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ast <br />G214PPR PRINTED: <br />STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />FOR BOARD USE ONLY] <br />AMT PAID <br />ICHECK NO. <br />DATE <br />ICENSE NUMBER: A -01474 -003 <br />EFFECTIVE DATE: 09/01/97 EXPIRATION DATE: 08/31/99 <br />AME OF ORGANIZATION: Lake Owasso Residence °bit -�-" °•- Vol Council <br />GAMBLING PREMISES INFORMATION <br />AME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />arket Place Ctr <br />900 N Rice St <br />ittle Canada 55113 <br />OUNTY Ramsey IS THE PREMISES LOCATED WITHIN THE CITY LIMITS ?: Y <br />OES YOUR ORGANIZATION OWN THIS SITE ?: No <br />F NO, LIST THE LESSOR: <br />arket Place Ctr LLC <br />440 Flying Cloud Dr #203 <br />den Prairie MN 55344 <br />AME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />QUARE FEET PER MONTH: <br />QUARE FEET PER OCCASION: <br />LESSOR INFORMATION <br />IaGdl,al <br />AMOUNT PAID FOR RENT PER MONTH: 0 <br />AMOUNT PAID PER OCCASION: 238 <br />BINGO ACTIVITY <br />.INGO IS CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />STORAGE ADDRESS <br />'.900 N Rice St <br />ittle Canada MN 55113 <br />L\S(=.S\k alt.. <br />.rwt —Bank of Little Canada <br />850 Rice St <br />, ittle Canada MN 55113 <br />;AMBLING BANK ACCOUNT NUMBER: 105115147321 <br />BANK INFORMATION <br />)N THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />,UTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />'HE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br />`Ue1`CcAQU(i(e 1C1)6N5 \koNCaSri ) 'NO;Pw (I1n. 1; \\ICx <br />Sys ail n E,1.A0,400, Q\ 1 \e Lpw, \(, cc1n. 414A\n cnc cl r <br />--\ \DOckS\ c )QnS0, Sr Shcreu;eu; n. 1 �. e.rgbPr <br />Sl'Snr G \ I\fn ,G{\ {i\CP J, O,`i-1111" <br />(BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />'HIS FORM WILL BE MADE AVAILABLE IN AI <br />PAGE 218 <br />LARGE PRINT, BRAILLE) UPON REQUEST <br />