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<br />Sta te of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br /> <br />For Board Use Only <br />Amt Pd <br /> <br />b\ <br /> <br />Check # <br /> <br />eG2t4PPR Printed: 9/512001 <br /> <br />License Number:B-01485-012 <br /> <br />Effective Date: 4/1/2000 <br /> <br />Expiration Date: 3/31/2002 <br /> <br />Name of Organization: North Suburban Youth Foundation <br />Gambling Premises Information <br /> <br />Name of the establishment where gambling will be conducted <br /> <br />Big Ten Supper Club <br />4703 N Hwy 10 <br />Arden Hills, MN 55112 <br />County: Ramsey <br /> <br />Note; Our records show the premises <br />is located within the city limits <br /> <br />Lessor Information <br /> <br />John Welsch <br />2058 Jefferson <br />St Paul, MN 55105 . <br />Name ot the property owner (If dIfferent): <br /> <br />Square footage leased per month: 48 <br />Rent paid per month: 1,000.00 <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: <br /> <br />. <br /> <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br /> <br />Storage Information <br /> <br />55 E Co Rd B <br />Little Canada, MN 55117 <br /> <br />2900 N. Rice St., Little Canada - 4703 N. Hwy 10, Arden Hills <br />738 Thomas Ave., St. Paul, <br /> <br />Bank Information <br /> <br />North American Banking Company <br />2230 N Albert <br />Roseville, MN 55113 <br /> <br />Gambling Bank <br />Account Number: 18002394 <br /> <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits and <br />withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br /> <br />Name <br /> <br />~ <br />Gale Pederson <br /> <br />Drake Anderson <br /> <br />Address <br /> <br />City, State, Zip Code <br /> <br />-~ <br />Roseville MN 55113 <br />Roseville, MN 55113 <br /> <br />Title <br /> <br />929 W. Roselawn <br />1436 Ryan Ave W <br /> <br />Member <br /> <br /> <br /> <br />1i:oJI~ <br /> <br />(Be sure to complete the reverse side of this application) <br /> <br />This fonn will be made available in alternative format (ie. large print, braille) upon request. <br /> <br />Page I of 2 (Continued on Back) <br />