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<br />FOR BOARD USE ONLY
<br />AMT. PAID
<br />CHECK #
<br />II DATE II
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<br />STATE OF MThTNESOT A
<br />GAMBLING CONTROL BOARD
<br />
<br />REI\'EW AL APPLICA nON FOR
<br />BINGO HALL LICENSE - LG300
<br />
<br />PRINTED: 12/01/98
<br />
<br />LICENSE NUMBER: BH013 EFFECTIVE DATE: 06/01/99
<br />
<br />EXPIRATION DATE: 05/31/00
<br />
<br />Annlicant Information
<br />
<br />Name of Applicant: Pot O'Gold
<br />DBA, if applicable:
<br />
<br />Business Address: 3776 Connelly Arden Hills MN 55112
<br />
<br />Phone Number: 612-631-1724 Fax Number:
<br />
<br />MN Sales & Use Tax ID #: 1123411
<br />
<br />Type of Business Sole Proprietorship
<br />
<br />Main Office Address (if different from above):
<br />
<br />Local Unit of Government Acknowledl!ement
<br />
<br />. the Bingo Hall is located within the city limits, the *City must sign the application.
<br />the Bingo Hall is located outside the city limits, Both the **County and **Township must sign the application.
<br />
<br />Name of *City or **County
<br />
<br />Name of **Township
<br />
<br />Arden Hills ,~
<br />
<br />~iJ44'MI /1. ~
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<br />Signature of Person receiving the application
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<br />Dt.rtM(1,~ z.e, \ ~ ~ 8
<br />Date Application Received
<br />
<br />N/A
<br />
<br />By signature below, the township acknowledges
<br />that the legal owner of the bingo hall is applying
<br />for a bingo hall license renewal within township
<br />limits.
<br />
<br />Signature of Person receiving the application
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