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EOR BOARD USE ONLY
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<br /> FEE
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<br /> • Minnesota Lawful Gambling ,CHECK
<br /> • Premises Permit Application. - Part 1 of 2 INITIALS ---
<br /> 'DATE
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<br /> Glatt of piemises permit
<br /> C.�] (check one)loan Organization bash license number_--,,...,�azi�. [1 A($400) Pull-tabs,tipboards,paddlewheels,raffles,bingo
<br /> Prernides permit number_ _—•—_— . (ii B($250) Pull-tabs,lipboards,paddlewheels,raffles
<br /> rid New 0 C($200) Bingo only
<br /> D($1 50J Raffles only •
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<br /> Name f Organization • .
<br /> Celebrity Bowl Charities, Inc. — _-_
<br /> Business Address oI Organization-Street or P.O Box(Do not use the address of your gambling manager)
<br /> 60th & Nicollet S
<br /> City— --�-- Stale Zip Code • County , Daytime phone number
<br /> Warne-of�f:inneapol:is ___ ___ hln. 55419 Menne in 61 869-2475 _
<br /> chief executive officer(cannot be your gambling manager) Title Daytime phone number
<br /> John A. Lever __ _ C.B.O. ( 507) 345-8316
<br /> Bingo Occasioiitis •
<br /> If applying for A class A or C permit, sill in days and beginning Fr ending hours of bingo occasions:
<br /> No more t.hitiri sevetz bingo Occasion:4 may be conducted by your organization per week.
<br /> Day Beginning/Ending!lours l)ay Beginning/Ending flours Day Beginning/Ending flours
<br /> ----- ---to --- ----to --• ----tO-- —.-.
<br /> _ -_t° -- - --- - -to - -to —
<br /> -- .to — It bingo will not be conducted,check here nil
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<br /> FJ;ime of estaliiishitrent w r�e;re arn56n i will ire 'uc;ted - - - --y" street A3-drhss iso not ti`se a—st oFilccr fox nurn$at)
<br /> ..g7/ / -;D L//IV -S -_------_----,—-- . .j._1=,0 hii aA w.'f'- ,0 -- —
<br /> Is the premises locattid within city limits? C .Yes L J No If no,is township l--�I organized ED Unorganized-E:it-rnincowPornte-d -
<br /> Cii,and County whale gambling premised is located on Township and County whore gambling premises is located if uutside of c;ty limits
<br /> /Nai)s'L'i E•r 4 --- -I-- -- -- — - —— -
<br /> Ng.me and address of legal owner of.premises City State Zip Code
<br /> p at;E L L_,_ ' 1.1 e.e `__ o y Gifdve:1,41,�1 d ,1 d Meto/2 'jY £4 �
<br /> !. i9 /v ___,,,5-,_s:/.1_,•_Z —_. _-
<br /> tic es your organization own the bedding where the gambling will be condti ted? El YES ® NO
<br /> If no,attach the following: .
<br /> t' ' a copy of the lease(10-m10202)with terms for nt least one year.
<br /> : ' a copy of ti sketch of the floor plan with dimensions,showing What portion is being leased.
<br /> 1 lease an
<br /> A d sketch we hot required for Class D appliratiens.
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<br /> /� ress city 1 state dip code ..
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