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►�� <br />Lawful Gambling License Renewal Application <br />LG20OR <br />Board Use Only <br />(Make necessary changes to information directly on the application) <br />Annual Organization License Fee of'$ O '` qrr <br />License #: Expiration Date: 12/31/2003 <br />70 Organization: Midway Speedskating Club Inc <br />Business Address: 2780 Snelling Ave Ste 107, Roseville, MN 55113 <br />11 <br />Phone: { - sl 3 �-- 3 3 2_ b <br />County: Ramsey <br />N <br />Chief Executive Officer: Kenneth Harasyn <br />0 <br />Home Address: 16035 36th PI N, Plymouth, MN 55446 <br />Phone: (763) 694 -6166 <br />e <br />Date of Birth: <br />Social Security #: <br />� <br />Organization Treasurer: Teresa Bruckner <br />Home Address: 2160 Arcade St, Maplewood, MN 55109 <br />Phone: (651) 772 -9129 <br />Date of Birth: <br />Social Security #: <br />-- - - -___ <br />Annual Premises Permit Fee 150 and Ci t. <br />$i ty or Co-unty`resolution required'per site <br />i�L- <br />Site #: Org Owns Site: N We will not be renewing this site s <br />fD <br />7 Site Name: Roseville Bingo Hall <br />Street Address: 2525 N Snelling Ave, Roseville, MN 55113 <br />County: Ramsey <br />Bank Name: Community National Bank <br />c <br />Address: 1501 W Co Rd C, Roseville, MN 55113 <br />Gambling Acct #: 2000602 <br />