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IJs t <br />1214PPR ~RIN'T~.D: <br /> <br /> STATE OF MINNESOTA <br /> GA34~LING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br /> <br />BOARD USE ONLYI <br /> <br />PAID <br /> <br /> NSE AK3MBER: B-01203-007 EFFECTIVE DATE: 08/01/97 EXPIRATION DATE: 07/31/99 <br /> ~FORGANIZATION: Lions R-m-ey Club <br /> <br />IGAMBLING PREMISES INFORMATION <br />AME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />la L Liqr~or <br /> 00 167th Ave NW <br /> a~se~r <br />I~oka <br /> <br />55303 <br /> <br /> IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: X <br /> <br /> ES YOUR ORGANIZATION OWN THIS SITE?: No <br /> NO, LIST THE LESSOR: <br />'o.hn Nieswaag .01 Oakwood Dr <br /> ,unds View MN 55112 <br /> <br />rE OF PROPERTY OWNER (WHEN NOT LESSOR): <br /> <br />UARE FEET PER MONTH: 20 <br /> UARE FEET PER OCCASION: 0 <br /> <br />LESSOR INFORMATION <br /> <br />AMOUNT PAID FOR RENT PER MONTH: 500 <br />AMOUNT PAID PER OCCASION: 0 <br /> <br /> BINGO ACTIVITY <br />INGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTAC~,~T <br /> <br />STORAGE ADDRESS <br /> <br />Bank Anok& <br /> 47 & 167th Ave NW <br />~amsey ~N 55303 <br />~LING BANK ACCOUNT NUMBER: 003858333803 <br /> <br />BANK INFORMATION <br /> <br /> THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />E ORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOL~NT. <br /> ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br /> <br />I(BE SURE TO COMPLETE THE REVERSE SIDE OF THIS A~PLICATION) <br /> <br />THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br /> <br /> <br />