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LG214 <br />(11114180) <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 1 <br />gOratattor ntiOrmo tton . ; . �y�.� ev m ::h <br />FOR BOARD USE ONLY <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />Legal Name of Organization <br />St. Joseph's Society for Charity Tor <br />Business Address of Organization - Street or P. 0 Box (Do not use address of gambling manager) <br />2940 Rice Street <br />City State Zip Cade County Business phone number <br />Little Canada MN 55113 Ramsey 612) 482-1057 <br />Name of chief executive officer (cannot be gambling manager) Title Business phone number <br />Stefano Salute C.E.O. 612)482 -1057 <br />Address of chief executive officer - Street or P. O. Box <br />2500 Morrison Street <br />City State Zip Code County <br />Little Canada MN 55117 Ramsey <br />PQ APPca#xc <br />Class of Premise Permit Fee <br />'❑ Class A — Bingo, Raffles, Paddlewheels, Tipboards, Pull -tabs $200 <br />a] Class B — Raffles, Paddlewheels, Tipboards, Pull-tabs $125 <br />❑ Class C — Bingo only $100 <br />❑ Class D — Raffles only $75 <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 Day Beginning /Ending Hours <br />to <br />to <br />to <br />to to <br />to <br />to <br />Status of Premise Permit - check one: <br />❑ New premise — Fill in base, organization premise permit number <br />al Renewal of existing premise permit — Fill in complete premise permit number B- 00465 -004 <br />❑ Previously expired premise permit — Fill in complete premise permit number <br />Page 14 <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 Day Beginning /Ending Hours <br />to <br />to <br />to <br />to to <br />to <br />to <br />Status of Premise Permit - check one: <br />❑ New premise — Fill in base, organization premise permit number <br />al Renewal of existing premise permit — Fill in complete premise permit number B- 00465 -004 <br />❑ Previously expired premise permit — Fill in complete premise permit number <br />Page 14 <br />