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• <br />LG214 <br />';... (7nyp+) <br />Minnesota Lawful Gambling <br />Premises Permit Application - Part 1 of 2 <br />FOR BOARD USE ONLY <br />BASE # <br />PP # <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />App <br />Class of premises permit <br />Renewal (check one) <br />Organization base license numbefl00 o /f7r ❑ A ($400) Pull- tabs, tipboards, paddlewheels, raffles, bingo <br />Premises permit number _0 /ii %A —o° ❑ B ($250) Pull -tabs, tipboards, paddlewheels, raffles <br />New ❑ C ($200) Bingo only <br />D ($150) Raffles only <br />: w.! ttcv,. x: xyn! nyie.. evym ;n.:<y.<n:<ueynp.:,:yy<tttt:>.. :!!• !met:< <yNrr«Ha,.!:Gtt.YSG'A :2K. Ser. wa,±��.<,.... �H /. 2!.: /q.QC /0. «g•I[.,:5«S' <5!a af, .<,mv .x,(5'6". / < " <SG #• ne:u<:ESS <br />/ 7 a.u•^'5 fqt< 326ii <br />IIIZA.tt<!i!: rut_�. <br />Name of Organization <br />usiness Address of Org nization - Street or P. 0 Box (Do not use the address of your gambling manager) <br />' , 1703 / j>r•• .6—.5- /i7 <br />City State Tip Code County Daytime phone number <br />Name of thief executive officer (cannot be your gambling manager) Title / Daytime phone number <br />a <br />635-/ <br />B o Oc anions <br />If applying for a class A or permit, fill in days and beginning & ending hours of bingo occasions: <br />No more than seven b - . occasions may be conducted by your organization per week. <br />Day Beginning/Ending Hours Day Bey • it Hours .. Day Beginning /Ending Hours <br />to to ,.. to <br />to If bingo will not be conducted, check here 15g <br />lam nrtg P en <br />•ameo esta• lishment where g bmgwi • =con• • treet A•' :ss(•• not use a post o'tot box number) <br />- a8 ww/ 0 -- auLe <br />Is the premises located within city limits? Yes = No 0 no, is township O organized 11 unorganized p unincorporated <br />.E' K /F//F'bi rru eu /cu•�j /i� /k <br />arum <br />en✓vcuun ,r,;.? room{. y:". v.<%iici //rci:rFv//.rc <br />City and County where gambling premises is located OR Township and County where gambling premises is located 0 outside of city limits <br />Name and address of legal owner of premises City State Tip Code <br />. d-6 8"3 0 can C,...az f f oi-. .,. -,./ At-, 5-57 a y <br />s your organization own the builckng where the gambling will be cond ? p YES ED NO <br />If no, attach the following: <br />• a copy of the lease (form LG202) with terms for at least ane 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 applications. <br />p; 2%# ::0; ;::1d>: % %:'.'<�`�•::.:ar;/A' • 6i:% /Y :<y :is� S.:5":'::% Nin9•itil%':' ?.:'rY•' %e,,ott,:i,. <br />Addiress of storage space of gax bbu a puxent Da:et,tsaa�o naz <br />Address City State Zip code <br />3 firei4 0t, gib 19c /LK- <br />Page 36 <br />ST? 7 <br />etal <br />