Laserfiche WebLink
<br />State of Minnesota <br />Gambling Conh'ol Board <br />Premises Permit Renewal Applieation <br /> <br />^ Ti1.S>>NI&JT (3 <br /> <br />For Board Use Only <br /> <br />\/L <br /> <br />Amt Pd <br /> <br />el4PPR Printed: 3/112002 <br /> <br />Check # <br /> <br />License Number:A-31686-001 <br /> <br />Effective Dale: 10/1/2000 <br /> <br />Expiration Date: 9/30/2 002 <br /> <br />Name of Organization: St Katherine Ukrainian Orthodox Church <br />Gambling Premises Information <br /> <br />Name of the establishment where gambling will be conducted <br /> <br />Pot 0 Gold Bingo <br />3776 Connelly Ave <br />Arden Hills, MN 55112 <br />County: Ramsey <br /> <br />Note: OJr records show the premises <br />is located \\<ithin the city limits <br /> <br />Lessor Information <br /> <br />Name of the property owner (If different): <br /> <br />G.~(J<~ SIQd"w <br /> <br />Square footagc leased per month: <br /> <br />Rent paid per month: <br /> <br />Square footage leased per bingo occasion: g' 'f g <br />'0 <br />Rent paid per bingo occasion: '56)0, - <br /> <br />. <br /> <br />Bingo Activity <br />OUf records indicate that Bingo is conducted on these premises. Please refer to the instructions for required <br /> <br />Storage Information <br /> <br />3776 Connelly <br />Arden Hills, MN 55112 <br /> <br />Bank Information <br /> <br />Fir,tn Bank <br />26':19 Sndlill!; Ave N <br />Rosnill", MN 55113 <br /> <br />Gambling Bank <br />AccotUlt Number: 000 <br /> <br />On the lines provided below list the name, addre.';,$ and title of .at least two persons authorized to sign checks and make deposits and <br />withdrav.'als for the gambling account. llle organization's treasurer may nol handle gambling funds.. <br /> <br />Name <br /> <br />Address <br /> <br />City, State, Zip Code <br />Sonth St, Paul, MN 55075 <br /> <br />Title <br />G-""9//<;&. <br /> <br />/.16-1( <br /> <br />Joe Anaya <br /> <br />241J F.arl Lane <br /> <br /> <br />vc <br /> <br /> <br />C'<.o <br /> <br />72 WALL I>IJE <br /> <br />'Z 77 rz: <br />(Be sure to complete the reverse side of this application) <br /> <br />This form will be made available in alternative format (ie.large print, braille) upon rcquesL <br /> <br />Page I of2 (Continued on Back) <br />