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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />LG214PPR Printed: 10/16/2001 <br />License NumberA-00003-001 <br />For Board Use Only <br />Amt. Pd <br />Check <br />Effective Date: 5/1/2000 Expiration Date: 4/30/2002 <br />Name of Organization: VFW Post 6583 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 />Lessor Information <br />Note: Our records indicate that the <br />organization owns this premises <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 <br />7984 Lake Dr <br />Lino Lakes, MN 550142138 <br />Bank Information <br />Gambling Bank <br />Account Number: 3000225 <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 />Name <br />Address <br />City, State, Zip Code <br />Dean Johnson <br />4702 106th Ave NE <br />Circle Pines, MN 55014 <br />C CO <br />Delmar DeVere Jordahl <br />19172 E Front Blvd NE <br />East Bethel, MN 55092 <br />6-444i Pk i 'VC— 41)1, 15, <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 />Page 1 of 2 (Continued on Back) <br />