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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />LG214PPR Printed: 5/24/2002 <br />For Board Use Only <br />Amt. Pd <br />Check # <br />— License Number: B-98052-001 <br />Effective Date: 9/1/2000 Expiration Date: 8/31/2002 <br />Name of Organization: Lino Lakes Lions Club <br />Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br />American Legion Post 566 <br />7731 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 />Lessor Information <br />Square footage leased per month: CD <br />Rent paid per month: % 600 <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: <br />J <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br />Storage Information <br />Ev=z C 1. £ tiJ Sic ►a C� C; <br />Lino Lakes State Bank <br />7449 Village Dr <br />Lino Lakes, MN 55014 <br />Bank Information <br />Gambling Bank <br />Account Number: 103093 <br />On the linesprovided 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 />Title <br />Iry Zastrow <br />911 Orange <br />Lino Lakes, MN 55014 <br />—Jve "17avis"1 <br />T. <br />Lino Lakes, MN 55014 <br />Lino Lakes, MN 55014 <br />YI/te wtbZ( <br />Ray-muu Hubei l JvIrn uir <br />?M_-tiIro��e Ni— <br />791},Nancy <br />r' `l l kOWO.A.� 4\ , <br />(Be sure to <br />plete 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 />