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AUG. 31. 2004 8:57AM GROOTWASSINK REAL ESTATE <br />Minnesota Lawful Gambling <br />LG302 Bingo Hall Occasion List <br />Bingo Hall Information <br />NO. 779 P. 7 <br />7/03 <br />Bingo hall name <br />Address <br />Rotating Schedule: Yes (If yes, submit a calendar with the name of the organization(s) conducting bingo on each day.) <br />No <br />Schedules <br />1 No more than 21 bingo occasions <br />are permitted at each hall per week <br />2 If the organization does not yet have <br />a permit number, write "permit (or <br />exemption) applied for." <br />3 Enter the starting and ending times <br />for each occasion (for example, <br />7 -9 p.m., 3:30 -6 p.m.). A bingo <br />occasion must be at least 90 <br />minutes and no more than four <br />hours long. <br />Changes in the above information <br />must be submitted in writing to the <br />Board within ten days if : <br />1. an organization conducts bingo <br />on a day and time other than that <br />reflected on the Bingo Hall Occasion <br />List, or <br />2. an organization is added or <br />deleted on the schedule. <br />Mail this form to: <br />Gambling Control Board <br />Suite 300 South <br />1711 W. County Road B <br />Roseville, MN 55113 <br />8 <br />Questions on th's form should be <br />directed to the Gambling Control Board <br />at 651 - 639 -4000. If you use a TTY, call <br />us by using the Minnesota Relay Service <br />and ask to place a call to 651 -638 -4000, <br />This, form will be made available in <br />alternative format (i.e. large print, Braille) <br />upon request. <br />The information requested on this form <br />will become public information when <br />received by the Board, and will be used <br />to determine your compliance with <br />Minnesota statutes and rules goveming <br />lawful gambling activities. <br />Name of organization <br />conducting bingo occasions <br />Organization's premises permit or <br />exemption permit number or <br />Excluded authorization bingo date <br />Hours of <br />bingo <br />occasions 3 <br />occasions3 <br />Sunday <br />I / <br />/v <br />Monday <br />I, , - <br />Tuesday <br />(i <br />, <br />rl / <br />Wednesday <br />tit <br />,// <br />Thursday <br />Friday <br />Saturday <br />1 No more than 21 bingo occasions <br />are permitted at each hall per week <br />2 If the organization does not yet have <br />a permit number, write "permit (or <br />exemption) applied for." <br />3 Enter the starting and ending times <br />for each occasion (for example, <br />7 -9 p.m., 3:30 -6 p.m.). A bingo <br />occasion must be at least 90 <br />minutes and no more than four <br />hours long. <br />Changes in the above information <br />must be submitted in writing to the <br />Board within ten days if : <br />1. an organization conducts bingo <br />on a day and time other than that <br />reflected on the Bingo Hall Occasion <br />List, or <br />2. an organization is added or <br />deleted on the schedule. <br />Mail this form to: <br />Gambling Control Board <br />Suite 300 South <br />1711 W. County Road B <br />Roseville, MN 55113 <br />8 <br />Questions on th's form should be <br />directed to the Gambling Control Board <br />at 651 - 639 -4000. If you use a TTY, call <br />us by using the Minnesota Relay Service <br />and ask to place a call to 651 -638 -4000, <br />This, form will be made available in <br />alternative format (i.e. large print, Braille) <br />upon request. <br />The information requested on this form <br />will become public information when <br />received by the Board, and will be used <br />to determine your compliance with <br />Minnesota statutes and rules goveming <br />lawful gambling activities. <br />