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Central STATE OF MINNESOTA IFOR BOARD USE ONLY <br /> GAMBLING CONTROL BOARD ANT PAID <br /> PRMfXSES PERMIT RENEWAL APPLICATION CHECK NO. <br /> 4PPR PRINTED:10/11/95 DATE . <br /> LICENSE NUMBER: B-02945-002 EFFECTIVE DATE: 04/01/94 EXPIRATION DATE: 03/31/96 <br /> NAME OF ORGANIZATION: Sports St Anthony Boosters <br /> GAMBLING PREMISES INFORMATION <br /> NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br /> Apache Wells <br /> 3800 Silver Lake Rd <br /> St Anthony 55418 <br /> COUNTY Ramsey 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 /> 1� FEET PER MONTH: 24 AMOUNT PAID FOR RENT PER MONTH: 800 <br /> 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 /> lot Bank <br /> 3928 Silver Lake Rd <br /> St Anthony MN 55418 <br /> GAMBLING BANK ACCOUNT NUMBER: 11654011860 <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�GAlMBLINNG FUNDS. ,f <br /> C!a'L B iCB n �►'I� �c�J S/ <br /> Q-0►` Soh OK <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 />