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State of Minnesota <br /> Gambling Control Board Arne Pd <br /> Premises Permit Renewal Application <br /> Check <br /> LG2I4PPR Printed: 2/16/2000 Dat <br /> License Number: B-02069-005 Effective Date: 7/1/1998 Expiration Date: 6/30/2000 <br /> Name of Organization: TSE <br /> Gambling Premise! Information <br /> Name of the establishment where gambling will he conducted <br /> 01 Mexico Note:Our records show the premise* <br /> 1754 Lexington Ave is located within the city limits <br /> Roseville,MN 55113 <br /> county: Ramsey <br /> Lessor Information <br /> John Pavlick <br /> 1754 Lexington Ave <br /> Roseville, MN 55113 <br /> Name of the property owner (If different): Square footage leased per month: 48.00 <br /> Rent paid per month: <br /> Square footage leased per bingo occasion: <br /> .per <br /> Rent paid per bingo occasion: <br /> Bingo Actives <br /> Our records indicate that Bingo is not conducted on these premises. <br /> Storage Information <br /> ..- v►►� iq •.1 " o�►� Bank Information <br /> -0--T 1j�"2M"Z.WAoW"-SEaW LW I N&IV � Gambling Bank <br /> �, <br /> Account Dumber: <br /> 3 7-&%CN %1 <br /> On the lines provided below list the name,address and title of at least two persons authorized to sign checks and make deposits <br /> and withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br /> Name Address City, State,Zip Code Title <br /> zotrl VN%%C-e� so)c tC4 At rn Y\L <br /> CkrAy <br /> V N S75703 e ck�� <br /> -%"\eev� 12%Z2 -Yhy\ niv/ <br /> Ike Y"AV &0, <br /> (Be sure to complete the reverse side of this application) <br /> This form will be made available in alternative format(ie. large print,braille)upon request. Page 1 of 2(Continued on Back) <br />