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LG214PPR Printed: 1/10/2003 <br /> <br /> M & L Liquor <br /> 5900 167th Ave NW <br /> Ramsey, MN 55303 <br /> County: Anoka <br /> <br /> Name of the property <br /> <br /> Our records indicate that <br /> <br /> 6845 Hwy 10 <br /> Ramsey, MN 55303 <br /> <br />2¢WAve~ain St <br />/d[~N 55303 <br /> <br /> State of Minnesota <br /> Gambling Control Board <br />Premises Permit Renewal Application <br /> <br />For Board Use Only <br /> <br />Amt. Pd <br />Check # <br /> <br /> License Number: B-01203-007 Effective Date: 8/1/2001 Expiration Date: 7/31/2003 <br />· Name of Organization: Ramsey Lions Club <br /> <br /> Gambling Premises Information <br /> <br />Name of the establishment where gambling will be conducted <br /> <br />Note: Our records show the premises <br /> is located within the city limits <br /> <br />Name of the property owner (If different): <br /> <br />Lessor Information <br /> <br />Square footage leased per month: ~ L) <br />Rent paid per month: 30 0* ~ <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 /> Bank Information <br /> <br /> Gambling <br /> Bank <br /> '~. d, /~o,~ 2..-C'0 Account Number: ~1 <br /> <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checl~ and rnmce aeposks 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 /> <br />Frank Jay Frederick 7841 150th Ln NW Ramsey, MN 55303 <br />Patrick E Crowe 1037 108th Ln ~ Coon Rapids, ~ 55433 <br />Thomas Phillip Kujawa 8330 1~ ~ ~msey, 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 1 of 2 (Continued on Back) <br /> <br />-87- <br /> <br /> <br />