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Pon 9OAfD USIA oNLX <br /> Lc21 d BASE it <br /> (malt) PP 1 <br /> E EE <br /> M#riiiefota t duJett Gditibtiing CHECK <br /> Premises I4 t A 1Lettthitit Plitt i t1f 2 INit1ALs <br /> p� DATE <br /> :•,::..w:. ,.::.:..,.:y• r.:r•%•• :v ;rx: <o:.e:•cx: r ......•y: x•:n. •F :q??: TYw }w:.r..?;x <br /> <vY::::- 17i�:: v). v:F .CQJ: >Y:n.l..: '?:�•J}:F+, b :i'..K..v}. <br /> ?::.r rX :,P,..:r Y.!f <F.?;YF.F:•gi'. "v �Y;�vn?. r:J,:i F'. \:y ':d`: <br /> CIats of premises permit <br /> n tieneviwal (check ono) <br /> Organlialton base license number El A (fd00) Pull -tabs, tipboards, paddlewheels, raffles, bingc <br /> Premises permit number B (32501 full -tabs, dpboards, paddlewheels, raffles <br /> Ed New C (3200) Bingo only <br /> D ($150) Sallies only <br /> e: S ::x`.:';?`:;' +r.^.,?y:.,.... F., ^•.:x' Ff?:eh'''� ^:eq .5: {,w..kxY:.. ,r ro:• <br /> i18�::�f`d�>�ri .fig. <br /> Name of OrgdnIzatioit <br /> rR1,F RRTTY ROW1. C ART'TtPS TN('. <br /> 13usiness Address of Organiza on Street or P. 0 Box (00 not use the address of your gambling manager) <br /> 110 WALNUT E. BOX 877 <br /> City State Zip Code County Daytime phone number <br /> MANKATO, MN 56001 BLUE EARTH (507) 345 -8316 <br /> Flame of chief executive officer (cannot be your gambling manager) Tide Daytime phone number <br /> JOHN A. LEVER C.E.O. 507 388 -6208 <br /> fig Oct;aalotta <br /> If applying tot it b11Al A oi, c Permit. 1311 iii days and beginning A elidin hours o[ bingo occasions: <br /> No more than heveti blrigo occaaioris ttiay be conducted by yotit organization per week. <br /> bay tleginning/Endtng flours Day Beginning/Ending fiour3 Day Pegirtning /Ending Hours <br /> to to to <br /> fd to to <br /> f� tf b6gd *111 not be ebtlidtieted. ehaeit bete ttj <br /> ita e esIa f'ime`ni were gambling ea, to cone ucte ir set ess i not use post o x number <br /> q(1() foLv4 W. L rt /2iV/%7'C f4ceo;✓ />2A) Ss71 <br /> Is the premlke! located within city Omits/ pp Yet Cl No lino, Is toamship d Organized d Womanizer:, f:0 unincorporated <br /> Gibs end CoUnf11 *herd Gambling premitea is looted OFt Township and County where gambling premises la located if outside of city Omits <br /> Name and address of legal owner of premises City State Zip Code <br /> /3.1/0 p1[ (y f9-1/C L /gf/L /nw S'S 04 <br /> ()Des your organization own the bulling where the gambling will be =inducted? p YES en NO <br /> if no, attach the following: <br /> a copy of the lease (form LG202) with terms for al least one year. <br /> t d copy of a sketch of the Aoor pl *ith dimensions, showrng what portion (a being leased. <br /> A lease and sketch are not required f& Class D applications. <br /> Address City State Zip code <br /> lib EAST WALNUT MANKATO MN. 56001 C o1� 6,9 �r-s <br /> �S� u W P� /i j /6 r/i j -Z. -rev <br />