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State of Minnesota <br />Gambling Control Board <br />Premises Permit Renewal Application <br />J214PPR Printed: 11/15/1999 <br />For Board Use Only <br />Amt. Pd <br />Check # <br />Date <br />Initials <br />License Number: B-00011-001 <br />Effective Date: 4/1/1998 Expiration Date: 3/31/2000 <br />Name of Organization: VFW Post 6583 Aux 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 />VFW Post 6583 <br />7868 Lake Dr <br />Lino Lakes, MN 55014 <br />Name of the property owner (If different): <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 />40.00 <br />0.00 <br />Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br />Storage Information <br />Firstar Bank <br />7984 Lake Dr <br />Lino Lakes, MN 550142138 <br />Bank Information <br />Gambling Bank <br />Account Number: <br />3003389 <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 />Title <br />Su53v Van ye.St:. <br />/U.'3-�4.nV/Sc. Ar, <br />,lnv ,tytk�S)Yln SUI`/ <br />G/ADys Bro ►4e;r <br />?9/ lli�IC1 ��he. <br />J-inoLt. ,)1/1 .S5 -oil <br />teRe-5i-1cv,T <br />Give may, <br />r <br />J <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 />