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0,G214PPR Printed: 9/5/2001 <br />State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />For Board Use Only <br />Amt. Pd <br />Check # <br />License Number- 00011 -001 <br />Effective Date: 4/1/2000 Expiration Date: 3/31/2002 <br />Name of Organization: VFW Post 6583 Aux Lino Lakes <br />Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br />VFW Post 6583 <br />7868 Lake Dr <br />Lino Lakes, MN 55014 <br />County: Anoka <br />Note: Our records show the premises <br />is located within the city limits <br />Name of the property owner (If different): <br />• <br />Lessor Information <br />Square footage leased per month: <br />Rent paid per month: <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br />Storage Information <br />7868 Lake Dr <br />Lino Lakes, MN 55014 <br />Firstar Bank <br />7984 Lake Dr <br />Lino Lakes, MN 550142138 <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits and <br />withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br />Bank Information <br />Gambling Bank <br />Account Number: 3003389 <br />Name <br />Address <br />City, State, Zip Code <br />Title <br />1 <br />Gladys Ann Broker <br />799 Vicky Ln <br />Lino Lakes, MN 55014 <br />G4008/4113 '•a t2 • <br />6 L U -,9g4S id e vi r <br />Susan Van Hese <br />7033 Sunrise Ave <br />Lino Lakes, MN 55014 <br />(Be sure to complete the reverse side of this application) <br />This form will be made available in alternative format (ie. large print, braille) upon request. <br />• <br />Page 1 of 2 (Continued on Back) <br />