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<br />:..st STATE OF MINNESOTA I FOR BOARD USE ONLY I
<br />GAMBLING CONTROL BOARD I AMT PAID I
<br />PREMISES PERMIT RENEWAL APPLICATION I CHECK NO, I
<br />,G214PPR. PRINTED: I DATE e
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<br />,ICENSE NUMBER: B-01485-012 EFFECTIVE DATE: 04/01/96 EXPIRATION DATE: 03/31/98
<br />iAME OF ORGANIZATION: North Suburban Youth Roseville Assoc
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<br />GAMBLING PREMISES INFORMATION
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<br />:AME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED
<br /><ig Ten supper Club
<br />,703 N Hwy 10
<br />,rden Hills 55112
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<br />;OUNTY Ramsey IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y
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<br />LESSOR INFORMATION
<br />OES YOUR ORGANIZATION O'^N THIS SITE?: No
<br />F NO, LIST THE LESSOR:
<br />'OM Welsch
<br />:058 Jefferson
<br />:t Paul MN 55105
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<br />:AME OF PROPERTY OWNER (WHEN NOT LESSOR) :
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<br />QUARE. FEET PER MONTH: 48 AMOUNT PAID FOR RENT ,PER MONTH:1?00 ,
<br />.QUARE FEET PER OC;CASION: 0 AMOUNT:PAID PER OCCASION:. "'" ,',0
<br />.,-,> ,. .
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<br />, .. ";"~', '-;.,;-_:::'. .;' . .'_ BINGO ACTIVITY '.: ::_:,\..::::. ~'<.:'.' ::,,_ ..' _.,..._ ~:;,:, '. .~.~_::;:.:.-~:-':,;~.:.~'"',..~'~:, '~;;'~:'-..Y
<br />:INGO IS . CONDUCTED . ON ,THIS PREMISES: No . IF YES,' REFER TO INSTRUCTIONS FOR "REQUIRED iATTACHMENT
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<br />,;~~~~H~~>~5511r': .',STORAGE ADDRESS.. >"L::'~: '. ..:'::':;'~'yts~ :~,:;~~~;!~i
<br />:~: o~~~i~$~~w::f~;>~.i .>: '.,. " . . BANK' INFORMATION .,.. ..~':~;';:-:.'.'". :?:{,~,t~>'?,;~'it.,,95~:'
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<br />'osevi1le .MN 55113 " .', ..:. . .:-"..,:
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<br />}AMBLING BANK ACCOUNT NUMBER: 102321400 ..",' .'.
<br />. ',"W
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<br />)N THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND,TITLE OF AT LEAST TWO PERSONS
<br />\UTHORIZED.TO SIGN CHECKS AND'MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING .ACCOUNT.
<br />,- .'.' .', . ',' -' ".-'~ ,,- .',. .
<br />:HEORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. ..' .'. " ',' . , '......,...,.
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<br />.. . ...., ' '. ..' :.,. '. : .'.. . (BE SURE . TO:C;:OMPLETE.THERmRSE' .SIDE ,OF 'THIS. A1>PLlcATJ:ON)'
<br />rHIS FORM WILL, BE "MADE AVAILABLE .INALTERNAT,IVE,FORMA'l,,;(IiE.:)LARGE.PRINT ,'SRAILLEl.:W.,ON "R,EQUEST
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