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Rant STATTS OF MINNESOTA IFOR BOARD US S ONLY 1 <br /> ANBLT G CONTROL BOARD AMT PA,rD � <br /> .PJ?RXXS3S PRR 'T MlnWAZ APPL.TCAT CN CHECK NO. <br /> LC 2 14 P PR PRINTED: DATE <br /> LICENSE NUMBER: A-01485-009 EFFECTIVE DATE: 04/01/96 EXPIRATION DATE: 03/31/98 <br /> NAME OF ORGANIZATION: North Suburban Youth Roseville Assoc <br /> GAMBLING PREMISES INFORMATION <br /> NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br /> X of C Council 4021 <br /> 2555 Snelling Ave <br /> Roseville 55113 <br /> COUNTY Ramey IS THE PREMISES LOCATED WITHIN THE CITY LIMITS? ; Y <br /> LESSOR INFORMATION <br /> DOES YOUR ORGANIZATION OWN THIS SITE?: No <br /> IF NO+ LIST THE LESSOR: <br /> Naa&rath Bldg Aa ooc <br /> 2555 N Snelling Ave <br /> RoeavillO NN 55113 <br /> NAME OF PROPERTY OWNED (WHEN NOT LESSOR) : <br /> SQUARE FEET PER MONTH: 0 AMOUNT PAID FOR REND' PER MONTH: <br /> SQUARE FEET ET PER OCCASION: 7260 AMOUNT PAID PER OCCASION: 25- <br /> BINGO ACTIVITY <br /> BINGO is CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> STORAGE ADDRESS <br /> 2555 Snelling AvO N <br /> Roeavilla NN 55113 <br /> BANK INFORMATION <br /> Roseville Ccam=ity Bank <br /> 1501 W Co Rd C <br /> Roseville MN 55113 <br /> GAMBLING BANK ACCOUNT NUMBER: 096005624 <br /> CST THE LINES PROVIDED B3I LIST THE NAME, ADDRESS ALTO 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 IUUMLE GAMBLING FUNDS. <br /> L PA 4,Tf C16 +atr <br /> elf,■ ■4� i <br /> (BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br /> THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />