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LG214 <br />n itt4190f <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 1 <br />Organ tiation Tits pain xon <br />FOR BOARD USE ONLY <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />Legal Na`LA QUWASSO RESIDENCE VOLUNTEER COUNCIL <br />Business Address of Organization - Street or P. 0 Box (Do not use address of gambling manager) <br />210 No. Owasso Blvd. <br />City State <br />Shoreview Mn <br />Name of chief executive officer (cannot be gambling manager) <br />Janet L. Thul <br />Address:otchief executive officer - Street or P.O. Box <br />635 Heinel Drive <br />Zip Code County <br />55126 Ramsey <br />Titre <br />President <br />Business phone number <br />( 612 484 2234 <br />Business phone number <br />(612) 484 2234 <br />City <br />Roseville <br />State <br />Mn <br />Zip Code <br />55113 <br />County <br />Ramsey <br />Type of ApplYeation <br />Class of Premise Permit <br />ZZ Class A — Bingo, Raffles, Paddlewheels, Tipboards, Pull -tabs <br />❑ Class B — Raffles, Paddlewheels, Tipboards, Pull -tabs <br />❑ Class C — Bingo only <br />❑ Class D— Raffles only <br />Fee <br />$200 <br />$125 <br />$100 <br />$75 <br />The class of premise permit <br />must be reflected by class of <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 organization per week. <br />Day Beginning/Ending Hours Day Beginning /Ending Hours <br />10:10 th 1:15 Thursday and Fridaty <br />74!5 to 1 M00 Monday thru Sundayo <br />PM yM <br />to <br />Schedule attached <br />Day Beginning /Ending Hours <br />to <br />to <br />Status of Premise Permit • check one: <br />❑ New premise — Fill in base organization premise permit number <br />CR Renewal of existing premise permit — Fill in comolete premise permit number 4 (') /4 7 q - cc a_ <br />❑ Previously expired premise permit — Fill in complete premise permit number <br />Page 6 <br />