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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />.G214PPR Printed: 2/5/2003 <br />For Board Use Only <br />Amt. Pd <br />Check # <br />License Number: A -05967 -001 <br />Effective Date: 9 /1/2001 Expiration Date: 8/31/2003 <br />Name of Organization: Little Canada Historical Society <br />Gambling Premises Information <br />Name of the establislunent where gambling will be conducted <br />Market Place Center <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 />Market Place Center LLC <br />6440 Flying Cloud Drive <br />Eden Prarie MN 55344 <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 conducted on these premises. Please refer to the instructions for required at <br />Storage Information <br />2900 Rice St <br />Little Canada, MN 55113 <br />US Bank <br />2850 Rice St <br />Little Canada, MN 55113 <br />Bank information <br />Gambling Bank <br />Account Number: <br />104756667408 <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 />Address City. State, Zip Code Title <br />Joan Tschida • v <br />Leona Morelan <br />657 Spryer Ave <br />117 7L, *a^ d Ave <br />Roseville, MN 55113 <br />Little Canada <br />MN <br />Bard Member° <br />Kathleen Manson <br />699 LaBor%e Rd <br />St. Paul, MN 55117 <br />Sec. <br />Robert Walter Anderson <br />838 Black Oaks Lit <br />Anoka, MN 55303 <br />Gambling Mgr <br />(Be sure to complete tl e reverse side of this application) <br />This form wilI be made available in alternative format (ie. large print, braille) upon request. Page 1 of 2 (Continued on Back) <br />