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LG214 <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 2 <br />tzambfingpz` n tges:h{ormatioa . <br />Name of establishment where gambling will be eonduetad <br />Tittle Canada Bingo Hall 2940 Riee St. Little Canada Mn 5S11Z <br />Is the premises located within city limits? ® yes 0 no <br />Street Address (do not use a post office box number) <br />City and County where gambling premises is located OR Township and County where gambling premises is located 11 outside of city limits <br />Oity of Little Canada <br />Name and Address of legal Owner of Premises <br />County of Ramsey <br />City State <br />Zp Coda <br />Movers Warehouse 2940 Rice St. Little Canada, Mn. 55113 <br />Does the organization own the bu ldng where the gambling will be conducted? ❑ YES Q 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 />• <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 appliicantions. <br />Rent: Per Bingo <br />$ 3 3 6. 310 c c a s i o n Total square footage leased <br />For gambling with bingo <br />For gambling without bingo $ <br />• <br />15,600 Sn.Ft. <br />Total square footage leased. <br />Address of storage space of gambling equipment <br />Address City <br />2940 Rice Street Little Canada <br />State <br />Mn. <br />Zip code <br />55113 <br />Bank. t3IY3IatiOn;;: <br />(aacn permitted gamoing premises must have <br />Sank Name <br />First Bank — Little Canada <br />San* Address <br />2850 Rice Street. <br />separate cnecxmg account) <br />Bank Account Number <br />051 - 1511000 n5t- 5S000ii6 <br />City State Zp Coce <br />Little Canada Mn. 55113 <br />Name, add ess, and tide of persons authorized to sign checks and make deposits and withdrawals. <br />Name Address Title <br />Celeste Houle 1970 Case St. St. Paul, Mn. 55119 r p n <br />Lloyd Walsh 4855 Debra Lane Shoreview, Mn. 55126 Vice Pres <br />JoAnn M. Sherman 2442 Rice St. #152 St. Paul, Mn Gambling Manager <br />Page 9 <br />