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I AMT PArD <br />I CHECK <br /> DATE NO. <br /> 214PPR PRINTED: <br /> <br /> NSE NUMBER: B-01203-005 EFFECTIVE DATE: 08/01/97 EXPIRATION DATE: 07/31/99 <br /> <br />~D24E OF ORG~I~TION: Lions R,m~ey Cl~ <br /> <br /> STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PEP~ZT RENEWAL APPLICATION <br /> <br />IFOR BOARD USE ONLX[ <br /> <br /> OF EST LIS E ZRE GAMS I S WILL SE CO UCTEO <br /> <br />W37 Hwy 10 ~ <br />~ey 55303 <br /> <br />~oka IS ~ P~ISES LO~TED WI~IN ~ CI~ LIMITS?: Y <br /> <br /> YOUR ORGANIZATION OWN THIS SITE?: NO <br /> NO, LIST THE LESSOR: <br />3am~to Productions Inc <br /> Hwy 10 NW <br /> ey MN 55303 <br /> <br />r OF PROPERTY OWNER (WHEN NOT LESSOR): <br />SQUARE FEET PER MONTH: 133 <br />FARE FEET PER OCCASION: 0 <br /> <br />LESSOR INFOP/4ATION <br /> <br />AMOUNT PAID FOR RENT PER MONTH: 1000 <br />AMOLYNT PA.ID PER OCCASION: 0 <br /> <br /> BINGO ACTIVITY <br />IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> <br />STORAGE ADDRESS <br /> <br />BANK INFORMATION <br /> <br /> Bank Anoka <br /> 47 & 167th Ave NW <br />Ramsey MN 55303 <br /> <br />LINGBA/qK ACCO~ ~ER: 003858333803 <br /> <br />ON THE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />'~EORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WIthDRAWALS FOR TEE GAMBLING ACCOUNT. <br /> ORGANIZATION'S TREASURER MAY 'NOT HANDLE GAMBLING FUNDS. <br /> <br />m(BE SURE TO COF~PLETE 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 />