|
EG214
<br />
<br /> Minnesota Lawf'dl Gambling
<br />Premises Permit Application - Paxt I of 2
<br />
<br />FOR BOARD USE ONLY
<br />
<br />BASE #
<br />PP#
<br />
<br />FEE
<br />CHECK
<br />INITIALS
<br />DATE
<br />
<br />I .on.-,..'"'"' ": ','"' ;"---'),;I :'i':'Cla~s~'Of premises l:~rmit[] ($400,
<br /> ...... Organization base r~.ense number P. ull-tabs, t~pbeards, paddlewheels, raffles, bingo
<br />
<br /> ' _'"" Premises ..':rpe~,t. LuLberrminm. ......... f ' "' ' ':' .'~':'~ ." .' '..'~'i"i'.:-." '" ' ' :-'~'1~" ",,~$25~,~'~' :P,~ll-tabs, §pboards, pad~ewh~'ls, raffle's_ -.__ - "
<br />a . "-..-,',-...', ". ,-.' ........
<br /> .,~j_:;... New. . ............ :-,~:' ..... '.'.:'.~.':'..' .'.'..::."' ..... '-'::;".",':':" ....." ..... : .... ".-';'-=,':.:;~,,,~'1'~: C(S~0j..~ng'oon~, ' ' :'~' "'
<br /> .-
<br />
<br />I· ;. ;,~'.~;:~.; .,' '~' ':g'-~' .... .' - ' . '9. ~.~ ' -~.'~-~ /.~!'~'. ~.~' · .~....: . ~ -- · -- :>-. .. , - ' .....
<br />
<br /> ..' ,,~:..,~.,}~,.~:,;,,,[~,.~. 1., ,f; .... '.' , ,,.,.?,,,,.,.......:., .',-,. ,- '~',,..1..,-,," : :-,~,' :.;.. :.....~q ,: -. ,.~.-.~ . ;,. ..~.... ..~: -. .- . ~ ..,., __,,. .~ . .
<br />
<br /> :' '~"-. -./.~.,. .?. . ,- . ~2,.i.: ,,~.'.;~...:-A. .: ~2~..~.3 .'-x.'.-.':,'~.'-x::. -:~.-.'~..'!,'A':!:':'.'-"':::~:'::.'.-.,::'::::-~::::::-::::,:--:,:':.-:-
<br />
<br />i.i ;. Name olOrganizat/o~ , . ,. . .. .... ......t - · ' - .' :;'-'~'~- .... ' ": ....-,-;--",".q -.;k; ::.--:; -,..'),:;: .,:f,,,.':',. '~.:-:,d
<br />
<br /> -' Business Address o! OrganizalJoll - S~ee! or P. 0 Box (Do not use the address of your gambling manager) .... - - . ..~- . --.' .,
<br /> ' q/// ...~- .'/h~ · ~.":" ~..:' ::: :.':. ¢ '"'":': '""" ..... ~
<br /> · :..: .,;:' . -.- ~.' .. - :..,', .' -.'.'
<br />iCity. - .; . .s.:'r,u: ~;; .... Slam .;- ~...- : ZipCode .... County Dg~ime phone number
<br /> :'.'./~Nrmr.:,:~.'. '.'., ::.; ,,.-.-:i .... , ......
<br /> Name of d',~e! executive officer (cannot be your gambling manager): . 'l'ilJe .... Daytime phone number
<br />
<br />I:' £/~L. ~. /dF__&? '"'": · : "" '""' ?Y~s,'~¥~-/' (0i2-1
<br />
<br /> Bingo Occasions · · ' ~' ' . ;..: . .
<br /> . Ir applying for a class'A o~:'C Permit, fill in clays a.nd beginnir~ & ending hours of bingo occasions:
<br /> · ' No more than seven bingo occasions may b¢;cbnducted by your organization per week.
<br /> Day
<br /> Beginning/Ending
<br /> Day
<br /> DaY
<br />
<br /> to ' ' ': '.. to to
<br />
<br />I:' ".';~ .... , " ' '. '. ,.';. "': .."" '' .' ........ ~'~ , " '. ".'t',t... '" ' '.' ·
<br /> "'' '-~. ' '" to', ' ' · ,' " : '.' ." ... -'to · :. ' to -
<br /> '. "'.-:;,',': ~"';:'" . ........ :;. :~.":.'::~i:Z~i~,,'.-'::-'.,';':"?'~':;~,~".'.-..':';'~'."'.: :',:'~'~:.'-".:'>:'~':':'~:','{'"' :'~)':-""~.K' "~- :". ':.,:'::"- ;"-.",-. " ~ .... ':
<br /> "'::"':~ ...... "' __;'" '"to, ' '~' "~ ..'. - .".. Lf ~fi~O' ;~ilI ~°t b~'~:'~adUCted;' ch~'ck here ~--] ................ . ........
<br /> · ;.." ....'.'. ...'; i .... -... '..M".'. ,;',u:'::~:.(.;.;.':':;~.:::' .'. :'..?-' :: . ",'. ,' . ".=~ ::: 'q .... . .': ~.:..~'; - - . ..... ,....,. ,..-.. - ... ·
<br />
<br /> -'. ;: .......... ".~. ' ...... ' ......~1 .............. :.-:-~.:.x~ ~:~::~::::~:~:~:~:~:i~::~::~::::~:::~;~:~:~::~:~::~:~:~::~;~.:~:~:~:~:~:~:~:~:~:~.::~:~:~::~.:~:~)::::::::::::::::::~::::::~::::::~:~::::~:
<br />
<br /> · . Name o! estabhshmept whe)'e gambhng w~ll bp. con. d,ucmd .-...- ..... ;~ , - ,, Slreet Add~l.~.~(do n_.,ot use a post oflic.e.b~x number)
<br />_ · L\~~'. ~a-~ a~- ~- ~,'u, '... ~ 7~c~-o ~:/~ ;:~z~:~/-' /a~.- ~,~....
<br />I...".1s t.h.e. ~Fem..is~s.loca~-e~l w.i~in, city. I!...rnits?./ ~,.,YesI .[~ No 'i If,no, is t~wf(ship :'f-~-I 0rg~ized [~l unorganized ~ un'nc~rporamd
<br />
<br /> · ?' City and County where gambling premis,es !s I~!ed..0R:. T..o.,w~._~hip, and Counl~ where g~mbling premises is located ii` outside of city limits
<br />m.-':. '.-' ...... . .:.. i'-.._- ..'--. -
<br />· '.: Name and addiess of legal owner of premise, s ..::' .:. City .... '. · ' Stale / ' · - Zip Code
<br />-'.' t~'.' L."L' 8::. !,~.~" /d ~o~'-".~f/J-. '~J'j,~d~},/.~f-' li, tD'" ~',~ 3~¥ " :': ........
<br />
<br />Does yOUr organization own Ihe building where the gambling will be conducted? ~ YES ~ NO
<br /> -~ '." .............. I! no, attach the Iollowing: ...........
<br /> ': ' '"" ";' ' : ' ' , :.' a copy of ~ h~ase (form LG202) with terms for at least one yea~. "
<br /> ·" ' a copy of a sketch of ~ floor pla~ wilh dimensions, showing what portfon is being I"ased.
<br /> · ' ........... A lease and sketch are riel required f~ Class D applications.
<br />
<br />-- -' Address City State Zip code
<br />
<br />
<br />
|