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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 />LG214PPR Printed: I/10/2003 <br />License Number: B-01203-010 Effective Date: 10/1/2001 Expiration Date: 7/31/2003 <br /> <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 />Spectators <br />6415 Hwy 10 Suite 100 <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: <br /> <br />Rent paid per month: <br /> <br />Square footage leased per bingo occasion: <br /> <br />Rent paid per bingo occasion: <br /> <br />Bingo Activity <br /> <br />Our records indicate that Bingo is not conducted on these premises. <br /> <br />Storage Information <br /> <br />6845 Hwy 10 <br />Ramsey, MN 55303 <br /> <br /> Bank Information <br />US Ba~'~ ~ Z',4~a S ~t~ ('o,~ ~" '~7'/?~/L. Gambling Bank <br />2nd/~v~ain St ~ ff. /.?~ ~r 2_r'O Account Number: ~ <br />.,.~d~MN 55303. ~'.r~.-,' >z,: /.t.4,,, j')"O F"d (~ //-,'~'?'~ ~' <br /> ~-~/Y~/5- . <br />o~ ~e li~¢s provided below list ~e frame, ~ddr~ss ~d titl~ of~t l~t t~e ~r~e~ authorized to $i~ checks ~nd-make deposits a~d <br />withdrawals £or the ~amblin§ ~ccount, The organization's treasurer ~ay not handle ~amblin§ Eu~ds. <br /> <br /> Name Address City, State, Zip Code Title <br /> <br />Frank Jay Frederick 7841 150th Lo NW Ramsey, MN 55303 <br />Patrick E Crowe 1037 108th Ln ~ Coon ~pids, ~ 55433 <br />Thomas Phillip Kujawa 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 1 of 2 (Continued on Back) <br /> <br />-91- <br /> <br /> <br />