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STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />LG214PPR PRINTED:08/13/93 <br />LICENSE NUMBER: B-01816-004 EFFECTIVE DATE: 02/01/92 <br />NAME OF ORGANIZATION: Lions Houndsview Club <br />FOR BOARD <br />ANT PAID <br />CHECK N0. <br />DATE <br />EXPIRATION DATE: 01/31/94 <br />GALLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Roberts Off 30 <br />2400 Co Rd H2 <br />Hounds View 55112 <br />COUNTY RAMSEY IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br />LESSORINFORMATION <br />DOES YOUR ORGANIZATION OWN THIS SITE?: No <br />IF NO, LIST THE LESSOR: <br />Robert Waste <br />2345 Co Rd H2 <br />Mounds View MN 55112 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: 40 <br />SQUARE FEET PER OCCASION: 0 <br />AMOUNT PAID FOR RENT PER MONTH: 1000 <br />AMOUNT PAID PER OCCASION: <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />STORAGE ADDRESS <br />7462 Spring Lake Rd Unit E-063 <br />Noundsview HN S5112 7807 Hwy 65 NE <br />BANK INFORMATION <br />Firstar New Brighton Bank <br />X70M[XyjugaXr= 2299 Palmer Drive <br />K0§ft" (M HN 55112 New Brighton <br />GAMBLING BANK ACCOUNT NUMBER: 70OS92 <br />ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />AUTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />THE ORGANIZATION's TREASURER MAY NOT HANDLE GAMBLING FUNDS. �O pt. <br />04 <br />View, M 5511L <br />De JT- <br />John P. Wharton 7462 S2ring Lake Road, 116unds View, PIN 55112 G-far.rduNa WGl <br />David 14aas 5225 Sunn side Drive, Mounds View, NN 55112 ASII' µtGJt <br />(BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />THIS FORM WILL BE HARE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />