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State of Minnesota For Board Use Only <br />Gambling Control Board <br />Premises Permit Renewal Application <br />Amt. Pd <br />Cheek # <br />GC214PPR Printed: 1/1 003 <br />License umber: A-03162-010 Effective Date: 1/1/2002 <br />xprrattcn Date. 7/3112003 <br />Dame of Organization: American Business womens Chapt Lady Slipper <br />Gambling Premis Information <br />Name of the establishment where garnblirig will be conducted <br />Roseville ffingo Mall <br />2525 N Snelling Ave <br />Roseville, MN 55113 <br />County: Ramsey <br />Note: Our records show the premises <br />is located within the city limits <br />Lessor Information <br />Capitol City Investments, LLP <br />3647 McKinley St NE <br />inneapolos MN 55418 <br />.Name of the property owner (If different); <br />Square footage leased per month' <br />Rent paid per month: <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: jWr1_--# f <br />Bingo Activi!y <br />Our records indicate that Bingo is conducted on these premises. Please refer to the instructions for required at <br />2525 N Snelling Ave <br />Roseville, MN 55113 <br />Wells Fargo <br />1220 W County Rd E <br />Arden Hills, NIN 55112 <br />Storage Information <br />Bank Information <br />Gambling Bank <br />Account Dumber: 3528255745 <br />On the lines provided below list the name, address and dtle of at least two persons authorized to sign checks and make deposits and <br />withdrawals fbr the gambling account. The erg anizatiods treasurer may not handle gambling funds, <br />Name <br />Mary Goette <br />Debra Jean Burehett <br />Sharon Kay 5ibeil <br />Address <br />632 redwood Ln <br />5043 Madison NE <br />City, State, Zip Code <br />Amp <br />New Brighton, MN 55112 <br />Minneapolis,, SIN 55421 <br />Title <br />President <br />Vice President <br />Marl n : Da mm a n (Be sure to complete the reverse side of this application ) G Ma n a g e r <br />This farm will be made available in alternative format (ie. large print, braille) upon request. Page 1 of 2 (Continued on Back) <br />