Laserfiche WebLink
LG300 <br />(Rev. i6 orA <br />FOR OFFICE USE ONLY <br />Fee <br />Date <br />Chk Initial <br />Minnesota Lawful Gambling License # <br />Bingo Hall License Application - Part 1 <br />(See instructions for completion of this application) <br />Is this application for a new license, or a renewal? <br />Bingo: 'TaII Information <br />❑ New <br />® Renewal <br />1. Name of bingo hall Bingo Hall Phone <br />LITTLE CANADA BINGO HALL (612)483 -1203 RAMSEY <br />County (where hall is located) <br />Street address of hall City or Township where hall is located State Zip code <br />2940 NORTH RICE STREET LITTLE CANADA MINNESOTA 55113 <br />2. Mailing address of bingo hall <br />SAME AS ABOVE <br />City <br />State Zip code <br />3. Is the bingo hall located within city limits? Yes I x i No <br />If 'No,' indicate township in which bingo hall is located <br />cane 1S .iI2, pY'n tatLU. II.{ ftteajvnermus thethelessorof:!thebing Jeflj <br />4. Name of legal owner of bingo hall property - - - -- <br />MOVERS WAREHOUSE INCORPORATED <br />Phone <br />( 612 483 -2943 <br />Business Mailing Address City State <br />2940 NORTH RICE ST. SUITE 100,LITTLE CANADA,MINNESOTA <br />5. Names of all owners, officers, directors, partners, managers and supervisors <br />(each person named must fill out a separate Bingo Hall Personnel Information form, LG315 and Affidavit, LG316) <br />Zip Code <br />55113 <br />a THOMAS SHORT <br />b. RICHARD MANDERFELD <br />f. <br />k. <br />9. <br />o• DAVID SLIPY <br />d. ELIZABETH O'DONNELL L <br />e. <br />h. <br />m. <br />n. <br />a. <br />Sole proprietorship <br />gra caftbrts <br />r 1 <br />Partnership <br />XX <br />MA;. 54tE5 usE LA <br />Corporation 34 -69678 <br />7. Have /do any persons listed in items 4 and 5: <br />a. been convicted of a felony? <br />b. ever been convicted of a crime involving gambling? <br />c. ever held a bingo hall license previously in Minnesota? <br />d. owe delinquent taxes in excess of $500 as defined in Minnesota Statutes section 270.72? <br />e. ever been convicted of assault, criminal violation involving the use of a firearm, or making <br />terroristic threats? <br />f. after demand, not filed tax returns required by the Minnesota Commissioner of Revenue? <br />8. Are any of the individuals listed in items 4 or 5, or a person holding a financial or managerial interest <br />in the bingo hall, or affiliate thereof — <br />• a licensed distributor or affiliate of the distributor under section 349.161? <br />a licensed manufacturer or affiliate of the manufacturer under section 349.163? <br />Page 54 <br />an affiliate of a wholesale distributor of alcoholic beverages? <br />Yes <br />