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<br />Minnesota Lawful Gambling <br />Bingo Hall license Renewal Application - LG300 <br /> <br />. <br /> <br />License number: <br />Effective date: <br /> <br />BH013 <br />6/1/2001 <br /> <br />Name of applicant: <br />Expiration date: <br /> <br />Pot Q'Gold <br />5/31/2002 <br /> <br />Personnel: <br />The owner of the premises must be the lessor of the bingo hall. Subleases are not allowed. <br /> <br />. Verify that the personnel list below is complete and accurate, and contains all owners, officers, managers, directors, <br />supervisors, and persons or entities with a direct or indirect financiai interest of five percent or more, as prescribed by <br />board rule. <br />· Add new personnel not listed and submit an LG315. <br /> <br />Name <br />Goldie Katherine Sledow <br /> <br />Role <br />Owner <br /> <br />Duties <br />None <br /> <br />. <br /> <br />Oath <br /> <br />. I declare that this application is correct and complete to . I declare that any lease agreements between the bingo <br />the best of my knowledge and belief. hall licensee and lawful gambling organizations will <br />. I will familiarize myself with the laws of the state of specifically identify any goods or services that the <br />Minnesota and rules of the Board governing gambling and organization is required to purchase from the lessor or a <br />agree, if licensed, to abide by those laws and rules, third party vendor, and that all goods and services <br />including amendments to them. fumished as a part of the lease agreement will be valued <br />. I declare that I am qualified under the telTl1s of Minnesota at their fair market value. <br />Rules, part 7862.0010, subpart 3, to be licensed as a . Changes in the information submitted in this application <br />bingo hall and will abide by the restrictions set forth in will be submitted in writing to the Board and local unit of <br />Minnesota Rules, part 7862.0010, sl/Apa;;t I~' 'I) 0 . govemment within ten days after the change occurs. <br />:fl~ tL'2:J....I.).Ji-<9U/ Date:;;i - L., - (;) ( <br />Signature of chief executive officer - <br />~c U..~"- K,.,th. ,"-n'M ~.~oc.0 <br />Name (please print) <br /> <br />. <br /> <br />Mail Renewal Application to Gambling Control Board, with attachments. <br /> <br />LG300" Bingo Hall License Renewal Application Mail to: <br />LG302.. Bingo Hall Occasion List <br />LG315 .. Bingo Hall Personnel Information <br />Resolution.. Local unit of govemment approval <br />resolution (city or county); and <br />Check for $2,500 license fee payable to "State of <br />Minnesota" (fees are considered earned and are not <br />prorated or transferrable) <br /> <br />Gambling Control Board <br />Suite 300 South <br />1711 west County Road B <br />Roseville, MN 55113 <br />