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LG214 <br />0m090). <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 1 <br />OrganYZateo 7nforr abort',' <br />FOR BOARD USE ONLY <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />Legal Name of Organization <br />St. Joseph's Cori Pty for Charity Tnr <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 Code 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. 0. Box <br />2500 Morrison Street <br />City <br />Little Canada <br />State <br />MN <br />Zip Code <br />55117 <br />County <br />Ramsey <br />Type of Appl €cation:; <br />Class of Premise Permit Fee <br />❑ Class A — Bingo, Raffles, Paddlewheels, Tipboards, Pull -tabs $200 <br />al 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 />• <br />to <br />Status of Premise Permit - check one: <br />❑ New premise — Fill in base organization premise permit number <br />12 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 17 <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 />• <br />to <br />Status of Premise Permit - check one: <br />❑ New premise — Fill in base organization premise permit number <br />12 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 17 <br />