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LG300 <br />(aw.1oclaso) <br />Minnesota Lawful Gambling <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? ❑ New n Renewal <br />FOR OFFICE USE ONLY <br />Fee <br />Date <br />Chk Initial <br />License # <br />Bttrgo J t mformat an <br />..1. Name of bingo hall <br />The Market Place <br />Street address of hall <br />2900 N Q N.. Riche St. <br />he <br />2., c /ogTCF ankl, Attn: Martin J. <br />801 Marquette Ave. <br />Bingo Hall Phone <br />(612 ) 490 -1057 <br />County (where hall is located) <br />Ramsey <br />City or Township where hall is located State <br />Little Canada <br />MN <br />Zip code <br />55113 <br />Kr &Ytan <br />Minneapolis <br />State Zip code <br />MN <br />55402 <br />3. Is the bingo hall located within city limits? Yes 1 X 1 No <br />f 1 <br />If "No; indicate township in which bingo hall is located <br />jj r�SJ r 9144.4tign {4heownermusrbn.�h&Mssorefthnbt <br />4. Name of legal owner of bingo hall property <br />MKP, Inc. <br />Phone <br />(612) 661 -8345 <br />Business Mailing Address <br />c/o TCF Bank, Attn: Martin J, Krogman <br />City <br />Minneapolis <br />5. a es o a I. wners, o icers, directors, partners, managers and supervisors <br />(each person named must fill out a separate Bingo Hall Personnel Information form, LG315 and Affidavit, LG316) <br />a. Mayer S. Tapper <br />State <br />MN <br />Zip Code <br />55402 <br />f. <br />k. <br />b. <br />c. <br />d. Jeffrey T. Doering <br />e. <br />Joseph T. Green <br />9. <br />Martin J. Krogman <br />h. <br />m. <br />n. <br />Sole proprietorship <br />Partnership <br />0. <br />Corporation <br />/A&. 54t.eS R -usE 7-i4X <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 ection 349.163? <br />Wage 99 <br />• an atllliAlp nf a whnlocain r1ktrihiitn. nf nlrnhnnr, hn,mrnnnn -0 <br />Yes <br />I 1 <br />1_1 <br />f-1 <br />No <br />X <br />X <br />X <br />X <br />r <br />X <br />El <br />Prl <br />f5i—I <br />