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Minnesota Lawful Grambling <br />am <br />G d%I 1V19" Av%pj$ <br />Q64I Ung Licensez�Ljv ation d- Part go <br />Gamb,Ung, Premises Infoirnmtlion 1101 <br />Name of as Itshiment where, gamNing will be GonduCtOd Street address (do not uIse a, post office, box number) <br />IF <br />QV1 and Counity we, gambling promises is located. OR Township and Counlry whre, gambling promises is located it outside of arvy dry limits - tr <br />CITY CCXJNTY TOWNSHIP C(XJNTy <br />w"Ij %J 6 LA-C- <br />Legal oWw of gambling prIss • Name of le &w,, it not ft legal mnef <br />Y'\ <br />Address of owrovor City State dip Code <br />zsss \j ILLE <br />I Does the organization own the building where the gambling will 'be nducted? 0 YES NO (NOTE: Organizations <br />may not pay themseives, rent Iff they own the building or have a holding coImpany. A lease must be submitted showing rent... <br />payments as, zero from gambling funds N the organization"s holding com�pan�y owns the promises. <br />N NO, attach the foilowing: <br />e a copy of the lease"With terms for one year. <br />* a py of a sketch of the floor plan with dimensions, showing what portion is being leased. <br />A lease and sketch are, not required for Class D applications.' <br />Rent, <br />For binigo with other gambling $—:500 Total square footage leased C13 1 C> . & .9 ..k %.I Is <br />1.40 1111411b . I . . 4111 <br />0 all <br />-4, r- F- <br />A 4p <br />YAh 1. _-1 ah <br />-.1pm9p -F 9-9riri. <br />Gambling manager' "s name, <br />• <br />wv 0 <br />Ar <br />917: v 0I �WA <br />4p a 9., • 4 t # 101 li f filet: <br />I TI <br />jimul <br />III rarj[=-11 LAI <br />r Ir X <br />dW K <br />40 <br />—41 <br />