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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 />NAME OF ORGANIZATION: North Suburban Youth Roseville Assoc <br />GAMBLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Market Place Center <br />2900 N Rice St <br />Little Canada 55113 <br />COUNTY Ramsey I5 THE PREMISES LOCATED WITHIN THE CITY LIMITS ?: Y <br />LESSOR INFORMATION <br />DOES YOUR ORGANIZATION OWN THIS SITE ?: No <br />IF NO, LIST THE LESSOR: <br />MKP Inc <br />801 Marquette Ave <br />Minneapolis MN 55402 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: 0 AMOUNT PAID FOR RENT PER MONTH: 0 <br />SQUARE FEET PER OCCASION: 11600 AMOUNT PAID PER OCCASION: 45-3 - <br />2rco „1 <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />STORAGE ADDRESS <br />2900 N Rice St <br />Little Canada MN 55113 <br />BANK INFORMATION <br />Mid 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 12 <br />