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STATE OF MINNESOTA FOR BOARD USE ONLY <br /> GAMBLING CONTROL BOARD AMT PAID <br /> PREMISES PERMIT RENEWAL APPLICATION CHECK NO. <br /> LG214PPR PRINTED:10/13/93 DATE <br /> WNSE NUMBER: B-02945-001 EFFECTIVE DATE: 04/01/92 EXPIRATION DATE: 03/31/94 <br /> NAME OF ORGANIZATION: Sports St Anthony Boosters <br /> GAMBLING PREMISES INFORMATION <br /> NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br /> Stonehouse <br /> 2700 Hwy 88 <br /> St Anthony 55418 <br /> COUNTY HENNEPIN IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br /> LESSOR INFORMATION <br /> DOES YOUR ORGANIZATION OWN THIS SITE?: No <br /> IF NO, LIST THE LESSOR: <br /> City of St Anthony <br /> 3301 Silver Lake Rd <br /> St Anthony MN 55418 <br /> NAME OF PROPERTY OWNER (WHEN NOT LESSOR) : <br /> SQUARE FEET PER MONTH: 27 AMOUNT PAID FOR RENT PER MONTH: 800 <br /> SaNLARE FEET PER OCCASION: 0 AMOUNT PAID PER OCCASION: 0 <br /> BINGO ACTIVITY <br /> BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> STORAGE ADDRESS <br /> 251 5th St NW <br /> New Brighton MN 55112 <br /> BANK INFORMATION <br /> i tar , 5 �- B J t-' <br /> q (,! Z- -2S3 -tiy�3 <br /> t thwr�� 18 3�z 8 s: I&;•t�- La kc 12� <br /> �. <br /> GAMBLING BANK ACCOUNT NUMBER: <br /> �c�'ff1 �I (o5tf� li� bt> <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 <br /> �.HANDLE/GAMBLING FUNDS. <br /> (,[� �`Z.�{ /�As% '�•.y �rS. S�/Yla.�d1-%t��/'1,> 554/ SeG,I+ �Jftrr �f"���, <br /> A✓,_L ��%� f'�i 31C/� E-J�-c 9. ,ere A)� Ct.IIPASLLyx S�y1a �ftiIj <br /> . rT <br /> ���.i �c y �. �] °Cj ��N3 Ao ) <br /> (BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br /> THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />