Laserfiche WebLink
West <br />LG214PPR PRINTED: <br />STATE OF MINNESOTA IFOR BOARD USE ONLY$ <br />GAMBLING CONTROL BOARD 'AMT PAID I <br />PREMISES PERMIT RENEWAL APPLICATION 'CHECK NO. <br />IDATE <br />LICENSE NUMBER: B- 03017 -003 <br />EFFECTIVE DATE: 07/01/96 EXPIRATION DATE: 06/30/98 <br />NAME OF ORGANIZATION: Fire Circle Pines Centennial Fighters Relief Assoc <br />GAMBLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Millers on Main <br />8001 Lake Dr <br />Lino Lakes 55014 <br />COUNTY Anoka IS 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 />James Miller <br />7851 Knoll Dr <br />Lino Lakes MN 55014 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: 36 AMOUNT PAID FOR RENT PER MONTH: 1000 <br />SQUARE FEET PER OCCASION: 0 AMOUNT PAID PER OCCASION: 0 <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />Centeryill . ..f. e64, 8 <br />STORAGE ADDRESS <br />/1404/07. L -L .e b <br />Forest L -L e, Pr2 03bs^° <br />BANK INFORMATION <br />Firstar Centennial <br />1 Commercial St <br />Circle Pines MN 55014 <br />GAMBLING BANK ACCOUNT NUMBER: 1016989 <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 />14r hvr /%„ ier /7.516 c tr'. (2" try; lit ,n,. _s7S"0 g <br />/ ;10 LSennt4+ /cal%i G/tnV; ew jaHL L; L-t- lS. ill 1,..> ��SDiq <br />r•i6tn eo!✓ard 74)7 zdrr4'rvi �I {� r')/1.� --S s' <br />/irno+hy 131,11 /B7.5". Qveac� Cen4- er ✓.I1t, 117JJ r <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 />