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State of Minnesota For Board Use Only <br /> Gambling Control Board <br /> Premises Permit Renewal Application Amt. Pd <br /> Check# <br /> 10214PPR Printed:9/5/2001 <br /> License NumberB-02945-001 Effective Date: 4/12000 Expiration Date:3/31/2002 <br /> Name of Organization: St Anthony Village Sports 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 /> Name of the property owner(If different): Square footage leased per month: <br /> Rent paid per month: 4 q06 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 /> 251 5th St NW <br /> New Brighton, MN 55112 <br /> Bank Information <br /> US Bank Gambling Bank <br /> 3928 Silver Lake Rd Account Number: 173100727200 <br /> St. Anthony,MN 55418 <br /> On the lines provided below fist 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 /> Susan Ruth Holten 2909 Rankin Rd St.Anthony,MN 55418 <br /> G'ari.1,1ih% Mir <br /> John Fabian 4016 Macalaster St.Anthony,MN 55421 <br /> (Be sure to complete the reverse side of this application) <br /> This form will be made available in altemative format(ie. large print,braille)upon request. Page l of 2 (Continued on Back) <br />