09-11-1996 Council Agenda - Laserfiche WebLink

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PRINTED: 07/19/96 STATE OF MINNESOTA GAMBLING CONTROL BOARD BINGO HALL LICENSE APPLICATION - LG 300 PART 1 OF 2 FOR BOARD USE ONLY AMT. PAID CHECK # DATE LICENSE NUMBER: BH046 EFFECTIVE DATE: 02/01/97 EXPIRATION DATE: 01/31/98 NAME OF BINGO HALL Little Canada Market Place STREET ADDRESS OF BINGO HALL 2900 N Rice St CITY, STATE ZIP CODE Little Canada MN 55113 BINGO HALL PHONE NUMBER 612- 483 -1203 MAILING ADDRESS OF BINGO HALL 6440 Flying Cloud Dr #203 Eden Prairie MN 55344 TYPE OF BUSINESS Limited Liability Co MN SALES & USE TAX ID # N/A NAME OF LEGAL OWNER OF BINGO HALL PROPERTY Market Place Center Limited Liability Co PHONE 612- 944 -1665 BUSINESS MAILING ADDRESS 6440 Flying Cloud Dr Suite 203 Eden Prairie MN 55344 ATTACH A COPY OF ONE OF THE FOLLOWING SHOWING PROOF OF OWNERSHIP OF THE BINGO HALL PROPERTY: WARRANTY DEED, CONTRACT FOR DEED, PROPERTY TAX STATEMENT, OTHER NAMES OF ALL OWNERS, OFFICERS, DIRECTORS, PARTNERS, MANAGERS AND SUPERVISORS Robert Grootwassink Partner Mark Hotzler Partner Each person listed above must fill out a Bingo Hall Personnel Information, Form LG315 LOCAL UNIT OF GOVERNMENT ACKNOWLEDGEMENT -If the bingo hall is located within any city limits, the city* must sign the application. -If the bingo hall is located outside any city limits, the county* AND township ** must sign the application. City* or County ** Name Little Canada Ramsey Signature of person receiving application Title Date Received TOWNSHIP By signature below, the township acknowledges that the legal owner of the bingo hall is applying for a bingo hall license within township limits. Township ** Name N/A Signature of person receiving application Title- Township official Date Received Township is: Page 2 _ Organized Unorganized _ Unincorporated