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<br /> ------ <br /> . . - <br /> FOR BOARD USE ONLY:I <br /> AMT. PAID , <br /> CHECK # i. <br /> STATE OF MINNESOTA IIDATE . <br /> GAMBLING CONTROL BOARD It <br /> RENEWAL APPLICATION FOR <br /> BINGO HALL LICENSE - LG300 <br /> PRINTED: 12/01197 <br /> LICENSE NUMBER: BH013 EFFECTIVE DATE: 06/01/98 EXPIRATION DATE: 05/31/99 <br /> Aoolicant Information <br /> Name of Applicant: Pot O'Gold <br /> DBA, if applicable: <br /> Business Address: 3776 Connelly Arden Hills MN 55112 <br /> Phone Number: 612-631-1724 Fax Number: <br /> MN Sales & Use Tax ID #: 1123411 Type of Business Sole Proprietorship <br /> Main Office Address (if different from above): , <br /> Local Unit of Government Acknowledl!ement <br /> If the Bingo Hall is located within the city limits, the *City must sign the application, . <br /> If the Bingo Hall is located outside the city limits, Both the **County and **Township must sign the application. <br /> Name of *City or **County Name of **Township <br /> Arden Hills Q, N/A <br /> ..~ ;L, . cJfJ By signature below, the township acknowledges <br /> that the legal owner of the bingo hall is applying <br /> Signature of Person receiving the application for a bingo hall license renewal within township <br /> \) I ~) 98 limits. <br /> Date Applicati6n Received Signature of Person receiving the application <br /> c> 'rt j/lE4rW1{7"L <br /> Title of Person Signing the Application Date Application Received <br /> Title of Person Signing the Application <br /> Township is: Organized <br /> Unorganized <br /> Unincorporated . <br /> ---------- <br />