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LG214 <br />n/2oAn <br />C <br />X <br />Minnesota Lawful Gambling <br />Premises Permit Application - Part 1 of 2 <br />e °of Apglicaizorz: <br />541. <br />Renewal <br />Organization base license number <br />Premises permit number <br />New <br />Organxzctt v n Xn or na <br />Name of Organization <br />Little Canada Volunteer Fire Dept. <br />3z M <br />Class of premises permit <br />(check one) <br />❑ A (5400) Pull-tabs, tipboards, paddlewheels, raffles, bingo <br />El B (5250) Pull tabs, tipboards, paddlewheels, raffles <br />❑ 0 (5200) Bingo only <br />❑ D (5150) Raffles only <br />FOR BOARD USE ONLY <br />BASE # <br />PP a <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />4 • <br />Business Address of Organization • Street or P. 0 Box (Do not use the address of your gambling manager) <br />325 E. Little Canada Road <br />City State <br />Little Canada MN <br />Zip Code <br />55117 <br />County <br />Ramsey <br />Name of chief executive officer (cannot be your gambling manager) Tide <br />Richard E. Boss, III Fire Chief & C.E.O. <br />Daytime phone number <br />(61Z 484 -2722 <br />Daytime phone number <br />(61 484 -2722 <br />Bingo Occasions <br />if applying for a class A or C permit. fill in days and beginning & ending hours of bingo occasions: <br />No more than seven bingo occasions may be conducted by your organization per week. <br />Day Beginning/Ending Hours Day Bcginning/Endtng Hours Day Beginning /Ending Hours <br />to <br />to <br />to <br />to <br />to <br />11bingo will not bo conducted, check here <br />CO <br />to <br />Gmi ti ing m swnorr us #snrast »/ .�.,"n� ."sq y" errs ,w- mtxx'r Y <br />Name of establishment where gambling wd(be conducted street dress (do not use a post (Ake box number) <br />Gordies Place 201 E. Little Canada Rd., Little Canada, MN 55117 <br />Is the premises located within city limits? ® Yes CD No If no, Is township O organized unorganized p unincorporated <br />City and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits <br />Little Canada <br />Ramsey <br />Name and address of legal owner of premises City State <br />Gordies, Inc. 201 E. Little Canada Rd., Little Canada, MN 55117 <br />Zip Code <br />Does your organization own the buildng where the gambling will be conducted? =7 YES 1373 NO <br />If no. attach the following: <br />• a copy of the lease (form L0202) with terms for at least 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 applications. <br />Address o£ storage:ispace-otggliallit 1equipxnent Dotwtusaapc� xx ;m ee <br />Address City State Zip code <br />325 E. Little Canada Road, Little Canada, MN 55117 <br />2504 Rice Street, Little Canada, MN 55113 <br />Page 88 <br />