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<br /> IY ~\~)1 A. 1/1..-
<br /> East STATE OF MINNESOTA IFOR BOARD USE ONLY I
<br /> I GAMBLING CONTROL BOARD I AMT PAID I
<br /> PREMISES PERMIT RENEWAL APPLICATION I CHECK NO. ' I
<br /> PPR PRINTED: I DATE I
<br /> NUMBER: B-03162-003 EFFECTIVE DATE: 08/01/95 EXPIRATION DATE: 07/31/97
<br /> ORGANIZATION: American Business Womens Chapt,Lady Slipper Roseville
<br /> GAMBLING PREMISES INFORMATION
<br /> ItAME OF ESTABLISHME~.~~~E,GAMBLING WILL BE CONDUCTED ',~'\
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<br /> lahertys Arden Bowl,: '~:i::, ;--~;,'.~:~~::.
<br /> 1273W Co Rd E .,' ":""
<br /> rden Hills ;:;55112 '.' ;;..
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<br /> COUNTY Ramsey , . IS THE PREMISES LOCATED WITHIN THE CITY ,LIMITS?':' 'Y" ..: "."
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<br /> " LESSOR INFORMATION
<br /> OES YOUR ORGANIZATION OWN THIS SITE?: No . ,:-':'~:'
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<br /> IF NO, "LIST ,THE LESSOR:,' <', ' ' . :,,",J",
<br /> IIlahertys Arden Bowl Inc .-~' " :;. ~~':-,--~-~t.::;_:~ :,
<br /> 273 W Co Rd E ' -+'.- . ,. ~ , : :';:';:,~~:;",: ':,;":':~;~~i
<br /> Arden Hills MN 55112
<br /> lAME ~~ PROPERTY Owm;R (WHEN NOT LESSOR) :
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<br /> _E FEET PER MONTH: ' 28 ' AMOmrr PAID FOR I<ENT.PER MoNni:(io'oo
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<br /> E FEET PER OCCASION: 0 AMOUNT PAID' PER OCCASION : " "",;,>,"",,':0
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<br /> IIINGO IS CONDUCTED ON THIS PREMISES: No BINGO ACTIVITY --:~:'~:j- .
<br /> IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT
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<br /> STORAGE ADDRESS,
<br /> 11153 16th Ave SE and Route 4 Box 86
<br /> inneapolis MN 55414 -,Pine City MN 55063-9721 " :...J,' :.:~.fr-," '.'
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<br /> ~itie:t c:a;~ ',:inn~'s:t~;,;,~'{{;:~~~:;::;, " ".:,' ,.,,' ';,," ,BANK INFORMATION",'.,$:~'i;t"'c;~:"("..~'~~~E~~i~~tk:r';~f~~lti: ,,:~
<br /> crden Hills MN 55112 . '..',/' .", , , , .": ";".", ",' . "J,:" "~<,"J:(:(I":'';l;
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<br /> flMBLING BANK ACCOUNT .NUMBER: 3528255745 ',,'~ ',- ~,"-'";,':.,,.::;, <::;"":."',,Z;);."li1i~~"""~.
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<br /> IN THE' LINES PROVIDED BELOW LIST THE. 'NAME, . ADDRESS' AND', TITLE~'?.F ",fl.: ,:'.L~ST ,TW.():~~ER~(:lN!!>?\<il~" ~\ ,'~4,
<br /> UTHORIZEDTO SIGN 'CHECKS;AND MAKE DEPOSITS ,AND WITHDRAWALS'FOR CTHE:GAMBLING:ACCOum}t:;<:, 'wi;::, '<if;
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<br /> arlyn,Darnrnan ,< ,2700 'N "Da'le':St ;;jf208 "+',;'Ho'seville,",MN ~'+\55113>"'Gaiiibl'in~(;'Maria'f!:)<:' .
<br /> ;:~:~i:;fl~~it'~:~~~~~re~~~:~~271~~::i;1;~m==l
<br /> r~~~r che tt " ~j;2'R'~~~O od · La, n e,' N~~ Br_igh~'()hi/MN;(tfg;~}t~,;;{;},.,t~~!;B~'~:<':~{~~~;~~~~~rl
<br /> < ' ,,(BE SURE ,TO COMPLETE 'THE 'REvERSE SIDE ;OFTH:i:S;APPLlCATioin~~;
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<br /> IHIS FORM WILL BE MADE AVAILABLE IN ALTERNATlVE,~ORMAT (1. E. LARGE PRINT,' ~RA.~LLEl UP~~ :f'j~~ST;!
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