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LG214 <br />(9/3/9% <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 1 <br />Orgaaizafioir :En a=3. <br />FOR BOARD USE ONLY <br />FEE <br />CHECIC <br />ThaTTAiS <br />DATE <br />Legal Name of Organtzavon <br />North Ramsey 500th Lions Club <br />Business Address of Cvganizadon - Street or P. O Box (Do not usa address of gambling manager) <br />P.O. Sox 17031 <br />City <br />St. Paul hIN. <br />State <br />. <br />Zp Code County <br />55117 Ramsey <br />Name of chief executive officer (cannot be gambling manager) Tide <br />J. Gregory Hellie Pres. <br />Address of thief executive offxur - Street or P.C. Box <br />15 Echo St. <br />CI State z Cate County <br />City MN. 55126 Ramsey <br />Business phone number <br />( ) 426 -0702 <br />Business phone number <br />.633 -8150 <br />Class of Premise Permit <br />❑ Class A — Bingo, Raffles, Paddlewheels, Tipboards, Pull-tabs <br />❑ Class B — Raffles, Paddlewheels, Tipboards, Puil -tabs <br />❑ Class C — Bingo only <br />St, Class 0 — Raffles only <br />The class of premise permit <br />must be reflected by class at <br />the organization license. <br />Bingo Occasions <br />If class A or C, fill in days and beginning and ending hours of bingo occasions: <br />No more than seven bingo occasions may be conducted by an orlanizatiozi per week. <br />Day Beginning/Ending Hours Day Beginning/Ending Hours Day Beginning /Ending Hours <br />to <br />to <br />to <br />Status of Premise Permit - check one <br />to <br />to <br />to <br />to <br />❑ New premise — Fill in gale organization premise permit number <br />❑ Renewal of existing premise permit — Fill in 2=1;1fetepremise permit number <br />A- b1v(8� <br />Previously expired premise permit — Fill in (=niece premise permit number q <br />• Page 32 <br />