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<br />\,. <br /> <br />Northeast <br /> <br />STATB OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PBRMIT RENEWAL APPLICATION <br /> <br />IFOR BOARD USE ONLY I <br />IAMT PAID I <br />I CHECK NO. I <br />I DATE I <br /> <br />I :PPR PRINTED: <br /> <br />LICENSE NUMBER: B-00562-450 <br /> <br />EFFECTIVE DATE: 01/01/96 <br /> <br />EXPIRATION DATE: 12/31/97 <br /> <br />NAME OF ORGANIZATION: Multiple Sclerosis Minneapolis Chapt Minn <br /> <br />GAMBLING PREMISES INFORMATION <br /> <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Kellys Korner <br />7098 Centerville Rd <br />centerville 55038 <br /> <br />COUNTY Anoka <br /> <br />IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br /> <br />LESSOR INFORMATION <br /> <br />DOES YOUR ORGANIZATION OWN THIS SITE?: No <br />IF NO, LIST THE LESSOR: <br />Bill Bisek <br />6331 Nobel Ave N <br />Brooklyn Center MN 55429 <br /> <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR) : <br /> <br />o <br /> <br />AMOUNT PAID FOR RENT PER MONTH: 700 <br />AMOUNT PAID PER OCCASION: 0 <br /> <br />f <br /> <br />~E FEET PER MONTH: <br />~E FEET PER OCCASION: <br /> <br />36 <br /> <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> <br />STORAGE ADDRESS <br /> <br />7098 Centerville Rd <br />Centerville MN 55038 <br /> <br />BANK INFORMATION <br /> <br />Firstar Bank Of Hugo <br />14431 4th Blvd N <br />Hugo MN 55038 <br /> <br />GAMBLING BANK ACCOUNT NUMBER: 810301657 <br /> <br />ON THB LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />AUTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />THE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br /> <br />Leslie Ogg <br /> <br />2344 Nicollet Ave, Minneapolis <br /> <br />MN 55404 <br /> <br />. .......... <br /> <br />Board of Directors <br /> <br />Stephen Claypatch <br /> <br />2344 Nicollet Ave, Minneapolis <br /> <br />MN 55404 <br /> <br />Board of Directors <br /> <br />(BE SORE TO COMPLETB THB RBVERSE SIDE OF THIS APPLICATION) <br /> <br />THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />