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� <br />Minnesota Lawful Gambling <br />LG214 Premises Permit Application <br />(see Required Attachmentson Page 2) Annual �� �� <br />Organization information <br />Organization name <br />i.., r q�+ �� r`�� ���� � <br />Name of chief executive officer (CEO) <br />_� � � t-t �� � A: S � i"�4 � V'+ <br />� <br />Pa <br />FOR BOARD USE ON LY <br />Check # $ <br />Organization 1lcense number <br />G 2 `r� �i % <br />6/03 <br />1 of 2 <br />Daytime phone number <br />�1�..-��-�� ��3�� <br />Gambling premises information <br />Name of establishment where gambling will be conducted Street address (do not use a P.O. box number) I <br />��� �. �r� �� -� � � � � � � P �� � � �. � � f +� �, �.� � �_ .. . ., � <br />�i�+��r to�rl�l� -..,_...--�--��ur���:... ._ -- ��— ��7 ��# <br />�� � �� � � �}� ��E� ��� � � � � � . <br />Does your organization own the building where the gambling will be conducted? <br />_Yes �w4 I f no, attach �G215 Lease for Lawful Gambling Activity <br />Gambling bank account information <br />Bank name Bank account number <br />-,� • <br />— -v f � w� — • � . <br />�,� - <br />Address(es) of off-site storage space of gambling equipment related to this site <br />(Do not use � o � � -•- - <br />� �J_ <br />.- s � <br />_ � . — z . — �. � � <br />.�• ,IS— �F y'� � <br />Bingo occasions (including bar bingo) <br />Enter day and beginning/ending �ours of bingo occasions (indicate AM or P.M.). An occasion must be at least 1-1/2 <br />hours, not to exceed 4 hours. No more than 10 bingo occasions may be conducted per week. <br />� <br />�p�jlnn Hni irc <br />� <br />� <br />m � <br />Go <br />ko <br />� � � Hniirc <br />� <br />� <br />W <br />G] <br />� <br />Noon hour bingo <br />Noon hour bingo must be conducted between 11:00 am and 2:OQ p.m. on a leased premises which must have a <br />license for the sale of inmxlcating beverages on the premises under chapter 340A. Check the day(s) that noon hour <br />bingo will be conducted. <br />_Sunday Monday Tuesday Wednesday Thursday _Friday _Saturday <br />