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Minnesota Lawful Gambling <br />I %`74A Qrr. w.: re e+ rl— :d J►....si: tel: <br />6/03 <br />Page 1 of 2 <br />s.vs.a —r ® ereeel.��..7 I GII III LJYt.JIJIILrCILIVII <br />(see Required Attachments on Page 2) Annual Fee $150 <br />FOR BOARD USE ONLY <br />— <br />Check # $ <br />Organization information <br />Organization name • Organization license number <br />Name of chief executive officer (CEO) Daytime phone number <br />cl C� U//V -Zo s�- C/ 9g3�� <br />Gambling premises information <br />Name of establishment where gambling will be conducted Street address (do not use a P.O. box number) <br />!V S IV e c / e. .R U E <br />Cityyy or township County Zip code <br />XoS <br />e U/ '�Nt�'n S e' y l I <br />Does your organization own the building where the gambling will be conducted? <br />__Yes -No If no, attach LG215 Lease for Lawful Gambling Activity <br />Gambling bank account information <br />Bank name Bank account number <br />Eo m ly_viv,'�% r!r r; vrvf j� �y � _ -_� �Il `1 % U ill 3 <br />Bank street address City State /Zip code -- <br />Address(es) of off -site storage space of gambling equipment related to this site <br />(Do not use a P.O. box number) <br />Address City State /Zip code <br />Bingo occasions (including bar bingo) <br />Enter day and beginning /ending hours of bingo occasions (indicate A.M. or P.M.). An occasion must be at least 1 -1/2 <br />hours, not to exceed 4 hours. No more than 10 bingo occasions may be conducted per week. <br />Dav Beginning /Ending Hours BeoinningLEndina Hours <br />Sl�nl / c to �5 ' u,"e c w to ! y `� <br />3.cL to -2 to -,6".yS� <br />7 c� to yS % . �tJ to W <br />rU to 0. Y S to <br />Noon hour bingo <br />Noon hour bingo must be conducted between 11:00 a.m. and 2:00 p.m. on a leased premises which must have a <br />license for the sale of intoxicating beverages on the premises under chapter 340A. Check the day(s) that noon hour <br />f bingo will be conducted. <br />_Sunday _Monday — Tuesday _Wednesday _Thursday _Friday _Saturday <br />----- - - - - -- - -- ------- ----------- ----- --------- - - -- -- <br />