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<br />. <br /> <br />Minnesota Lawful Gambling <br />LG214 p P "tA <br /> <br />r t" <br /> <br />6/03 <br />Page 1 012 <br /> <br />. <br /> <br /> remises erml pp lea Ion <br /> FOR BOARD USE ONLY <br />(see Required Attachments on Page 2) Annual Fee $150 Check # $ <br />Organization information <br />Organization name Organization license number <br />U1 A+ Bn 'I q c1e.. IJ::"h.C- 0-:;' $547 <br />Name of chief executive officer (~EO) Daytime phone number <br />j61r-"" c- \ ctc;:> e- \N\..a.v' f...:,12 -<;?;;J-l- 4-h:3 <../ <br />Gambling premises information <br />Name of establishment where gambling will be conducted Street address (do not use a P.O. box number) <br />~GUIl'"...IS fuv,f-6,YI~C. 1;)0 1 W c~ Rd 6' <br />City or township County Zip code <br />A-Y"dev\ H-I) Is J2 AI-1 se<f 5"5 JI?- <br />Does your organization own the buiiding where the gambling will be conducted? <br />_Yes p.NO If no, attach lG215 lease for lawful Gambling Activity <br />Gambling bank account information <br />Bank name Bank accOLHlt number <br />Bye~ev 13 <v...lc.. ,;JJ-#/ Ie, c.; 3 06 / <br />Bank street address City State/Zip code <br />/}tJ6/ i-e'fl.....q/,vt Ave fJ A.--cl",,.., /II lis f1tJ ~5/1Z- <br />Address(es) of off-site storage space of gambling equipment related to this site <br /> (Do not use a P.O. box number) City State/Zip code <br />Address <br />__E;3 11m I 51u'l p- ;;LS> J s;-#. Sf /Vw New 6v-{'i~ H...J 5511 Z- <br />Bingo occasions (including bar bingo) <br />Enter day and beginning/ending hours of bingo occasions Ondicate A.M. or P.M.). An occasion must be at least 1-1/2 <br />hours, not to exceed 4 hours. No more than 10 bingo occasions may be conducted per week. <br />~ Beaimina/fndina Hours Din' BeQinnina/Ending: Hours <br /> ~. to to <br /> to to <br /> to to <br /> to to <br /> to to <br />Noon hour bingo <br />Noon hour bingo must be conducted between 11:00 a.m. and 2:00 p.m. on a ieased premises which must have a <br />license for the sale of intoxicating beverages on the premises under chapter 340A. Check the day(s) !hat noon hour <br />bingo will be conducted. <br />_Sunday _Monday _Tuesday _Wednesday _Thursday _Friday _Saturday <br /> <br />. <br />