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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />G214PPR Printed: (/10/2003 <br />For Board Use Only <br />Amt. Pd <br />Check # <br />icense Number: B -00864 -003 <br />Effective Date: 8/1/2001 Expiration 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 />Hoggsbreath Bar & Restaurant <br />2504 N 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: <br />Rent paid per bingo occasion: <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br />325 E Little Canada Rd <br />Little Canada, MN 55117 <br />Storage Information <br />`7=a y vllti: <br />+ rr, <br />ifY) <br />�<. <br />` <br />Firstar Bank of Min4zesata <br />ATdetr33'ilis- 8ffiee nOtt zuia .; t `k\c <br />St- Paul, MN 55101 l.4Q:„ \1s `ev7m • <br />Bank Information <br />Gambling Bank P0lea'lo5 i 4 <br />Account Number: 1 <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 <br />Address City, State, Zip Code <br />Title <br />Robert Gordon Johnson <br />2442 Rice St #178 <br />Little Canada, MN 55113 <br />6 ir'n2J ,—:—,e <br />James Morelan <br />451 Eli Rd <br />Little Canada, MN 55117 <br />(Be sure to complete d e reverse side of this application) <br />This form will be made available in alternative format (ie. large print. braille) upon request. Page I of 2 (Continued on Back) <br />