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<br />FOR BOARD USE ONLY <br />AMT. PAID <br />CHECK /I <br />DATE <br /> <br />e <br /> <br />STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />RENEWAL APPLICATION FOR <br />BINGO HALL LICENSE - LG300 <br /> <br />PRINTED: 12109199 <br /> <br />LICENSE NUMBER: BH013 EFFECTIVE DATE: 06/01100 <br /> <br />EXPIRATION DATE: 05/31/01 <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: 651-631-1724 Fax Number: <br /> <br />MN Sales & Use Tax ID #: 1123411 <br />Main Office Address (if different from above): <br /> <br />Type of Business Sole Proprietorship <br /> <br />Local Unit of Government Acknowledl!ement <br /> <br />4It!f 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 /> <br />Name of *City or **County <br /> <br />Name of **Township <br /> <br />..d,rden Hills ~ <br /> <br />l~y( ~ <br /> <br />Signature of Person receiving the application <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 />'t. / "7 / 00 <br />Date Application Received <br /> <br />C, 'N T1tt:rlSI.f/l..t:-1Z. <br />Title of Person Signing the Application <br /> <br />Signature of Person receiving the application <br /> <br />Date Application Received <br /> <br />Title of Person Signing the Application <br /> <br />Township is: <br /> <br />Organized <br />Unorganized <br />Unincorporated <br /> <br />e <br />