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East <br />LG214PPR PRINTED: <br />STATIC OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />IFOR BOARD USE ONLY <br />AMT PAID <br />CHECK NO. <br />DATE <br />LICENSE NUMBER: 8- 00864 -005 EFFECTIVE DATE: 08/01/95 EXPIRATION DATE: 07/31/97 <br />NAME OF ORGANIZATION: Fire Little Canada Vol Dept <br />GAMBLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Gordies Place <br />201 E Little Canada Rd <br />Little Canada 55117 <br />COUNTY Ramsey 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 />Gordies Inc <br />201 E Little Canada Rd <br />Little Canada MN 55117 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: <br />SQUARE FEET PER OCCASION: <br />33 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 />325 E Little Canada Rd <br />Little Canada MN 55117 <br />BANK INFORMATION <br />Firstar Bank of Minnesota <br />4061 N Lexington Ave <br />Arden Hills MN 55126 <br />GAMBLING BANK ACCOUNT NUMBER: 812 30367 <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 />Robert G. Johnson, 2815 Lakeside Court, Little Canada, MN Gambling Manager <br />Richard E. Boss, III, 57 E. Bryan,-Little Canada, MN Fire Chief <br />James Morelan, <br />451 Eli Road, little Canada, MN Ass. Fire Chief <br />(BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />Page 134 <br />