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State of Minnesota For Board Use Only <br /> Gambling Control Board Amt Pd_ <br /> Premises Permit Renewal Application Check# <br /> Date <br /> Initials <br /> _LG214PPR Printed: 11/15/1999 <br /> License Number:B-02945-001 Effective Date: 4/1/1998, Expiration Date:3/31/2000 <br /> Name of Organization: Sports St Anthony Boosters <br /> Gambling Premises Information <br /> Name of the establishment where gambling will be conducted <br /> Stonehouse Note: Our records show the premises <br /> 2700 Hwy 88 is located within the city limits <br /> St. Anthony,MN 55418 <br /> County: Hennepin <br /> Lessor Information <br /> City of St.Anthony <br /> 3301 Silver Lake Rd <br /> St. Anthony,MN 55418 <br /> Name of the property owner(If different): Square footage leased per month: 24.00 <br /> Rent paid per month: 900.00 <br /> Square footage leased per bingo occasion: <br /> Rent paid per bingo occasion: <br /> Bingo Activity <br /> Our records indicate that Bingo is not conducted on these premises. <br /> Storage Information <br /> Bank Information <br /> 1st Bank Gambling Bank <br /> 3928 Silver Lake Rd Account Number: 11654011860 <br /> St. Anthony,MN 55418 <br /> On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits and <br /> withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br /> Name Address City, State, Zip Code Title <br /> (Be sure to complete the reverse side of this application) <br /> This form will be made available in alternative format(ie. large print,braille)upon request. Page 1 of 2 (Continued on Back) <br />