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LG214 <br />(9/3/901 <br />Minnesota LawfitI Gambling <br />Premise Permit Application - Part 1 <br />FOR BOARD USE ONLY <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />Orgaaizatlon En%aaaiiozs <br />Legal Name of Organaatan <br />Little Canada Charity Plus, Inc. <br />Business Address of Organization - Street or P. 0 Box (Do not use aairess of gambling manager) <br />2940 Rice Street <br />City State ,Tip Code County Business phone number <br />Little Canada Mn. 55113 Ramsey (61g 482 -0733 <br />Name of chief executive officer (cannot be gambling manager) Title Business phone number <br />,Celeste Houle <br />C.E.O. ?121482 -0733 <br />Address of chief executive offerer - Street or P. O. Box <br />1970 Case Street <br />City State <br />St. Paul Mn. <br />ter..:.. rs>.y x>,•bw.,,»::«^^w <br />trYPettt7 .Pli Satioxt> <br />Zip Code County <br />55119 <br />Class of Premise Permit <br />® Cass A — Bingo, Raffles, Paddlewheels, Tipboards, Pull -tabs <br />❑ Class B — Raffles, Paddlewheels, Tipboards, Pull -tabs <br />❑ Class C — Bingo only <br />❑ Cass 0 — Rattles only <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 orlanizatioil per week. <br />Day Beginning/Ending Hours Day Beginning/Ending Hours Day Beginning /Ending Hours <br />to <br />to <br />to <br />to to <br />to <br />Status of Premise Permit - check one: <br />❑ New premise — Fill in bae, organization premise permit number <br />%❑ Renewal of existing premise permit — Fill in rtmDlet %premise peenit number A –00393-005 <br />❑ Previously expired premise permit — Fill in =tet %premise permit number <br />Page 8 <br />