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Minnesota Lawful Gambling <br />LG214 Premises Permut Application <br />6/03 <br />Page i of 2 <br />(sea Requlriad Attachawnts on Page 2) Annual Fee $ i 50 <br />O P O- " US OLY <br />4rganization information <br />Usedc # $ <br />organization name <br />North Suburban Youth Foundation <br />Orga"LmU°" knm number <br />Name of chief e,ceoudve ofioer ([Ep) <br />01485 <br />R Robert Mason <br />DaWme pNm number <br />651 - 638 -4600 <br />----- - Gambling premises In-f-- ----- <br />Name of estahfbhrrva where wing will be corducW <br />Street addrm <br />KFAN The Restaurant <br />00 not use a P.O. box number) <br />City or iP 2901 <br />Snelling Avenue <br />Roseville County <br />Zip oode <br />Ramsey <br />� your wganfratfan own the 6uildrg r►rttere the gambling wild be aor�duded? <br />55113 <br />Yes Y.-No If no, attach LG215 Lease for La wFul Garts6liny Actin^ty <br />Gambling bank account information <br />Bank name Bank account number <br />North Ameri= 1 <br />Bank stileet addrm <br />3 0 Albert '� ab�ip axle <br />Street North Roseville <br />Address(es) 55113 <br />(es) of off lta storage space F <br />ng equipment related to this sits <br />gambling Addr-ess ( not u a P.O. hex number) of <br />55 COUnty Road B East aty StatelZip code <br />Little Canada MN 55117 <br />Bingo occasions ins <br />� [uding bar bingo) <br />EVer day and beginnNjewfing Fmm of bingo moans i <br />hours,, not ba exceed 4 �. No r�� � �� A.M. �r �,M.�. An must at l�ast 1- <br />ti,�rr 1 bin may be inducted per week. <br />to <br />W <br />to <br />W <br />to <br />to <br />to <br />to <br />W <br />to <br />Noon hour bingo <br />Nn hour bind must be conducted betwem 11:00 a.m. and 2:00 <br />1 c� for the sale it xi p.m. n a [eased r s rich rnr have a <br />bingo will be oond�. tine Prem� under char 34oA. Check the da S) ftt mmn hnt i <br />—Sunday —Monday TuY Wednesday .YhUrsday —_Friday �Saturday <br />