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—�� �� <br />Minne�ota Lawful Gambling <br />��R�, {l�G�OaR} t�awful �ambling �.�ce�se R�newal Appl�ca�tian <br />Corr�ions should be rriade directly on this application <br />� Submlt one check for all renewal fc�s, gayable to State of Mir�nesoha <br />Organizat��n requir�ments: <br />r 1. An annuai arganizatian iicense iee of $350 is requirerf, <br />Gamb[ing license #� �.13 Currcntlit�nseexpireson zlaalauo6 <br />` Itenewing ticense from 3/J./2006 ta 2/28/200B <br />�r���!ezaL���n: o!�;�,rxc,�� ! �i�n ��a�* ��a2 ��s��.r;;�° <br />70� W Co Rd C, Rasevi(!e, MN 55113 <br />(t1�)483-3535 Ramsey County <br />� CEU: Tom Nalipinski � <br />6�5 N Owasso Blvd, 5horeview, MN 55125 <br />Treasurer: David L H�gg <br />� 2851 F�r�wo�d St, Rosevi�le, MN 55�.13 <br />Premises pernnit requ�rements: <br />1. An ann�1��<;��mi�es permit fee af �15U, <br />lease ac�r�rnen� far each site <br />daes not awn is <br />' �i�a� ii�e on€y- <br />�� Check th4s bmf only 1f � <br />f Yourorganiratlon � <br />I qua�liies far the waiver of � <br />w�i8 OYga�iu.�iftn f �€CEvlSE <br />� fee de8ned !n Mlnn�a�a � <br />� Statute 944.16 Subd. 6 � <br />(651)484-8�16 <br />�651)636�-0530 <br />5i� numher OU1 �kt '��.��� �15 hox if this site has been discontinued or wiil not be renewed. <br />���� ����� �[lS�' �'�� <br />.. _ __.__ � <br />� <br />1 iuni� � � <br />9oard [tce 47nly ; <br />i00 W Co R C, Rasey�lle, MN 55� 13 Ramsey County <br />�. �---Tawnship of (if applicable) Gamhling aCCOUnt 0960167f521109 <br />Does vrganizatia� c�wr� th�s site? Y l�t S�ir Rosevilte Bank <br />Does organization conduet bir�go o� premises? Y ��v _� �`�'� � Go Rd B, Roser��lle, MN 55213 <br />� If yes, tlie attached Iist oF the days ar�d kseginnirx� and ending hours of your hingo c�ccasions musf be � <br />. u�dated and returned. ' <br />s <br />