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LG214PPR pri~ <br /> <br /> State o£ 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:A-03035-003 Effective Date: 11/1/1999 Expiration Date: 10/31/2001 <br /> <br />Name of Organization: Anoka Area Hockey Assoc <br /> <br /> G..a .m. bli~ng Premises Information <br /> <br />I <br />I <br />I <br /> <br />Name of the establishment where gambling will be conducted <br /> <br />J-Rs Entertainment Center <br />6141 Hwy 10 NW <br />Ramsey, MN 55303 <br />County: Anoka <br /> <br />Note: Our records show the premises <br /> is located within the city limits <br /> <br />I <br />I <br />I <br /> <br />Lessor Information <br /> <br />Name of the property owner (If different): <br /> <br />Square footage leased per month: <br />Rent paid per month: I io ~ o ~- <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: 2~ cc> .~' <br /> <br />Bi.ngo Activi~ <br /> <br />I <br />I <br />I <br />I <br /> <br />Our records indicate that Bingo is ~'conducted on these premises. <br /> <br />Storage Information <br /> <br />I <br />I <br /> <br />Bank Information <br /> <br />1st National Bank of Elk River <br />1121 W Hwy 10 <br />Anoka, MN 55303 <br /> <br />Gambling Bank <br />Acco unt Number: <br /> <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make deposits and <br />withdrawals for the gambling account. The orgmfization's Ixeasurer may not handle gambling funds. <br /> <br />Name Address City, State, Zip Code Title <br /> <br />Pamela Erickson 6825 151 Ave NW l~amsey, MN 55303 ~F <br />Victor Edwin Bunes ~~N:W-_r~x~ C.-r-~i q~'2'°a/M Anoka, MN 55303 Gambling Manager <br /> <br />(Be sure to complete the reverse side of this application) <br /> <br />--T~t~orm will be made available in alternative format (ie. large print, braille) upon request. <br /> <br />Page l of 2 (Continued on Back) <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br />