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<br />last 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 />oG214PPR PRINTED: I DATE ~
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<br />~ICENSE NUMBER: A-00489-006 EFFECTIVE DATE: 05/01/96 EXPIRATION DATE: 04/30/98
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<br />fAME OF ORGANIZATION: Church of St Mary Romanian Orthodox St Paul
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<br />GAMBLING PREMISES INFORMATION
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<br />lAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED
<br />\rden Hills Bingo Hall
<br />3776 Connelly Ave
<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 />JOES YOUR ORGANIZATION OWN THIS SITE?: No
<br />IF NO, LIST THE LESSOR:
<br />;oldie S iedow
<br />3004 Jamley
<br />"ake Elmo MN 55112
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<br />"AME OF PROPERTY OWNER (WHEN NOT LESSOR) :
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<br />3QUARE FEET PER MONTH: 0 .AMOUNT PAID FOR RENT PER MONTH: 0 .
<br />,QUARE FEET PER OCCASION: . 9404 AMOUNT PAID PER OCCASION,:: :'~':'., 300
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<br />}~,_ "_', '..,:.;".:- ' BINGO ACTIVITy,,:.:...,...... ',", ,~.<.,;' ';':~<_'~:",;-:':'_' _ ;;::~c.~~~~';._':; .;~',. r~-'
<br />3INGO IS'CONDUCTEDON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTIONS'FOR REQUIREDcATTACHMENT
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<br />"-"."-'. . '~'.- . STORAGE~'AnDRESS .' ':~.:~. -'. -'c: .~.~~-/.-:::~;2:k~.\: ... ~~.:~,,~~,:~~
<br />3776.connelly,Ave.
<br />\rden' Hills MN 55112. ..' ..: .'., "''\,S: :
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<br />FirstarRosevi1~~ Bank BANK INF~~TioN' "'-',,;,~'-'~' ,..;.:,~,::.<t-:i~.Y;f'~T
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<br />2100 N Snelling ." ,.- " . '. .... ,..".,'. " .'... ".
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<br />Rosevi1l;' MN 55113 '. " ., . .' '~'.
<br />3AMBLING BANK ACCOUNT NUMBER: 372000306 '" '.
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<br />ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSON~_,
<br />AUTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS .FOR THE ,GAMBLING ACCOUNT:
<br />THE ORGANIZATION'S TREASURER MAY NOT HANDLE.GAMBLING.FUNDS,
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<br />, . .~ . . .(BE ..SURE 'TO' COMPLETE..::rHE' REvERSE ;SIDE OF ,THIS 'APPLICATION)
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<br />THIS FORM ,WILL BE. MADE AVAILABLE IN ALTERNATIvE'FORMAT;'(I;E;;'LARGE;PRINT,"BRAILLE)",iUPONREQUEST
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