
<br />I-~ !I.~,a~ :::";"'~: Ie;"" (tDnri'LGZ02) wi1l1 bliirUlloralleast one year." "' ""':.:.:'!.,:.'::':.;
<br />.a'.. ... a copy 01 a sketch of Ihe floor plan wi1h dimensions, showing what portion is being leased. .... .. . ... .... ~ ~
<br />-_. .. A lease and sketch are not required for Class 0 applications.
<br />
<br />I :Adr.,rt..r.:;;q-ar'::'::.::):n$~Hw.p:;fi;,,~t";m~f:%1t:Wf.fi::~M~W~fI':~-~I~?:?:m:b:~~~_"tRf:~?it~r%~W__m~~1tfntWJWtfHWJ1ffM1f@~H@itm
<br />.e 5...0 .'.5 0 e"spacc".o.. am "e:em "-Dii 1_... .. .i\tiMliel"',,".'
<br />: .., :'::;" .', :',:,-.. ,.....-..-..:, .-..:;:"., d. .';'" .-::=:' ,.:-;' ." _, -' _ _n ,', _ ,_ .~,;.,. ",' .., _ ,'., . _, ..:.;:.".'" - ".' ::;:,<:~:,,;;;:.::,~::.,::::::.{.;::;~:;:;;:::::;:;:::::::::::::;::::;:;:;:::::::,:~
<br />.. Address City . Stale ZIp code
<br />
<br />.-- 3776 Connelly Ave. Arden Hills Minn. 55112
<br />
<br />
<br />
<br />I
<br />
|