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<br />OCT-28-2003 15:19 FROM:MARY RUE SCHUTTR CPR 7637841729
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<br />TO:651 483 8520
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<br />P.002
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<br />Board Use Only
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<br />Lawful Gambling License Renewal Application
<br />LG200R
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<br />> ',:" :.' ;'; )Ann'tici'tOrganizaflon License {Fee'$'j;SOJ~:<'" '"
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<br />, ',License #: Expiration Date: 1/31/2004
<br />1816 Organization: Mounds View Lions Club
<br />Business Address: 1458 85th Ave NE, Spring Lake Park, MN
<br />Phone: (763) 784-2908
<br />County: Anoka
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<br />55432
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<br />:',' :' .::; Organization Treasurer: John Robert Wharton
<br />,;,' ,;';' ,j Home Address: 7462 Spring Lake Rd, Mounds View, MN 55112
<br />'~~';~:),f;: -Phone: - (763) 784-5040
<br />,..'.. Date of Birth: 10/12/1941
<br />~.>':t '; Social Security #: 483~46-4838
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<br />i::'W;!~f 1 Site #" Org Owns Site: N @ ~e-will notberenewing-this $ite- i
<br />;.,::' ,,'cn"! . --- -----~- ----
<br />;.:':,;';~) 3 Site Name: Mermaid Entertainment & Event Lef\..+er
<br />i;:", ',S!/ Street Address: 2200 Hwy 10, Mounds View, MN 55112
<br />::;:f/:~' County: Ramsey
<br />;t3::;3: 1 Bank Name: Western Bank
<br />~7~)~"~:J Address: 2711 NE Hwy 10, Mounds View, MN 55112
<br />.;/~~';,::1 Gambling Acct #: 9003013
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<br />i:~:'::','i.~j County: Ramsey
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<br />'Jj)~!l ;~:;::~ #: ~~~~: 10, MoundS ~ew, MN 55112
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<br />Chief Executive Officer:
<br />Home Address:
<br />Phone:
<br />Date of Birth:
<br />Social Security #:
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<br />Jerome Wayne Linke
<br />2319 Knoll Dr, Mounds View, MN 55112
<br />(763) 786-4696
<br />3/4/1949
<br />471-50-2427
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