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<br />Q':.~..~nq <br />" 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, payable to State of Minnesota <br /> <br />:-&;a-r{fus;.~o~-tf- <br /> <br /> <br />_______n._un <br /> <br />. <br /> <br />Organization requirements: <br />1. An annual organization license fee of $350 is required. <br /> <br />Current license term: 4/1/2004 to 3/31/2006 <br />Renewing license term: 4/1/2006 to 3/30/2008 <br /> <br />CEO: <br /> <br />1485 <br />North Suburban Youth Foundation <br />19/0 Oakcrest <br /> <br />Richard R Matson <br />2774 Dellwood St, Roseville, MN 55113 <br />Dale L Maristlien <br />5705 Dunlap Ave, Shoreview, MN 55126 <br /> <br />(612)638-4600 <br />oun 0 amsey <br /> <br />[J '--Checki:hisbo:;if~r- i <br />: organization qualifies for ! <br />i the waiver of the $350 <br />I or anization license fee <br />defined in MN Statute , <br />349.16 $ubd. 6 <br /> <br />Authorization: <br />Organization: <br /> <br />i <br />L <br />(612)889-4463 <br /> <br />Treasurer: <br /> <br />(651)780-9872 <br /> <br />~------------------------- <br />'Annual Goal for Charitable Contributions % I <br />L_________________________I <br /> <br />--..- <br />Premises permit requirements: <br />1. An annual premises permit fee of $150, <br />2. A separate resolution of approval including the site address from the local unit of government, (The local unit of <br />government does not sign this renewal application) and <br />3. A LG215 lease agreement for each site your organization does not own is required. <br /> <br />Site number 010 <br /> <br />Little Canada Bingo Hall <br />2900 Rice St, Uttle Canada, MN <br />L- Township of (if applicable) <br /> <br />ctied<- ihis"box if this site has been discontinued or will not be renewed. <br /> <br />:.BOard.U;e'O~~-: <br /> <br />Ramsey County <br /> <br />Gambling account # 18002394 <br /> <br />Organization owns this site: N North American Banking Co <br /> <br />Does your organization conduct bingo at this sitetS) N -, 2230 N Albert, Roseville, MN 55113 <br /> <br />Is the resolution of approval attached? Y @ .' If yes, the ~ttached list of the days and beginning and ending hours of your <br />bingSl _ocC?sions _rT!u:>t. be up~at~d and retur!1~. _ <br /> <br />55113 <br /> <br />. <br /> <br />Site number 012 <br /> <br />Big Ten Supper Club <br />4703 N Hwy 10, Arden Hills, MN 55112 <br />L- Township of (if applicable) <br /> <br />- ~-'- --- ~- <br />Check this box jf this site has been discontinued or will not be renewed. <br /> <br />:'&:;a-rd-use'O~ly-: <br /> <br />Ramsey County <br /> <br />Gambling account # 18002394 <br /> <br />Organization owns this site: N North American Banking Co <br /> <br />Does your organization conduct bingo at this site(]) N 2230 N Albert, Roseville, MN 55113 <br /> <br />Is the resolution of approval attached? Y /@ .. If yes, th:'ttaChed list of the days and be<)inning and ending hours of your <br />_ ~ing9 _ocC?~~n_s _~ust_ ~ _ uJ~~tE?d_ ~n~ _r~t~r.n~. _ <br /> <br />Site number 013 <br /> <br />Willards Bar <br />738 Thomas Ave, St. Paul, MN <br /> <br />L- Township of (if applicable) <br /> <br />LEI <br /> <br />Check this <br /> <br />if this site has been discontinued or will not be renewed. <br /> <br />r'&;a'rrl.u~.O~Y.[ <br />, . <br />. . <br />. . <br />. . <br />. . <br /> <br />Ramsey County <br /> <br />Gambling account # 18002394 <br /> <br />Organization owns this site: N North American Banking Co <br /> <br />Does your organization conduct bingo at this site? Y@ 2230 N Albert, Roseville, MN 55113 <br /> <br />Is the resolution of approval attached? Y (fb .. If'yes, .the'~ttached list of the days and beginning and ending hours of your <br />. . . ~if!go _~ca~i<?n5 -,~ust ~e _ up~~t~d. ~n~ Tetur.n~. <br /> <br />55104 <br /> <br />. <br />