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State of Minnes eta <br /> Gambling Control Board <br />Premises Permit Renewal Application <br /> <br />For Board Use Only <br /> <br />Amt. Pd <br />Check # <br /> <br />LG214PPR Printed: 1/10/2003 <br />License Number: B-01203-003 Effective Date: 8/1/2001 Expiration Date: 7/31/2003 <br /> <br />Name of Organization: Ramsey Lions Club <br /> <br /> Gambling Premises Information <br /> <br />I <br />I <br />I <br /> <br />Name of the establishment where gambling will be conducted <br /> <br />McDuffs <br />16659 St. Francis Blvd <br />Ramsey, MN 55303 <br />County: Anoka <br /> <br />Note: Our records show the premises <br /> is located within the city limits <br /> <br />Lessor Information <br /> <br />Name of the property owner (If different): <br /> <br />Square footage leased per month: X" I <br />Rent paid per month: l ¢> c> c> *~-' <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: /~ 4 <br /> <br /> Bingo ACtivity <br />Our records indicate that Bingo is not conducted on these premises. <br /> <br />Storage Information <br /> <br />16659 St. Francis Blvd <br />Ramsey, MN 55303 <br /> <br />4 ,~,. /' e7 tig ,,y ..t,y ? ~ 2 <br /> Bank Information <br /> <br />US Bank ~ /'4,.-~, wa¢-~ d Gambling Bank <br />2nd A,,~& Main St (;b,qt~ w,~/~t~, fl,t .,,/c Account Number: <br />,~ad~a, MN 55303 ~. 0. ~¢~ <br /> O / q lt;IO <br /> <br />On the lines provided below list the name, address and title o£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 /> <br /> Name Address City, State, Zip Code Title <br /> <br />Frank Jay Frederick 17841 150th Ln NW Ramsey, MN 55305 <br />~,~,,-,,._~ O~ (~4~ /.~t /z~.~.~ c~ ~' ~4~ <br />Patrick E Crowe 1037 108th Ln ~ Coon Rapids, MN 55433 <br />Thomas Phiilip Kajawa 8330 ~~ Ramsey, MN 55303 <br /> <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 I of 2 (Continued on Back) <br /> <br />83. <br /> <br /> <br />