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<br />~ <br /> <br />FOR BOARD USE ONLY <br />AMT. PAID <br />CHECK # <br />II DATE II <br />" II <br /> <br />t <br /> <br />. <br /> <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. ~ <br /> <br />Signature of Person receiving the application <br /> <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 <br /> <br />. ""'~ <br /> <br />,"-'. <br /> <br />-~~~.:::\~:::~ '\~7~t:~~~~}~~.,~~. '," <br />'ARDEN HillS'" Ml,r 55112' '." <br />, "." <')612)783',1840> " ' <br />"~ ~_".;.."," '_', "_'_" "",_C_,O' _'. <br /> <br />~ _ . ".,.,,~..., '. _-....~.,:-~-"'-_,_::.._;~,~:-o<_:., ~.>- <",:,-",.,-~~~::,;.~,:,:,~'.~ ~":.. >: ..:--_~ ~..:.- ....<""~ ~_ _ <br />,. ::~, ,..' :,"~.,'" .' ". ..".";. ...........-, -"'cd 6 9"2:" - . <br /> <br />._,,<;,_.,'~' ,,<....:_~ <br /> <br />~ _ -.,--' ~_ v <br /> <br />~".<' "'~ <br /> <br />.'. ~.:-".:,-:",-,,,;..~-;.,...>_.,,",~ <br /> <br />-.'..--," <br /> <br />" <br />..,...."':...,,'-,.... <br /> <br />."""c-__ ~: <br /> <br />_", . ._ c. . <br /> <br /> <br />~:~~i~~~ <br /> <br /> <br />." rt.--'>' CENTRAl:'BANK' :", <br /> <br />~.'. -.,.. <br /> <br />",.._,." <br /> <br />" <br />-- "." <br /> <br />.-;. "'" <br /> <br />''--'-~ <br /> <br />, FOR <br /> <br /> <br />~'_.- <br />..._~""<~~~.~::~:::'< ~> ';';,,~_:,o ':::__" <br />......~ -- .~- ~ ~-- "'- <br /> <br />.- "0-.. ._,.,.. <br />