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STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />RENEWAL APPLICATION FOR <br />BINGO HALL LICENSE - LG300 <br />PRINTED: 08/03/98 <br />FOR BOARD USE ONLY <br />AMT. PAID <br />CHECK 11 <br />lI DATE <br />LICENSE NUMBER: BH046 EFFECTIVE DATE: 02/01/99 <br />EXPIRATION DATE: 01/31/00 <br />Applicant Information <br />Name of Applicant: Little Canada Market Place <br />DBA, if applicable: <br />Business Address: 2900 N Rice St Little Canada MN 55113 <br />Phone Number: 612- 483 -1203 Fax Number: <br />MN Sales & Use Tax ID #: N/A <br />Type of Business Limited Liability Co or Firm <br />Main Office Address (if different from above): 6440 Flying Cloud Dr #203 Eden Prairie, MN 55344 <br />Local Unit of Government Acknowledgement <br />If the Bingo Hall is located within the city limits, the *City must sign the application. <br />If the Bingo Hall is located outside the city limits, Both the * *County and * *Township must sign the application. <br />Name of *City or * *County <br />Little Canada <br />Signature of Person receiving the' application <br />— /3 Q e <br />Date Application Received <br />Title of 'erson gning the Application <br />Name of * *Township <br />N/A <br />By signature below, the township acknowledges <br />that the legal owner of the bingo hall is applying <br />for a bingo hall license renewal within township <br />limits. <br />Signature of Person receiving the application <br />Date Application Received <br />Title of Person Signing the Application <br />Township is: <br />Organized <br />Unorganized <br />Unincorporated <br />Page 12 <br />