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4L <br />A4 <br />Will., <br />VOL <br />I-A, IV <br />U2`2 14 <br />• <br />4 <br />-W.Vv <br />.7 <br />f <br />PIT <br />AM M <br />Minnesota ,,llW Gantilibung: <br />Premise Pe- ---I- AppUcation Part 1 <br />a <br />'CA BOASW I ISE <br />ru ONLY <br />4m, <br />----------- ---------- <br />00 <br />46 <br />I to <br />A A. , r ,.. A SaIn't Agnes Schools q .,x <br />Busirms A&*ss of OlganizaWon - Still lor P. 0 Box (Do not use address of gamblinig man"er) � • <br />51301 Laf ond Avienue, <br />St' PjaUl, VAN M <br />wall city A) CO:b 5 5103 Col Ramsey Ouniff'O" phone. number <br />Vf 4111 qi0v <br />6 11 228-1161 <br />IIA at' chief execu*** offim (cannot be gambkng manager), Tide <br />Business phone number <br />T <br />"Ilk <br />-1886 <br />ohn E Boone Principal 227 <br />W P <br />of chief execudw off*w - Sweet at P. 0. Box <br />1215,0 87th Place North <br />Zip Code County <br />55369 Hennepin <br />11w Mapile Grove, W <br />4*- Mill <br />.. ................ ------------ TZ-- <br />Clus of Prendise Fernadt <br />Class A— Sri <br />ngo, Raffles <br />hhoards, P <br />i u ll- <br />tabs <br />Pa lewheo <br />ddls,.rl <br />Qlass 13 -"1 Raffles., Paddlewhoolls, Thboards, Pull-tabs The class of promise permit <br />must be reflected by class of <br />Cass, C —I B,in�go only <br />kPli <br />the organkaflon license, <br />aaw o'llmill Ratfies, on,ty <br />Ilk <br />131"o <br />Occasions <br />- - - - - - - WI gv occasions: <br />1, Uclihm, A or C. W in days and beellininin and endbmff hours of bin <br />an organizat ek. <br />No more seven bi=o occasions maybe conductedbyr per we <br />D" HO= <br />Day leginirdng/Ending Hours D" Ing Houn <br />. ............ <br />Status of Premise Permit - check one: <br />13 Now, promise — Fill *m I organization promise permit number <br />E.A.". Renewal, of existing promise permit Fill in 99IM21 promiso pormt number B-0 264 0-002 <br />❑ PrOviou�sly expired, promise permA •— Fill in comoliete promise rm t number <br />