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Minnesota Gambling Control Board Bingo Hall License Renewal Application . Pot O'Gold 3776 Connelly Arden Hills, MN 55112 License number: BH013 License expiJation date: 5/31/2003 DBA, if applicable: Retum by: 3/2/2003 Enclosed are your preprinted license application renewal forms. LG300 - Bingo Hall License Renewal Application ~ Draw a line through inaa:urate information and write in the correct information. _ Write in any missing information. _ Obtain and submit a resolution of approval from the local unit of government. _ The Chief Executive Officer must sign the renewal application. LG302 - Bingo Hall List Occasion _ Complete and submit the endosed LG302 - Bingo Hall Oa:asion Ust _ If you have a rotating schedule, submit a calendar for the license period. LG315 - Bingo Hall Personnel Information _ Draw a line through inaccurate information and write in the correct information. _ Write in any missing information. _ Each legal owner must complete a lG315 Bingo Hall Personnel Information form. If the legal owner of the bingo hall is an organization, corlXlration, firm, limited liability company, sole . proprietorship, or partnership, the following individuals must complete a lG315 form: partners, member of the board of directors, members of the board of governors; each officer (induding but not limited In president, vice-president, secretary, treasurer, controller, or general counsel); manager or supervisor of personnel or security, and each person or entity with a direct or indirect interest of 5% or more in the applicant _ If any person listed will not be renewing, write the termination date on his or her renewal form and retum it with your renewal application. If you need additional forms, visit our Web site at www.gcb.state.mn.usand click on Bingo Hallunder General Information and Fonns. For Your Information All personnel forms will be sent In the Deparbnent of Public Safety for a Bureau of Criminal Apprehension dearance and to the Department of Revenue for a tax clearance. Minnesota Rules, part 7862.0010, subpart lOa, provide: "Before issuing or renewing a bingo hall license, the board shall conduct or request the director of alcohol and gambling enforcement to conduct a background investigation, which may indude a review of the applicant's sources of financing, ownership, and organizational structure. Actual costs in addition to the initial and renewal application fees shall be borne by the applicant." Upon receipt and clearance, your application for renewal will be presented to the Gambling Control Board for consideration at a monthly meeting. If you have questions, please contact the Gambling Control Board at 651-639-4000. .