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I <br /> I <br /> I <br />I <br />I <br />I <br />I <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />LG214 <br /> <br /> Minnesota Lawful Gambling <br />Premises Permit Application - Part I of 2 <br /> <br />FOR BOARD USE ONLY <br /> <br />BASE# <br />PP# <br />FEE <br /> <br />CHECK <br />INITIALS <br />DATE <br /> <br />P-:~': ~<: ,~:,/, ~ ~'/'~ ~:~ ¥: ~. ~ ~:i~. ~* ./.<¢.:~ ~~.~;?';~-~ ~ ~:~'~ ~ ~. ~E~ ~:~:~ ~ ~ ~::~ ~:~ ~ ~ ~ ~. ~ ::::~ ~ ~ ~. :~ ~ ~:~ :~ ::~:::::: ::: :~ :~::~ ~ ~ ~ ~: .~ ~: ~ ~ ~ :~ ~::::~-~ ,' ~:~: ~:~:8~ ~:::::::::::::: <br /> Class of prem~s pe~it <br /> <br />r-] Renewal <br /> Organization base license number <br /> <br />Premises permit number <br /> <br /> (~eck one) <br />[] A (,$400) Pull-tabs, fipboards, paddlewheeis, raffles, bingo <br />~r'B ($250) PulMabs. tipboards, padolewheels, raffles <br /> <br />[-~ New [] C ($200) Bingo only <br /> <br />[] D ($150) Raffles only <br /> <br /> Name of Org~izaton <br /> <br /> Business A~ress of ~gani~on - S~eet or P. O ~x (Do riel use ~e address of ~our ~mblin9 manager) . <br /> <br /> City Sta~ ~p Co~ ~un~ . Oa~ime phone number <br /> <br />  e of ~ief ex~utive offi~r (~nnot be your gamb~ng mmager) ~e Day,me phone number <br /> <br />~ app~g for a c~ A or C pe~ ~ ~ da~ ~d beg~ & en~g ho~ ofb~o occasio~: <br /> No more ~ ~ b~o ~casto~ may be conducted by your o~a~a~on per wee~ <br />· .-Day Ben. Ending Houm Day Be~End~g Ho~ Day Berg/Ending Ho~s <br /> <br /> tO ,to. to <br /> · ' to .to.' .to <br /> __to, If blngo will not be'c~nducted, check here ' <br /> <br />Name of establishment where gambling w~ll be conducted Street Address (do .rot use a.post office box number) <br />D';~,o~d£ ~J~o~ys i3~-· ~;ll. ?5'so /-/~./ /~ /~o ~,,-,~/-- '' <br />Is the premises locatec~ within city limits? [];~]'Yes r-'l No I! no, is township I'-'1 organized f'--I unorganized r~l unincorporated <br /> <br />Ct~/o~and County where gambfing premises is located OR Township and County where gambfing premises is Idcated if outside of city fimits <br /> ' p. - I · ' <br />Name and actress o! legal owner of premises City State Zip Code <br /> <br />Does your organization own Ifle building where the gambling will be conducted? E~ YES ~ NO <br /> Ii~ no, attach the following: <br /> · a copy o[ Ifie lease (form LG202) With terms for at least one year. <br /> · a c~py o~ a sketch of the licor plan with dimensions, showing what port/on ts being leased. <br /> A tease and sketch am not required for Class D applications. <br /> <br />Address Cily State Zip code <br /> <br /> <br />