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East STATE OP MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />LG214PPR PRINTED:10 /11/95 <br />IFOR BOARD USE ONLYI <br />IAMT PAID <br />I CHECK NO. <br />I DATE <br />LICENSE NUMBER: A- 01485 -010 <br />EFFECTIVE DATE: 04/01/94 EXPIRATION DATE: 03/31/96 <br />NAME OF ORGANIZATION: North Suburban Youth Roseville Assoc <br />GAMBLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Market Place Center <br />2900 N Rice St <br />Little Canada 55113 <br />COUNTY Ramsey <br />IS THE PREMISES LOCATED WITHIN THE CITY LIMITS ?: Y <br />DOES YOUR ORGANIZATION OWN <br />IF NO, LIST THE LESSOR: <br />one )j1 •-L. 4t <br />801 Marquette Ave Cyycj F( <br />Minneapolis MN 55402 Et , <br />LESSOR INFORMATION <br />THIS SITE ?: No <br />CA. -1 <br />i, ) Cita-4 0 iva 71.03 <br />mw Ss3Yy <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: <br />SQUARE FEET PER OCCASION: <br />0 <br />11600 /0,1 ?d <br />AMOUNT PAID FOR RENT PER MONTH: 0 <br />AMOUNT PAID PER OCCASION: 238 <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />STORAGE ADDRESS <br />2900 N Rice St <br />Little Canada MN 55113 <br />BANK INFORMATION <br />Mid America Bank <br />2440 N Fairview Ave <br />Roseville MN 55113 <br />GAMBLING BANK ACCOUNT NUMBER: 102321400 <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 />Q. Oc(Lco0 PfN SS /13 C.E.U, <br />V , � Cr,^1C.tc RC Li 2J b t'?o�„ U�4v A K- <<ylCr s's- c„�,.<):,.,7�,- <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 15 <br />