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Central STATE OF MINNESOTA IFOR BOARD USE ONLY <br /> GAMBLING CONTROL BOARD JAMT PAID <br /> PREMISES PERMIT RENEWAL APPLICATION (CHECK NO. I - <br /> LG PPR PRINTED: DATE <br /> LICENSE NUMBER: B-02945-001 EFFECTIVE DATE: 04/01/96 EXPIRATION DATE: 03/31/98 <br /> y/s�/98 3/31100 <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 /> SQ& FEET PER MONTH: 24 AMOUNT PAID FOR RENT PER MONTH: e" q00 <br /> SQUARE 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 /> 2;ew Brighton MN 55112 <br /> BANK INFORMATION <br /> '_st Bank <br /> 928 Silver Lake Rd <br /> _ t Anthony MN 55418 <br /> GAMBLING BANK ACCOUNT NUMBER: .1-16-5441196-0- 173100727200 <br /> ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br /> _,UTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br /> THE ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br /> Sna T4n1 tan 2909-.Rankin Road S Anthany MN 99418 Gambling Manager <br /> John Fahian 4016 Mar-a1 attar nr _ St Anthony MN 55421 Admin. Vice Pr Gi dent <br /> (BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br /> '-HIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST? <br />