06/24/2002 Council Packet - Laserfiche WebLink

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State of Minnesota Gambling Control Board Premises Permit Renewal Application • LG214PPR Printed: 5/24/2002 For Board Use Only Amt Pd Check # License Number: B- 98052 -001 Effective Date: 9/1/2000 Expiration Date: 8/31/2002 Name of Organization: Lino Lakes Lions Club Gambling Premises Information Name of the establishment where gambling will be conducted American Legion Post 566 7731 Lake Dr Lino Lakes, MN 55014 County: Anoka Note: Our records show the premises is located within the city limits Name of the property owner (If different): • Lessor Information Square footage leased per month: clo Rent paid per month: 600 _ Square footage leased per bingo occasion: Rent paid per bingo occasion: J Bingo Activity Our records indicate that Bingo is not conducted on these premises. Storage Information Et/=zi_Ga S1-09-4-1-63 Lino Lakes State Bank 7449 Village Dr Lino Lakes, MN 55014 Bank Information Gambling Bank Account Number: 103093 On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits and withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. Name Address City, State, Zip Code Title (Be sure to plete the reverse side of this application) This form will be made available in alternative format (ie. large print, braille) upon request. Page 1 of 2 (Continued on Back) Iry Zastrow 911 Orange Lino Lakes, MN 55014 Jn DTfi '-1 Lino Lakes, MN 55014 Lino Lakes, MN 55014 Qi _ r (Be sure to plete the reverse side of this application) This form will be made available in alternative format (ie. large print, braille) upon request. Page 1 of 2 (Continued on Back)