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- <br /> STATE OF MINNESOTA FOR BOARD USE ONLY <br /> GAMBLING CONTROL BOARD AMT PAID ' <br /> PREMISES PERMIT RENEWAL APPLICATION CHECK NO. <br /> LG214PPR PRINTED:08/13/93. , DATE <br /> LICENSE NUMBER: B-01816-005 EFFECTIVE DATE: 02/01/92 EXPIRATION DATE: 01/31/94 <br /> NAMEOF ORGANIZATION:' Lions Moundsview Club ' <br /> GAMBLING PREMISES INFORMATION <br /> NAME OF; ESTABLISHMENT WHERE GAMBLING WILL BE"CONDUCTED' <br /> Donatelles Supper Club <br /> 2400 Hwy 10 <br /> Moundsview 55112 ; . <br /> COUNTY—R,. SEY - _- IS-THE-PREMISES- LOCATED WITHIN-THE CI-TY LIMITS?: Y <br /> . LESSOR INFORMATION <br /> DOES YOUR ORGANIZATION OWN THIS SITE?: No <br /> IF NO, LIST THE LESSOR: <br /> Ed Donatelle' :_ <br /> 5269 Jeffery Dr' 4 -- - <br /> New Brighton MN 55112" <br /> NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br /> SQUARE FEET PER MONTH: 30AMOUNT PAID FOR RENT PER MONTH: 600 <br /> SQUARE FEET 'PER'OCCASION: '0 _ AMOUNT'PAID PER OCCASION: 0 ` <br /> • BINGO ACTIVITY'` r t <br /> BINGO IStCONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> i.i • . ." ,3_';;,(5N, .se-'tb5 -• <br /> :'STORAGE ADDRESS <br /> 7462 Spring Lake Rd Unit E-0 <br /> Mounds View 10I 55112 <br /> ..• 7807 .Hwy 65 NE <br /> spring Lake' rark, MN• 55432 <br /> BANK INFORMATION • <br /> Firstar.*New_Brighton Bank ` • A '� ' 4 <br /> 2299 'Palmer Drive "� <x t. '" <br /> rimiaixrX MN <br /> 551 s.1:-2 Ninew,;Br.rKighton ,�' x ' ' x Y <br /> ` 3 ` -•Z a ] , s <br /> / . tl•GAMBLING BANK ACCOUNT NUMBER: 701333 <br /> .x -1 <.. <br /> ON'THE INES PROVIDED BELOW LIST THE NAME,`SAD KESS AND TITLE OF AT LEAST TWO PERSONS'" <br /> AUTHORIZED To" SIGN CHECKS AND MARE DEPOSIT'S ANI) WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br /> THE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br /> Raymond A- Long- 2604 Ridge Lane, - Mounds View, -MN • 55112 44.escbe.d.r <br /> ; k •11;' r r-'_� .. _Y - . ,- <br /> John-4R -Whar`ton : - 7462 Spring Lake Road,x(Mounds.•View,f MN 55112 hc.t u titc..2 <br /> David Maas 5225 Sunnyside .Drive; 7/sounds =View, MN ' 55112 's= hca.I2 <br /> • (BE SURE TO COMPLETE THE, REVERSE SIDE OF THIS APPLICATION) <br /> ,_ i ?. - -•. ,r3a:.'•., }r - ;6..irtt. a tbik t•YL .p:r.+ A <br /> '1,n, , _ .- , ;- ''�a4cd `g•,yr r ,je 'S:F k <br /> THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT,,(I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />