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LG3100 <br />Minnesota, Lawful Grambling <br />i Ifti 'lei A <br />Bingio Hall License X-X Pilication <br />.F I <br />(See inistructions for completion of this application) <br />Is this application for a new license, or a renewal? El New (Z Renewal <br />1. Name of bingo h�all <br />In ca Hall Phone County (where hall is located) <br />I <br />KNIGHTS' OF C•LUMBU'S HALL (612) 631-214,016 RAMSEY <br />-C*-OVT-G" <br />1 <br />---2555 No SNELLING AVE, ROSEVILLE, MN- 55113 <br />CRY <br />-Z7ffw-Tt—ng-a-a6ress oil ffn-gbo-fFall I State Zip code <br />3. Is thiei blinigo hall, located within ci lirn'ths'? 'Yes No I If nNo," indicate township in which bingo hall is located <br />NN ISM <br />W-0 <br />6. <br />iSol�e Propriletorsh" <br />I IP Partnership Corpoiralvion <br />W. 1* - MUNI <br />�0.119.05'00011` M04 <br />........... <br />- --------- ----- - <br />7. Haveldo any persions listed in items and 5: <br />Yes <br />No <br />ai. been convicted of 'a felony?l <br />b. ever, been convicted of a crime i'nviolving gambling? <br />L--j <br />c. ever held a, bingo hall license previouls,ly in Minnesota? (4) CURRENT LICENSE <br />dl. owe delinquent taxes, in excess of $'500 as defined in Minnesota Statutes section 270.72?, <br />le. ever been convicted of assault, criminal violation involving the use of a firearm, or making <br />terroristic threats?, <br />F7-1 <br />® after demand not filed tax returns requiired by the Minnesota Commissioner of Revenue? <br />8. Are any of the Individuals listed inharns 4 or 5, or a person Iholdin la financial or managerial interest <br />in thie bingo hall, or affiliate thereof -- <br />a licensed distributor or affiliate of the distributor under section 39.11 1 ? <br />a licensed manufacturer ior affiliate W the manufactu�r'eir under section 349.163.? <br />an aliffiliate, of a wholesale distributor I of ;al m-iiholic hrvvniiiiii-inirsir:? <br />