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tlZ14 <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 2 <br />Gamthhn Pre WAS Ttfarmattorc <br />Name of establishment where gambling will be conducted <br />Hoggsbreath Bar & Restaurant <br />Is the premises located within city limits? El yes 0 no <br />Street Address (do not use a post office box number) <br />2504. Rice• Street Little Canada MN 55117 <br />City and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits <br />Little Canada <br />Ramsey <br />Name and Address of Legal Owner of Premises City State Zip Code <br />Hoggsbreath Enterprises, Inc. Little canada MN 55117 <br />Does the organization own the building where the gambling will be conducted? OYES 2 NO <br />NOTE: Organizations may not pay themselves rent if they own the building or have a holding company. A letter must be sub- <br />mitted showing rent payments as zero from gambling funds if the organization's holding company owns the premises. The <br />letter must be signed by the chief executive officer.) <br />If NO, attach the following: <br />Rent: <br />* a copy of the lease with terms for one year. <br />* a copy of a sketch of the floor plan with dimensions, showing what portion is being leased. <br />A lease and sketch are not required for Class D applicantions. <br />For gambling with bingo $ Total square footage leased <br />For gambling without bingo $ 500.00/mo. Total square footage leased 24 <br />Address of storage space of gambling equipment <br />Address City State <br />2940 Rice Street Little Canada MN <br />Zip code <br />55113 <br />san C TIC_ fo7• rthtion <br />(each permitted gambling premises must have a separate checking account) <br />Bank Name. Bank Account Number <br />Firstar Banks. • 502289 <br />Bank Address • City State <br />P.O. Box 12001 St. Paul MN <br />Zip Coda <br />55112 <br />Name, address, and title of persons authorized to sign checks and make deposits and withdrawals. <br />Name Address Tile <br />Frank Graczyk 13 West Demont Little Canada MN 55117 Chief • <br />Richard E. Boss, III 57 E. Bryan Little Canada MN 55117 Assist. Chief & <br />G <br />Jim Morelan 451 Eli Road Little Canada MN 55113 Assist.ukmiie ng Manager <br />Page 11 <br />