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<br />" <br /> <br />Minnesota Law.fil.l Gambling <br />Premises Permit Application - Part 1 of 2 <br /> <br />FOR BOARD USE ONLY <br />BAS E # <br />pp # <br />FEE <br />CHECK <br />INITIALS <br />DATE <br /> <br />~' G 21 ..~ <br />:7/2919 1 ) <br /> <br />Class of premises pennit <br />(check one) <br />A ($400) Pull-tabs, tipboards. paddlewheels, raffles, bingo <br /> <br />o <br /> <br />Renewal <br />Organization base license number .841'.3 8tJC> <br /> <br />Premises permit number <br /> <br />o <br />~ 8 ($250) Pull-tabs, tipboards. paddlewheels, raffles <br />o C ($200) Bingo only <br />o 0 ($150) Raffles only <br /> <br />~ <br /> <br />New <br /> <br />:(qt9'gmq:tf.g1Jf._mqtim~1Ii~11w1~i~11~~1[~ii~i~ijiliri~~~~fl&~~::f~f.i~[!fw~~i~:j~:t?~:~~~I~:~1ir~t~~1:lt~l~;iilli.fj~~:;iiiif=;11~1:~;l~j;~i:~::ii::~ii:1:~::; <br /> <br />Name of Organization <br />Pee.:-..]l t3ro~ C- 5-c Jf~ <br />Business Address of Organization - Street or P. 0 Box (Do not use the address of your gambling manager) <br />ro ~oy VY'/ #C:-50 <br />City State Z~ COO: County /',. <br />C/ - 0 H A,/' ...:;:503 B tL,/ ~ s. ~ " <br />Name of chief executive officer (cannot be your gambling manager) Tide <br />~tJ1'7.- 5c--k#4Q...,",sc-~~ C~ e. 0., <br />Bingo Occasions <br />If applying for a class A or C permit. fill1n days and begin.n1ng & ending hours of bingo occasions: <br />No more than seven bingo occasions may be conducted by your oi~anizatlon per week. <br />Day Beginning/Ending Hours Day Beginning/Ending Hours Day Beginning fEnding Hours <br /> <br />c~ <br /> <br /> <br />Daytime phone number <br />(C/?) YC 'I - 7 Z Z j--- <br />Daytime phone number <br />{( / 2J C '7 z .- YS 7-.5---- <br /> <br />to <br /> <br />~ ~ <br /> <br />to <br /> <br />~ ~ <br /> <br />to <br /> <br />lfbingo will not be conducted, check here ~ <br /> <br />GaIiiBU!Jg:~~~;;i~~~;~::'ii.Y'g:~,r!qg~\t::ji:::::*:\~:~:i':':\~::::\:','::::~:,:::::::::~\::I:::::::::~~'::::::\il::I;~::::::::~:!:::::@$.::!::I::\:::~:::::~:\:\~:I::::::::~;:~::::~:::1:;::\::i:::~::::::;;;i:'::::;::':::::::;:::1\::::::;:;:::::::;:::I',:::::\::';,::::::::':::"~;::::::::\,::::::::::::;' <br />Name of establishment ~qer~~ambhng Will be conducted . ~tree Addre (do~ot use post oHic ",box nu ber). '. <br />. D (LI /l/' 0 () . . .~ -' ( -- -,-"""" ") r7 <br />. . ~ ~ " _ <.....J ....) v.( <br />Is the premises located within city limits? ~. Yes 0 No If no, is township ~organi.zed 0 unorganized 0 unincorporated <br /> <br />C,rt and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits <br /> <br />C" ~c..dr~-(//// I ~O-'-"L- <br />Name address of legal owner of premises City <br />7;LI n tJ -'.AJ L f1) '8, <br />Does your organization own the building where the gambling will be conducted? <br />If no. attach the following: <br />· a copy of the lease (form LG202) with terms fer at least one year. <br />· a copy of a sketch of the ftcor plan with dimensions. showing what portion is being leased. <br />A lease and sketch are not required for Class 0 applications. <br /> <br /> <br />Zip Code <br />~ S~),31 <br /> <br />Add~~~:~:}gf":~t6~~::'~p~:a:~::6r:::gailiibiiri~:::~q ill prii'~rit::::U&/;Grm~i~?~q:&;i~:6J%&i:::::':"::::f:::U"':':;i:'::.:.:..:.......<0:-;.:;.':.;:-. <br />Address City State Zip code <br />/7?c'~~ ~./T~~ ~-c:- ro,~!>r:- ~c;,("c.. h"~ F~ cr:y-- <br />