05-13-1987 Additions I - Laserfiche WebLink

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Gambling License Application Page 2 Type of Application: xClass A Class B Class C Class D xYes No 23 is gambling premises located within city limits? X Yes No 24. Are all gambling activities conducted at the premises listed in #19 of this application? If not, complete a separate application for each premises (except raffles) as a separate license is required for each premises. Yes xNo 25. Does organization own the gambling premises? If .no, attach copy of the lease with terms of at Last one year. )X Yes No 26. Does the organization lease the entire premises? If no, attach a sketch of 27. Amount of Monthly Rent (X Yes .No the premises indicating what portion is being leased. A lease and sketch 137,000 year L is not required for Class D applications. 28. Do you plan on conducting bingo with this license? If yes, give days and times of bingo occasions: ;113 a • 'p D a s f(L Times hursdays 7 :15 - 9:00 p.m. and 9:15 - 11 :00 p.m. Fridays 10:30 a.m. - 12:15_p.m. and 12:30 - 2:15 p.m. xYes' 'No 29. Has the S10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained? Attach copy of bond. 30. Insurance Company Name 31. Bond Number State Surety Company 32. Lessor Name 35. Gambling Manager Name A. Ed Amaro 288085 Little Canada Charity Bingo 33. Address 2940 Rice St, 36. Address 894 Western Ave, 34. City, State,Zip Little Canada, MN 55113 37. City, State, Zip St. Paul, MN 55117 38. Gambling Manager Business Phone ( 612 ) 483 -1203 39. Da e gambling manager became member of organization: r 1983 GAMBLING SITE AUTHORIZATION By my signature below, local law enforcement officers or agents of the Board are hereby authorized to enter upon the site, at any time, gambling is being conducted, to observe the gambling and to enforce the law for any unauthorized game or practice. BANK RECORDS AUTHORIZATION By my signature below, the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to fulfill requirements of current gambling rules and law. OATH I hereby declare that: 1. I have read this application and all information submitted to the Board; 2. All information submitted is true, accurate and complete; 3. All other required information has been fully disclosed 4. I am the chief executive officer of the organization; 5. I assume full responsibility for the fair and lawful operation of all activities to be conducted 6. 1 will familiarize myself with the laws of the State of Minnesota rest - r 1g gambling and rulcis of the Board and agree, if licensed, to abide by those laws and rules, including amendm is tfl,reto. 40. Official, Legal Name of Organization Minnesota 41. S. d � nature be'S .e b. r Executive Officer) Registry of Interpreters For the Deaf X '// Title of Signer President Date M..., c ACKNOWLEDGEMENT OF NOTICI I hereby acknowledge receipt of a copy of this application. B notice that this application will be reviewed by the Charitable become effective 30 days from the date of receipt (noted beta which specifically disallows such activity and a copy of that Board within 30 days of the below noted date. 42. Name of City or County (Local Governing Body) City of Little Canada Signature of person receiving ap X Joseph G. Chlebec Title - -_ - -" " - - -- Clerk- Treasurer cation Date received (30 day period begins from this date) 5/6/87 44. Name of Person delivering application to Local Governing Bogy GO 0001 02 (8.86( Whim (nnv A,,nd Page 31 Note: Ms. Ed Amara used the previous application and whited out the date and resubmitted the application with my signature appearing on it. Also, the pink copy was not attached to this application. Joe