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-. . Minnesota Gambling Control Board Bingo Hall License Renewal Application Pot O'Gold 3776 Connelly Arden Hills, MN 55112 License number: BH013 License expiration date: 5/31/2003 DBA, if applicable: Return by: 3/2/2003 Enclosed are your preprinted license application renewal forms. lG300 - Bingo Hall license Renewal Application _ Draw a line through inaccurate information and write in the correct information. _ Write in any missing infonnation. _ Obtain and submit a resolution of approval from the local unit of government. _ The Chief Executive Officer must sign the renewal application. lG302 - Bingo Hall list Occasion _ Complete and submit tl1e endosed LG302 - Bingo Hall Occasion Ust _ If you have a rotating schedule, submit a calendar for tl1e license period. . lG315 - Bingo Hall Personnel Information _ Draw a line through inaccurate infonnation and write in the correct information. _ Write in any missing information. _ Each legal owner must complete a LG315 Bingo Hall Personnel Information form. If tl1e legal owner of tl1e bingo hall is an organization, corporation, finn, limited liability company, sole proprietorship, or partnership, tl1e following individuals must complete a LG315 fonn: partners, member of tl1e board of directors, members of tl1e board of governors; each officer (induding but not limited In president, vice-president, secretary, treasurer, controller, or general counsel); manager or supervisor of personnel or security, and each person or entity with a direct or indirect interest of 5% or more in tl1e applicant _ If any person listed will not be renewing, write tl1e termination date on his or her renewal form and return it with your renewal application. If you need additional forms, visit our Web site at www.gcb.state.mn.usandclickon Bingo Ha//under Genera/Information and FOITTlS. For Your Information All personnel forms will be sent In tl1e Department of Public Safety for a Bureau of Criminal Apprehension dea rance a nd In tl1e Department of Revenue for a tax clearance. Minnesota Rules, part 7862.0010, subpart lOa, provide: "Before issuing or renewing a bingo hall license, tl1e board shall conduct or request tl1e director of alcohol and gambling enforcement In conduct a background investigation, which may indude a review of tl1e applicant's sources of finandng, ownership, and organizational structure. Actual costs in addition to the initial and renewal application fees shall be borne by tl1e applicant." Upon receipt and clearance, your application for renewal will be presented to the Gambling Control Board for consideration at a monthly meeting. If you have questions, please contact tl1e Gambling Control Board at 651-639-4000.