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.• <br />10214 <br />isrslsa <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 1 <br />rgattien rufazmaiioa:= <br />FOR BOARD USE ONLY <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />Legal Name at Organtranan <br />Little Canada Charity Plus Tnr <br />Business Address of Crganizadon -Street or P. O Box (Do not use address of gambling manager) <br />2940 Rice Street <br />City <br />Little Canada <br />State <br />MN <br />Zp Code <br />55113 <br />.:.Name of chief executive officer (cannot be gambling manager) . Title <br />Celeste Houle C.E.O. <br />Address of chief executive officer - Street or P.C. Box <br />1970 Case Street <br />City <br />St. Paul <br />State <br />MN <br />Zp Code <br />55119 <br />County <br />Ramsey <br />County <br />Ramsey <br />Business phone number <br />612) 482 -0733 <br />Business phone number <br />612 482 -0733 <br />( ) <br />Class of Premise Permit <br />❑ Class A — Bingo, Raffles, Paddlewheels, Tipbaards, Pull-tabs <br />® Class 8 — Raffles, Paddlewheels, Tipboards, Pull -tabs <br />❑ Class C — Bingo only <br />❑ Cass 0 — Raffles 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 organizatiori 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 to <br />Status of Premise Permit • check one: <br />❑ New premise — Piil in base organization premise permit number <br />Renewal of existing premise permit — Fill in ycmolete premise permit number D – 0 0 3 9 3 – 0 0 3 <br />❑ Previously expired premise permit — Piil in complete premise permit number <br />Page 8 <br />