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Al <br />Minnesota Lawfu i t, Gambling <br />@I @I <br />GamblingLieense Application - Part 2 <br />Name of e similt sniment w niere garni Wtng well be Iconductad Street aaaress (ool not', use a, post office box number) <br />OM& <br />lity and County where galmWing premises is located OR Township and Cou,nity whi gambling promises is lomited if outside of any city limits <br />CITY, CCUNTY TOWNSHIP COUNTY <br />6 1 LAl i5�e-t, ale-, <br />Lel oWner of gambling prernises, Name of lessor, if not me legal owner <br />Address of owner City State Zip Code <br />4SS 1 X wa:� <br />Does the organization own the, buil�d�ing wihere the garribling wi�l�l be conducted? YES SL NO (NOTE: Organizations <br />may not, play themselves rent, 0 they own thel, building or have a holding company. A lease must be submitted showing rent <br />pallyments, asi zero f �rom gambling funds, N th�e organt , zation's h,oldinig complany owns the promises. <br />attwh the following: <br />a copy of this Wasis wfth terims for one year. <br />a copy of' a sketch of the floor plain wilith dimensions,,, showing what portion is being leased. <br />A lease and isketch al,re niot requiredfor Classi D applAcations. <br />Rent-. <br />For binlgilo with other gambiling $ 'FCC)' Toillal square foolta,ge leased CI 3 K) <br />r <br />For gambling without bing o $ I Total square lootagile leased <br />�A <br />;1V <br />Giarnbling manager's name <br />0;C>d5C-qPvA ol i <br />Vill w ILLek I ZA BIS Ly C) I fC4 1 Uv1G wee <br />All <br />MT <br />I* r I I I ow I I [on <br />11 all <br />aI off all 44h.0 : .91 Z <br />L*jjt2-jj:l it, oil <br />a oil <br />W1 <br />oil' <br />a Jpfictks-JW4 <br />Wl, <br />III L <br />WLiMW <br />Vill w ILLek I ZA BIS Ly C) I fC4 1 Uv1G wee <br />