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LG214PPR Printed: 1/10/2003 <br /> <br />Holms Super Bowl <br />6720 I~ iverda le Dr <br />Ramsey, MN 5530 <br />County: Anoka <br /> <br /> . <br /> <br />Name of the propert <br /> <br />Our records indicate tha <br /> <br />6845 Hwy 10 <br />Ramsey, MN 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-01203-004 Effective Date: 8/1/2001 Expiration Date: 7/31/2003 <br /> <br />Name of Organization: Ramsey Lions Club <br /> <br /> Gambling Premises Information <br />Name of the establishment where gambling will be conducted <br /> <br />6720 Riverdale Dr NW <br />Ramsey, MN 55303 <br /> <br />Note: Our records sh~w 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: ..~ ~ <br />Kent paid per month: /(5) 00°~-~ <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: <br /> <br /> Bingo Activity <br />Our records indicate that Bingo is not conducted on these premises. <br /> <br /> Storage Information <br /> <br />? ~o £:~,- O~t,~ O~ <br /> <br />Bank ~nformation <br /> <br /> &~r~Om'~'*d &m'~tt'~rYk ~'~/~ G~bl~g B~k <br /> ~ ~a~ ~ro AccoumNmber: ~ <br /> <br />On ~e lines provided below li~ ~e n~e, ~dr~s and title of at least two persom au~or~ed to si~ checks and make deposi~ and <br />withdrawfls for ~e gmbling a~ount The orgm~mion's ~e~urer may not handle gmbl~g ~nds. <br /> <br /> Name Address Ci~, State, Zip Code Title <br /> <br />Frank Jay Frederick 7841 150th Ln NW Ramsey, MN 55303 <br />Patrick E Crowe 1037 108th La ~ Coon Rapids, ~ 55433 <br />Thomas Phillip Kujawa 8330 ~ ~ Ramsey, MN 55303 <br /> <br /> (Be sure to complete the reverse side of this application) <br />This [brm will be made available in alternhtive format (ie. large print, braille) upon request. Page 1 of 2 (Continued on Back) <br /> <br />-05- <br /> <br /> <br />