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lvamUllug Luulrui 041a1U <br />Premises Permit Renewal Application <br />LG214PPR Printed: 3/5/2001 <br />Amt. Pd <br />Check 4 <br />Dace <br />License Number:B- 00864 -005 <br />Effective Date: 8/1/1999 Expiration Date: 7/31/2001 <br />Name of Organization: Fire Little Canada Vol Fi-re Dept. <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 />Gordies Place Inc <br />201 E Little Canada Rd <br />Little Canada, MN 55117 <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 />33 <br />1,000 <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 />201 E. Little Canada Rd. <br />Little Canada, Mn, 55117 <br />Firstar Bank of Mn. <br />ST. PAUL, MN. 55101-- <br />ARDEN HILLS.OFFICE. <br />Bank Information <br />Gambling Bank <br />Account Number: 17 3 442 - 771 <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits <br />and 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 G. Johnson <br />2442 <br />Rice St. <br />#178 <br />LITTLM CANADA <br />MN.551T3 <br />Gambling Manage_ <br />Jim Morelan <br />451 <br />Eli Road <br />Little Canada,MN <br />CEO /Fire Chief <br />D31i/ <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 60 <br />Page I of 2 (Continued on Back) <br />