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LG214 <br />(I1ft4M) <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 1 <br />cusiness Hcaress of urganizaaon - street or P. O Box (Do not use address of gambling manager) <br />)!�o ;36x / 9g <br />Name of chief executive officer (cannot be gambling <br />Address of chief executive officer - Street or P. O. Box <br />Class of Premise Permit <br />Fee <br />❑ <br />Class A— Bingo, Raffles, Paddlewheels, Tipboards, Pull -tabs <br />$200 <br />Class B — Raffles, Paddlewheels, Tlpboards, Pull -tabs <br />$125 <br />❑ <br />Class C— Bingo only <br />$100 <br />❑ <br />Class D — Raffles only <br />$75 <br />FOR BOARD USE ONLY <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />The class of premise permit <br />must be reflected by class of <br />the organization license. <br />k <br />Bingo Occasions <br />If class A or C, fill in days and beginning and ending hours of bingo occasions: <br />No more than seven bingo occasions may be conducted by an organization per week. <br />Day Beginning/Ending Hours Day Beginning/Ending Hours Day Beginning /Ending Hours <br />to to to <br />to .._ to T to <br />to <br />Status of Premise Permit - check one: <br />❑ New premise — Fill in base organization premise permit number <br />.Renewal of existing premise permit — Fill in complete premise permit number L7z— <br />❑ Previously expired premise permit— Fill incomplete premise permit number <br />