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LG214 Minnesota Lawful Gambling Premise Permit Application - Part 2 :....wx+._y.>:a>Yh"D+>::x;;>..•.w:q.:nxavz»�.'Syn:.a:,:�:i.ux»ix..:.._.Y:&ya,::�.y:.y>:.S�.:S:::fiY:"x.V'.^>Y'v:S<»r. _,_..... n >::yg•.gws>::%s..y'^>:' .. .. 1 CurntzfngPrean�ses Iiz}`orma;tiiarc <t � � .' � :; _ '° Name of establishment where gambling will be conducted Street Address (do not use a post office box number) --;�7.",/ �O, " IiAJ-,e nJ ///`i4 S. u.o-rc� X-.s 4WX- Is the premises located within city limits? Ayes ❑ no City and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits Name and Address of Legal Owner of Premises city Does the organization own the building where the gambling will be conducted? ❑ YES state NOTE: Organizations may not pay themselves rent if they own the building or have a holding company. A letter must be sub- mitted showing rent payments as zero from gambling funds If the organization's holding company owns the premises. The letter must be signed by the chief executive officer.) If NO, attach the following: Rent: . a copy of the lease with terms for one year. ' a copy of a sketch of the floor plan with dimensions, showing what portion is being leased. A lease and sketch are not required for Class D applicantions. For gambling with bingo $ Total square footage leased For gambling without bingo $ �ac5` Total square footage leased 3 Address of storage space of gambling equipment Address Citj State Zip code ///P 9 .fT/cC4l�>ci2 iS Wd-- 4F4,Pr6, C1'1 Number ii</Gs` 394-t ct- .61 Name, address, and title of persons authorized to sign checks and makedeposits and withdrawals. Name �.� Address Tile �o� �r S/.� ✓S°�r,�.a �T �J.ai/Tn..K�-on �.cJ s3'iif' G�J�I.�✓,45.,,� �U' duo.! iC u�Ft, / S7Q/ l-./<� i/.rs,�r.� TeP �A,�� <.•e� .r.,,v ssa v�