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Minnesota Lawful Gambling 11 108 Page 1 of 2 <br />LG214 Prem Permit Application Annual Fee $ 150 FOR BOARD USE ONLY <br />Ch <br />Organization information <br />A <br />Organization name License number 09g2-�6 <br />Chief executive officer (CEO) IL, JoLgtj Daytime phone <br />ailhil g ire lse� �no€�r <br />,,� <br />Name of establishment where gambling will be conducted V YA - ""W s <br />Street address where premises is located L✓, <br />(Do not use a P.O. box number or mailing address) <br />City iE7E' Township <br />County <br />Zip code <br />1 �Cffi <br />Does your -organization own the building where the gambling will be conducted? <br />[]Yes :E <o If no, attach LG215 Lease for Lawful Gambling Activity. <br />tnbili i3an k 1 CCD!un <br />Ion lmu�t�e'in M�nraesota <br />:;:..... <br />Bank name Bank account number <br />Sr , <br />I S <br />Bank street address City State Zip code <br />7 7 7 �����k� �,� �� ��, /� � MN <br />i1 Te.rnpcsrarjrn�irrvaanen$7ff soy ?fergep& <br />{for gambling equipment : and re'co`rds related to #Ills srte rnusfi be storeci►n Mthnesota) <br />Address (Do not use a P.O. box number) City State Zip code <br />4 7 Al MN <br />N <br />Bj ;' O.C. r�s r,a d dPna is :r Ind .. . <br />Enter day and beginning /ending.hours of bingo occasions (indicate A.M. or P.M.). An occasion may not exceed 8 hours. <br />Dav Beginning/Ending Hours Day Beginning /Ending Hours <br />to to <br />to to <br />to to <br />to to <br />to to <br />to to <br />to to <br />to <br />to <br />to to <br />to to <br />to to <br />-64- <br />