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t STATE OF MINNESOTA. FOR BOARD USE ONLYI <br />GAMBLING CONTROL BOARD JAMT PAID <br />PREMISES PERMIT RENEWAL APPLICATION ICHECK NO. <br />14PPR PRINTED: DATE <br />ENSE NUMBER: A-02926-004 EFFECTIVE DATE: 03101196 EXPIRATION DATE: 02/28/98 <br />E OF -ORGANIZATION: ice Anoka Arena Assoc <br />GAMBLING PREMISES INFORMATION <br />LESSOR - -INFORMATION.W'... <br />-s,-YomORGANIZATION OWN THIS SITE? No 6 <br />NO-,2',LIST,TiiE <br />-athan'Ross-Inef", <br />'j <br />f, Aviv 10 xw;5, <br />r! <br />-S ey" 5 5 3 0 3 <br />!4 <br />6PERTY- OWNER (WHEN.NOT LESSOR) ` OE�� APR` <br />IK' <br />PEP 1000 <br />RENT MONTH <br />AMOUNT: PAID.: FOR] RE <br />MONTH <br />TARE FEET';. PEP, - M <br />-t �v 200 <br />'5929 ;AMOUNT. PAID PER: OCCASION' <br />TARE.FE R'-OCCASION: <br />BINGO ACTIVITY <br />TO INSTRUCTIONS REQUIRED�.. ATTACHMENT <br />GO IS :CONDUCTED ON THIS PREMISES Y86 IF. YES, REFER -FOR <br />x <br />STORAGE' ADDRESS <br />;I'- 142nd.• Ln.NW,-, <br />lsey�MN-55303 <br />p <br />I <br />I <br />I <br />I <br />k <br />BANK INFORMATION <br />-theast'State Bank <br />_ <br />, <br />Broadway Nb--- <br />Lne"apol is mN 55413 <br />SLING BANK ACCOUNT NUMBER: 10001691 <br />THjLl­N*_ES­ PROVIDED BELOW LIST THE NAME,.ADDRESS <br />AND TITLE <br />OF AT <br />LEAST TWO PERSONS,. <br />'HORIZED..TO SIGN.CHECKS AND . MAKE DEPOSITS . <br />.. AND WITHDRAWALS <br />FOR THE <br />GAMBLING ACCOUNT. <br />,,.ORGANIZATIONIS.TREASURER MAY NOT HANDLE- <br />GAMBLING.FUNDS. <br />ki <br />A <br />". (BE SURE To COMPLETE THS REVERSE SIDE OF THIS APPL ICATION) <br />(I. E. LARGE PRINT, BRAILLE) UPON REQUEST <br />_-S 'FORM'WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT. <br />