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LG214PPR Printed: 10/16/2001 <br /> <br /> State of Minnesota <br /> Gambling Control Board <br />Premises Permit Renewal Application <br /> <br />For Board Us.e. Only_ <br />Amt. Pd <br /> <br />Check # <br /> <br />License Number: B-02002-048 Effective Date: 3/1/2000 Exp imtion Date: 2/28/2 002 <br />Name of Organization: Climb Inc <br /> Gambling Premises Information <br /> <br />Name of the establishment where gambling will be conducted <br /> <br />Diamonds Sports Bar & Grill <br />7550 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 />Lessor Information <br /> <br />i <br />! <br /> <br />Name of the property owner (If different): <br /> <br />Square footage leased per month: <br /> <br />Rent paid per month: <br />Square footage leased per bingo occasion: <br />Rent paid per bingo occasion: <br /> <br /> I <br /> I <br />$1 <br /> <br /> Bingo ActivitZ <br />Our records indicate that Bingo is not conducted on these premises. <br /> <br /> Storage Information <br />r,~~ <br /> <br />! <br />! <br /> <br />Bank Information <br /> <br />Northland Security <br />14125 St Francis Bird <br />Ramsey, MN 55303 <br /> <br />Gambling Bank <br />AccOunt Number: <br /> <br />312495 <br /> <br />On the lines provided below list the name, address and title of at least two persons authorized to sign checks and make depnsits and <br />withdrawals tbr the gambling account. The organization's treasurer may not handle gambling funds. <br /> <br />Name Address City, State, Zip Code Title <br /> <br />Karen Lea Wirkus 6524 Crosby Ave E Inver Grove Heights, MN <br /> 550,5 ..... <br />Peg Wetli 6415 Carmen Ave E Inver Grove Heights, MN <br /> 55076 <br /> <br />(Be sure to complete the reverse side of this application) <br /> <br />I <br />I <br />I <br />I <br />I <br /> <br />_T~)form will be made available in alternative format (ie. {arge print, braille) upon request. <br /> <br />Page I of 2 (Continued on Back) <br /> <br />I <br /> <br /> <br />