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STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />LG214PPR PRINTED:10 /13/93 <br />FOR BOARD USE ONLY <br />AMT PAID <br />CHECK NO. <br />DATE <br />LICENSE NUMBER: A- 01485 -010 <br />EFFECTIVE DATE: 09/01/93 EXPIRATION DATE: 03/31/94:,,; <br />r .... w .. <br />NAME OF ORGANIZATION: North Suburban Youth Roseville Assoc„ <br />;/• <br />NAME OF ESTABLISHMENT WHERE GAMBLINGWILL BE CONDUCTED , <br />Market Place Center s "' "' y .' <br />2900 N Rice St is snx-5l <. "i1 Y : ?:T 8 <br />Little Canada 55113 '• t <sfr 't f'''`2 {` R .::" <br />... _.. ..__: :.0 .:;,V.7*: t _ail F n•^ <br />COUNTY Ramsey IS THE PREMISES LOCATED WITHIN THE CITY LIMITS Y r" <br />:..GAMBLING PREMISES INFORMATION <br />1.,,t; . . G: ;;I:1:;--11 el 3 f[ i _:=:.3 LESSOR INFORMATION '4;5 .J,!/ 1" ..:,'i ;1:.'1 :. <br />DOES YOUR.ORGANIZATION OWN THIS SITE? No .. <br />'IF NO, LIST THE LESSOR <br />MKP Inc t _. t1 t. < i'f ;? )( i,.s, F n ':i e<x i,) <br />T ra '.1'' iK: . , r. .M; ,07') '.:t:!4:, F r : ' r t 1 -3 <br />801 Marquette Ave <br />Minneapolis MN 55402 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: <br />SQUARE FEET PER OCCASION: <br />11600 <br />AMOUNT PAID FOR RENT PER MONTH: 0 <br />AMOUNT PAID PER OCCASION: - ,Y5-3- <br />2foo,IZ <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />:2900 N Rice St <br />Canada MN 55113 <br />STORAGE ADDRESS <br />BANK INFORMATION <br />'1Nid America Bank <br />2440 N Fairview Ave <br />�• Roseville MN 55113 <br />`GAMBLING BANK ACCOUNT NUMBER: 102321400 <br />...ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />`;;AUTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />:THE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS., <br />(BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />Page 5 <br />