Laserfiche WebLink
01/27/2003 13:29 <br />6517668351 <br />LG214PP12. Printed:9 /4/2002 <br />License Number: B- 03934403 <br />Name of Organization: Centennial Youth Hockey <br />G b� e mises Information <br />Name of the establishment where gambling will be conducted <br />Shirley Kayes <br />6510 Lake Dr <br />Lino Lakes, MN 55Q14 <br />County: Anoka <br />REC SPORTS & PLAY <br />State of Minnesota <br />Gambling Control Board <br />Premises Pemit Renewal Application <br />PAGE 02 <br />Effective Date: 411 /2001 Expiration Date: 3/31/2003 <br />Name ef the property owner (If different): <br />Note: Our records show the premises <br />is located within the city limits <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 Activ_it� <br />Our records indicate that Bingo is not conducted on these premises. <br />Storage Information <br />9420 Naples St NE <br />Blaine MN 55449 <br />'win City Federal <br />1059 Meadowlands Dr <br />White Bear Lake, MN 55127 <br />On the lines provided below list the name, address and-title of a t least <br />may not persons <br />handle gambling au r ed to sign checks and make deposits and <br />withdrawals for the gambling account. The organization aY <br />Address <br />Bank Information <br />Gambling Bank <br />Account Number: 5851499148 <br />Name <br />Tammy Larsen <br />City. State. Zit) Code Title <br />Lino Lakes, MN 55014 <br />Michael Gaydos <br />151 Glenview Ave <br />Lino Lakes, MN 55014 <br />Carl Anton 5aadion <br />13 (Be sure to complete the reverse side of this application <br />This form will be made available in altemal.ive format (ie. large print, braille) upon request. <br />Page 1 of 2 (Continued on Back) <br />