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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />LG214PPR Printed: 9 /5/2001 <br />For Board Use Only <br />Amt. Pd <br />Cheek 11 <br />License Number:A- 01485 -010 <br />Effective Date: 4/1/2000 Expiration Date: 3/31/2002 <br />Name of Organization: North Suburban Youth Foundation <br />Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br />Market Place Center , LLC <br />2900 Rice St <br />Little Canada, MN 55113 <br />County: Ramsey <br />Note: Our records show the premises <br />is located within the city limits <br />Name of the property owner (If different): <br />Lessor Information <br />Square footage leased per month: <br />Rent paid per month: <br />Square footage leased per bingo occasion: 11,600 <br />Rent paid per bingo occasion: 238.39 <br />Bingo Activity <br />Our records indicate that Bingo is)aconducted on these premises. <br />55ECoRdB <br />Little Canada, MN 55117 <br />Storage Information <br />2900 N. Rice St., Little Canada - 4703 N. Hwy 10, Arden Hills <br />738 Thomas Ave., St. Paul, <br />North American Banking Company <br />2230 N Albert <br />Roseville, MN 55113 <br />Bank Information <br />Gambling Bank <br />Account Number: 18002394 <br />On the lines provided below list the name, a'dress and tide of at least two persons authorized to sign checks and make deposits and <br />withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br />Name <br />Address <br />City, State, Zip Code <br />Titil^ <br />DiaK XXXX' .xx <br />'x4•ARYi MeYQXXxxxxxxxxxxxxx <br />xXXXXXXkXXX Xx <br />Drake Anderson <br />a r��•� • <br />Roseville, MN 55113 <br />' `<xQSz kxx <br />` 3t1I'M °kN <br />xxxxxxxxxxxx <br />Mia9exinogbRxx <br />Member <br />YL <br />LL:I 1VY VVU JLt L.I.L 1 \VJV VIlLV lull/ JJL1J <br />(Be sure to complete the reverse side of this application) <br />This form will be made available in alternative format (ie. large print, braille) upon request. <br />Page 1 of 2 (Continued on Back) <br />