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M AN N E S GTA WNWAR. GA M K NA 1!]�� WIS Pagelol`2 <br /> LA214 Premisalms F00ii-VAt hIRMPISCISUCH'I Miummal F% $1150 <br /> ..................................................................................................-U-........... .............................................................................................................. ..................................................................................................................... <br /> ................x...........x................. ............................................... .................................................. ............__..........__.......................... <br /> 11. Ifthe premises blessed,attach a copy ol'your lease, theLG215 MISH the application and required attachments to., <br /> Lease for Lawful Gambling flmthdty� Minnesota Gambling Control Board <br /> S <br /> Z $150 annual prernmes permit fee,Ax each permit(non-refundable). 1711 West County Road B, Suite 300 oath <br /> 55 <br /> Make check payable to "State of MinnesotaZRoseville, PIN 113' <br /> Questions? Call 651-539-1900 and ask for Licensing. <br /> ............... .......... ............................................................... ............... .................................................................... <br /> ................................................... .................................................... ..................................................................................................... ..........................................................................................................................................._'**_'*'**'*=............. <br /> Pamer- <br /> lie. <br /> 011tHissonstwe DOW 00 DI Daytime Phone: ............ ............................................. <br /> ............................................................... <br /> Abu, C91 vw.9"A swo U�p;o'lr_yh <br /> jqlarnhhng mannapor: Daytime Phone: f7�..................................................... <br /> ............................................................................................................................ ....................................................................................................................... <br /> U11411111-1108 PREMISES XNFQRVURIDNI: <br /> ............................................................................................................................. ............ ........................................................................ .......... <br /> Ewanx name of q.�Ate wvrlia�e be conducted: _f <br /> ...........Ef.......... .................................................... ................. <br /> arry previous names for this location: <br /> -------------------------------................................................................................................................... <br /> E7t) <br /> -------------------------------------------------------------------------------------- <br /> ��i <br /> Tounnilp <br /> An' 15 51- <br /> J) <br /> ..........................................................................................................................................................L.&PUMI:........ ............................:.:::.................................................................................................................. <br /> Mqnsr alp nkalAam own Me bOcky smane are ganUng wT to ccmrlun*T:� <br /> Yes N�o If no,attach LG215 Lease for Lawful Gambling Activity. <br /> A lease is not required if only a raffle will be conducted, <br /> any other orgamoven ranTAMg qwAdK9 at th's sAR Ion. <br /> Don't know <br /> Nksa� Bar bingo can only be conducted at a site where another form of lawful gambling is being conducted by he applying organk <br /> or another permitted organization. Electronic games can only be conducted at a site where paper pull-tabs are played. <br /> Wm ywr orywatiM n paesudy amouxted gamsho or AN WNT L.j ns ATIP0 L.J AM t W w in <br /> ............................................................................................. <br /> ................................................................................................................................................................................. <br /> M44 VALA hN,.i! MARY K 1110C1104.11 N'T 1 M1 FORM JVT 31)Fig M 1MMY HM 1 FAA P4114 MR!SAM 1101. <br /> ............................................................... ...................................................................................... <br /> A As /fj <br /> Bank www: 11 ...... ................................................... Rm&ASEEMS P401TWI: ............................................ <br /> 0%)Anj <br /> Batik Street Ahrkew: <br /> Apr, raw .01 i AAT TP Cost LA Y,,A <br /> roxxx wass i ............................................................................................................................ <br /> jr=L 1 EM 1 0 FU j a j JIM 11 it!HIM E F1 CNFF441171! STORAGE SVAATEIN�i: <br /> ................................................................... .............................................................................................................................................................. <br /> CRY: State: Z43 Cod x, <br /> 1 ev J& A . 04; A Af0AVLAIQ ! <br /> NON 017 V4 <br /> ............................................. -------------f---------------------------................. ..................................................!_ <br /> )"A or sty DIN <br /> ......................................... <br /> ................ .................................................... ---------- ............................................................................................................. <br /> ........... <br /> 25 <br />