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05-09-05
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11/14/2006 4:24:33 PM
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<br />l,---..,,"/ <br /> <br />GilP;~ling <br />1 Control <br />" <br /> <br />Minnesota Lawful Gambling <br /> <br />(LG200R) Lawful Gambling License Renewal Application <br /> <br />Corrections should be made directly on this application <br />. Submit one check for all renewal fees made payable to State of Minnesota <br /> <br />I-'d Ure ~I, I <br /> <br /> <br />-. <br />Organization requirements: <br />L.LAn annual organization Iice~se fee of $350is re~uired, <br /> <br />Organization license 3162 <br /> <br />,--- --~ --._~ <br /> <br />Current license term <br /> <br />8/1/2003 to 7/31/2005 <br /> <br />~ r - Check this box It your - - l <br />: organization qualifies for the 1 <br />[WaiVer of the organization license i <br />fee defined in Minnesota Statute <br />I 349.16 Subd. 6 I <br /> <br />American Business Womens Chapt Lady Slipper <br />c/o G Bailey 5607 Sheldon St N, Shoreview, MN 5 <br />(612)481-0672 <br /> <br />Ramsey County <br /> <br />~CheCk1hebox I CEO: Gidget Marie Bailey <br />I.boveifthe~e I 5607 Sheldon St, Shoreview, MN 55126 <br />IIS~ec~~'6'~:n I (651)784-5515 <br />I Treasu,.r I Last 4 digits of SS# *** - ** - 9810 <br />listed. A <br />I LG200B must I -~- <br />I be completed I Treasurer: Kenneth S Damman <br />I for each new I C d II MN 55113 <br />officer unless 346 S Mc arrons Blv , Rosevi e, <br />I Has already I (651)481-0672 <br />I been I <br />,-"ubmitted,-, Last 4 digits of 55# *** - ** - 3168 <br />.- -- --- ---- <br />Premises permit requirements: <br />11. An annual premises permit fFee of $150, <br />, 2, A separate resolution of approval induding the site address from the local unit of government, (The local unit of <br />ernment does not sign this renewal application) and <br />LG215 lease agreement for e~~~ite your organization does not own is require~~_.__ _ __ ,',_,_,_. <br /> <br />Date of Birth 10-27-1966 <br /> <br />Date of Birth 06-10-1937 <br /> <br />Site number 003 <br /> <br />Flahertys Arden Bowl <br />1273 W Co Rd E, Arden Hills, MN 55112 <br />~ ~ city jurisdiction, or ~ county jurisdiction <br /> <br />Site owned by organization N <br />Is bingo conducted by your organization? Y I N ~ <br /> <br />~ <br /> <br />Check this box if this site has been discontinued or will not be renewed. <br /> <br />Board Use Only <br /> <br />Ramsey County <br /> <br />If yes, the attached list of the days and beginning and ending <br />hours of your bingo occasions must be updated and returned_ <br /> <br />Gambling account: 3528255745 <br /> <br />Wells Fargo <br />1220 W County Rd E, Arden Hills, MN 55112 <br /> <br />Site number 005 <br /> <br />~ <br /> <br />Check this box if this site has been discontinued or will not be renewed. <br /> <br />I ~"d~O"" , <br /> <br />Scooters <br />755 Jackson StC; ~u;ty~~i~i:n~:; _county jurisdiction <br /> <br />Site owned by organization N <br />Is bingo conducted by your organization? Y IN - <br /> <br />eGambling account: 3528255745 Wells Fargo <br />1220 W County Rd E, Arden Hills, MN 55112 <br /> <br />Ramsey County <br /> <br />If yes, the attached list of the days and beginning and ending <br />hours of your bingo occasions must be updated and returned. <br /> <br />--_._~. "----- --..-------.----- - --------------- - -~- <br />
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