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Minnesota Lawful Gambling <br />11/08 Page 1 of 2 <br />LG214 Premises Permit Application Annual Fee $150 <br />fOR BOARD USE ONLY <br />Check # <br />Organization Information <br />Organization name AN JK j e L %o N r C yet 6 License number 01,20 j <br />Chief executive officer (CEO) �/���r �r �✓ Sr li i n� cue _ Daytime phone 3 •.2 VZ- 7F 6 <br />Gambling Premises Information <br />Name of establishment where gambling will be conducted <br />Street address where premises is located `7 5 SCE t/ w /U w CAJ <br />S P3 <br />(Do not use a P.O. box number or mailing address) <br />City Township <br />County <br />Zip code . <br />OR <br />44- &, I-e <br />j o 3 <br />Does your organization own the building where the gambling will be conducted? <br />❑Yes L� No If no, attach LG215 Lease for Lawful Gambling Activity. <br />Gambling BankAccountlnformation (mustbe n Minnesota) <br />Ba k name Bank account number <br />Bank street address City State <br />Zip code <br />I C / /i fff f MN <br />s7'3 <br />/31��� �� <br />All Temporary I and, Permanent Off- site`Storage Spaces <br />(for gambling equipment and records.related to tlhiS site - must be stored in Minnesota) <br />Address (Do not use a P.O. box number) City State <br />Zip code <br />al IVIN <br />MN <br />Bingo occasions {including bar bingo) <br />Enter day and beginning /ending hours of bingo occasions (indicate A.M. or P.M.). An occasion may not exceed 8 hours. <br />Day Beginning /Ending Hours y Beginning /Ending Hours <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />to <br />�es� °'Fo <br />�'Pcrnt Rv�'tst <br />-52- <br />