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East <br />LG214PPR PRINTED: <br />STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />FOR BOARD USE ONLY <br />AMT PAID <br />CHECK NO. <br />(DATE <br />LICENSE NUMBER: B- 00864 -003 EFFECTIVE DATE: 08/01/97 <br />EXPIRATION DATE: 07/31/99 <br />NAME OF ORGANIZATION:.Ai4rs Little Canada Vol 'Dept' F,' y� <br />GAMBLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Hoggsbreath Bar & Restaur <br />2504 Rice St <br />Little Canada 55117 <br />COUNTY Ramsey <br />IS THE PREMISES LOCATED WITHIN THE CITY LIMITS ?: Y <br />LESSOR INFORMATION <br />DOES YOUR ORGANIZATION OWN THIS SITE ?: No <br />IF NO, LIST THE LESSOR: <br />Hoggsbreath Enterprises Inc <br />2504 Rice St <br />Little Canada MN 55117 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: <br />SQUARE FEET PER OCCASION: <br />24 AMOUNT PAID FOR RENT PER MONTH: 1000 <br />0 AMOUNT PAID PER OCCASION: 0 <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />STORAGE ADDRESS <br />2504 Rice St <br />Little Canada MN 55117 <br />BANK INFORMATION <br />Firstar Banks of Minnesota, N.A. <br />B7oxxk40RA 4061 Lexington Ave. North <br />sji5ERaepegraAaR Arden Hills, MN 55112 <br />GAMBLING BANK ACCOUNT NUMBER: ) J JU?1& 173442771 <br />Norwest Bank Minnesota, N.A. <br />1220 West County Road E <br />Arden Hills, MN 55112 <br />352- 2101016 <br />ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />AUTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />THE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br />.. • <br />:. <br />57 East <br />..•. Uk <br />Robert (1. Johnson 7447 RicP St. * 17R , Litt1R Canada, MN X5119, G.M. <br />Jim Morelan <br />451 Eli Road, Little Canada, MN <br />Ac is Fire Chief <br />THIS FORM WILL BE MADE AVAILABLE IN <br />(BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />Page 144 <br />E. LARGE PRINT, BRAILLE) UPON REQUEST <br />