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LG214 <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 2 <br />rrrriiS'1liigPI'Bn2iSG5I�i, f(x!'1YliitLt7ii <br />Name of establishment where gambling will be conducted <br />Is the premises located within dty limits? [ yes 0 no <br />Street Address (do not use a post office box number) <br />55117 <br />City and County where gambling premises is located OR Township and County where gambling premises is located if outside of dty limits <br />City of Little Canada <br />County of Ramsey <br />Name and Address of Legal Owner of Premises City <br />State Zip Code <br />Gordies Place, Inc. 201 E. Little Canada Road Little canada MN 55117 <br />Does the organization own the building where the gambling will be conducted? OYES Eli NO <br />NOTE: Organizations may not pay themselves rent 11 they own the building or have a holding company. A letter must be sub - <br />mitted showing rent payments as zero from gambling funds 11 the organization's holding company owns the premises. The <br />letter must be signed by the chief executive officer.) <br />Rent: <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 applicantions. <br />For gambling with bingo <br />Total square footage leased <br />For gambling without bingo $ 600. 00 Total square footage leased 49 sq. ft. <br />Address of storage space of gambling equipment <br />Address City <br />State <br />?01 E. Tittle ranada Road Tittle r'arjda <br />$ank Inform/Ltition <br />MN <br />Zip code <br />5117 <br />(each permitted gambling premises must have a separate checking account) <br />Bank Name Bank Account Number <br />First Bank - Little Canada 051 - 5599938 051 - 1514310 <br />Bank Address City <br />2850 Rice Street Little Canada <br />State <br />MN <br />Zip Code <br />55113 <br />Name, address, and title of persons authorized to sign checks and make deposits and withdrawals. <br />Name <br />Address <br />Title <br />Stefano Salute 2500 Morrison Street Little Canada MN C.E.0.. <br />Z. Lois Blomberg 132 Demont Ave. E. *341 St. Paul MN Gambling_Manager <br />Page 15 <br />