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[est <br />214PPR PRINTED: <br /> <br /> STATE OF MINNESOTA <br />GAF~LING CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br /> <br />[FOR BOARD USE ONLY] <br /> <br />I AMT PAID <br /> <br />LICENSE NUMBER: B-03035-003 EFFECTIVE DATE: 11/01/97 EXPIRATION DATE: 10/31/99 <br />L OF ORGANIZATION: Hockey Anoka Area Assoc <br /> <br /> GAHBLING PREMISES INFORMATION <br />NAME OF ESTABLISHMENT WiqERE GAMBLING WILL BE CONDUCTED <br /> <br /> a/n s Saloon & Eatery <br /> 41 Hwy 10 NW <br /> sey 55303 <br /> <br />UNTY Anoka <br /> <br />IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br /> <br /> ES YOUR ORGANIZATION OWN THIS SITE?: No <br /> NO, LIST THE LESSOR: <br /> Dolores Gilbertson <br /> 30 Erm/ne Blvd NW <br /> <br /> sey ~ 55303 <br /> <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br /> <br />! <br /> FEET PER OCCASION: <br /> <br />48 <br /> 0 <br /> <br />LESSOR INFORMATION <br /> <br />~.40UNT P~ID FOR RENT PER MONTH: 1000 <br />AMOUI~T PAID PER OCCASION: 0 <br /> <br />BINGO IS CONDUCTED ON THIS PREMISES: No <br /> <br /> BINGO ACTIVITY <br />IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMA/T~ <br /> <br />STORAGE A/DDRESS <br /> <br /> 6141 H~r~ 10 NW <br />la~nsey M/q 55303 <br /> <br />orwes t Bank <br /> 15 3rd Ave N <br /> oka MN 55303 <br /> <br />BANK INFORMATION <br /> <br />LING BA/~K ACCOUNT NI3MBER: 125310100 <br /> <br /> ON THE LIN-ES PROVIDED BELOW LIST THE NAME, ADDRESS ~ TITLE OF AT LEAST TWO PERSONS <br />[ HORIZED TO SIGN CHECKS AND MltKE DEPOSITS A/qD WITHDRAWALS FOR THE GAMBLING ACCOLET~. <br /> ORGANIZATION'S TREASURER MAY NOT HANDLE GAMBLING FLrNDS. <br /> <br /> (BE SURE TO COMPLETE THE REVqERSE SIDE OF THIS APPLICATION) <br />IHIS FORM WILL BE ~J~DE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BP~AILLE) UPON REQLIEST <br /> <br /> <br />