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Minnesota Lawful Gambling <br />Premise Permit Application - Part 2 <br />h \�i.Keer=nus,nemnmmr snummwflm: <br />Cxnrnbianq awnusesinformattortm <br />Name of establishment ‘t here gambling will be conducted Street Address (do not use a post office box number) <br />Little Canada Bingo Hall 2940 Rice Street Li,t:,tle Canada 55113 <br />Is the premises located within dty limits? ® yes ❑ no <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 1p Code <br />A <br />Mover's Warehouse, Inc. <br />2940 Rice Street Little Canada MN - 55113 <br />Does the organization own the buildng where the gambling will be conducted? OYES ❑ 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 />• 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 />Rent: <br />For gambling with bingo $334.92 /session Total square footage leased 15,600 <br />For gambling without bingo $ Total square footage leased <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 />Zkifil nnfPT'llttitZOr1' <br />(each permitted gambling premises must have a separate checking account) <br />Bank Name Bank Account Number <br />First Bank, N.A. Little Canada 0511512489 <br />Bank Address City State <br />2850 Rice Street <br />Little Canada MN <br />Zip Code <br />55113 <br />Name, address, and title of persons authorized to sign checks and make deposits and withdrawals. <br />Name <br />Address <br />True <br />Frank Graczyk 13 West Demont Little Canada 55117 Chief <br />Richard E. Boss, III 57 E. Bryan Little Canada 55117 Assistant Chief & <br />Gambling Manager <br />,Tim Mnrplan 451 Eli Road Little Canada 55113 Assist. Chief <br />Page 17 <br />