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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />LG214PPR Printed: 1/10/2003 <br />For Board Use Only <br />Amt. Pd <br />Check# <br />. icense Number: B -00864 -005 <br />Effective Date: 8/1/2001 Expira tion Date: 7/31/2003 <br />Name of Organization: Little Canada Vol Fire Department <br />Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br />Gordies Place Inc <br />201 E Little Canada Rd <br />Little Canada, MN 55117 <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: <br />Rent paid per bingo occasion: <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br />Storage Information <br />325 E Little Canada Rd <br />Little Canada, MN 55117 <br />Firstar Bank of Minnesota <br />Arden Hills Office <br />St. Paul, MN 55101 <br />Bank Information <br />Gambling Bank <br />Account Number: 173442771 <br />On the lines provided below list the name, address and title 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 Address City, State, Zip Code <br />Title <br />Robert Gordon Johnson <br />2442 Rice St 4178 <br />Little Canada, MN 55113 <br />4 -/7s <br />James Morelan <br />451 Eli Rd Little Canada, MN 55117 <br />(Be sure to complete the reverse side of this application) <br />This form will be made available in alternative Format (ie. huge print, braille) upon request. <br />3 <br />Page I of 2 (Continued on Back) <br />