10-25-2000 Council Agenda - Laserfiche WebLink

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Premises Permit Application - LG214 Page 2 of 1/99 Bingo Occasions - for Class A or C Permits If applying for a class A or C permit. enter days and beginning /ending hours of bingo occasions indicate A.M. or P M) No more than ten bingo occasions may be conducted per week. An occasion must be at least one and one -half hours. not to exceed four hours. Qav Beginriinq /Fnding Hours ply Beginning /Ending Hours Qay ginning /Fading Hours to to to to 10 to 10 10 io 10 Gambling Bank Account Information Bank name U S BANKrti60qcount number' 541210032105187039406 Bank address City State /Zip code 2900 RICE ST. LITTLE CANADA, MN 55113 " New organizations: The account number may be obtained and submitted to the Gambling Control Board within ten days after you receive your premises permit. .Name, address, and title of members authorizedto sign checks from the gambling account. The organization's treasurer may not handle gambling funds. Name Address Title nary ann o'kane 90 labore ave 'gambling manager Sue Nelson 762 Labore Rd CEO 90 Lahore ave asst- Gamh Mgr ,1nhn J'Karim Deb Sinna 2929 PAYNE AVE LITTLE CANADA SECRETARY RA,9 T.ARnPP Rn T.TTTT.F rANAnA 551 17 PART r Pn RAY RANCnN Acknowledgment Gambling site authorization I hereby consent that local law enforcement officers, the board or agents of the board, or the commissioner of revenue or public safety or agents of the commissioners, may enter the premises to enforce the law. Bank records information The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill requirements of current gambling rules and law. Organization license authorization I hereby authorize the Gambling Control Board to modify the class of organization license to be consistent with the class of permit being applied for Oath I declare that: 1. I have read this application and all information submitted to the board is true, accurate. and complete: 2. all other required information has been fully disclosed; 3. I am the chief executive officer of the organization: 4. 1 assume full responsibility for the fair and lawful operation of all activities to be conducted: 5. I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the board and agree, if licensed. to abide by those laws and rules, including amendments to them, 6. any changes in application information will be submitted to the board and local unit of government within ten days of the change; and 7. I understand that failure to provide required information or providing false or misleading information may result in the denial or revocation of the license. Signature of chief executive officer (Designee may not sign) Date Page 33