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<br />~ast STATE OF MINNESOTA [FOR BOARD USE ONLY I
<br />GAMBLING CONTROL BOARD I AMT PAID I
<br />PREMISES PERMIT RENEWAL APPLICATION I CHECK NO. I
<br />LG214PPR PRINTED: I DATE .
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<br />LICENSE NUMBER: A-02847-003 EFFECTIVE DATE: 04/01/96 EXPIRATION DATE: 03/31/98
<br />NAME OF ORGANIZATION: Light Brigads Rosevi11e Arden Hills
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<br />GAMBLING PREMISES INFORMATION
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<br />Nk~E OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED
<br />Pot 0 Gold
<br />3776 Connelly Ave
<br />Arden 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 />JOES YOUR ORGANIZATION OWN THIS SITE?: No
<br />IF NO, LIST THE LESSOR:
<br />Goldie Siedow
<br />3eO' J_h, '777(., C"HNf3't..'--'r'.4uF
<br />T.1.-a ""IIl" Illl SS8H Afl.Pe'N 1~1'-'->!t1iJ 5"SI/z..
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<br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR) :
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<br />3QUARE FEET PER MONTH: 0 AMOUNT PAID FOR RENT PER MONTH: 0
<br />3QUARE FEET PER OCCASION: 9404 AMOUNT PAID PER OC,CASION:,'" 300 .
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<br />.. BINGO ACTIVITY._.,. .. ..y.... . ..',....... .
<br />BINGO IS CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTI6NS'FOR"RE6uIRED'~ATTACHMENT
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<br />. STORAGE ADDRESS':t\'. ." ";':"'i;>;;.,~;}'
<br />251 5th St NW EZ Mini Sto. ;,j{, CONNE;Lt..'(ISO<f W:H"'(. 'it. 11<1", t11\,~~;.~
<br />New Brighton MN 55112 Ar\Oc~ 111'-<'5 >?IIt... A.R17,;:!..iH'u.~ 5-5/1"::: ,RD5eV{<.<~1-tiJ5"SIIi.
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<br />Firstar< Bank ~;; ::':"";'';','> ~~;::,'.i;>,
<br />4061 Lexington AveN .., .,.. ......:'.
<br />Arden Hills MN 55112
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<br />GAMBLING BANK ACCOUNT NUMBER: '244644401
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<br />ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS
<br />.l\.UTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT';
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<br />THE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. >< . ,'. ,"
<br />\JONAt-O W. ffeWITT.. '. CEOI n1cfMAPCe LfJRCJ5eij/UFHrJ:SSlt~" "
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<br />ffrtBE'fl.T C l{,tJG . r GAM~l.1~6 tfF\~f'ru~~ , ,J,;oit- "'! ,,~~Y'1~lR~iN:H;dL-~)MiJ 55 II z..
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<br />. . .. ",,' '.. (BE SURE ,TO COMPLETETHE.REVERSE,SIDE OF THIS 'APPLICATION)
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<br />THIS FORM WILL BE . MADE AVAILABLE INALTERNATIVE'FORMATA(I .E>'WGE....piuNT, . BRAILLE) ':;U'i?ON ,REQUEST
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