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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />LG2I4PPR Printed: 11 /15/1999 <br />For Board Use Only <br />Amt. Pd <br />Check # <br />Date <br />Initials <br />License Number: A- 01485 -010 Effective Date: 4/1/1998 <br />Expiration Date: 3/31/2000 <br />Name of Organization: North Suburban Youth Roseville Ascoc F„,„' <br />Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br />Market Place Center <br />2900 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 />Market Place Ctr LLC <br />6440 Flying Cloud Dr #203 <br />Eden Prairie, MN 55344 <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: 11,600.00 <br />Rent paid per bingo occasion: 238.00 <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br />Storage Information <br />55 E. County Road B, Little Canada - 2555 Snelling Ave. Roseville - 2900 N. Rice St., Little Canada <br />1183 University Ave., St. Paul - 4703 N. Hwy. 10, Arden Hills - 738 Thomas Ave., St. Paul <br />Bank Information <br />Ng' -41-47-<-'`"-" L.,Fk,.. Co p..•1 <br />2440I*Fairview ye da3C) N • 4(6, - -T Et . <br />Roseville, MN 55113 <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 />Gambling Bank <br />Account Number: <br />i S'CtOa39 1 <br />-1-0-2-32/4•00- <br />Address <br />City. State, Zip Code <br />Title <br />R. Robert Matson <br />2774 Dellwood <br />Roseville., MN 55113 <br />CEO <br />Drake Anderson <br />1436 Ryan Ave. W. <br />Roseville., MN 5511 <br />Member <br />Gale Pederson <br />929 W. Roselawn Ave. <br />Roseville., MN 55113 <br />Member <br />This form will be made available in alternative forma <br />(Be sure to complete the reverse side of this application) <br />Page 196 <br />Page 1 of 2 (Continued on Back) <br />