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ttral <br /> <br /> STATE OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />?REMISES PERMIT RENEWALAPPLICATION <br /> <br />14PPR PRINTED:02/08/95~ <br /> <br />L~ENSE NUMBER: B-01203-0~4 EFFECTIVE DATE: 08/01/93 EXPIRATION DATE: 07/31/95 <br /> <br /> FOR BOARD USE ONLY <br /> AMT PAID_ <br />ICHECK NO. <br /> <br />'OF ORGANIZATION: Lions RamseF Club <br /> <br /> OAMBLIN~ PREMISES INFORMATION <br /> <br />OF ESTABLISHMENT WHE~RE GAMBLING WILL BE CONDUCTED <br /> <br />super Bowl <br />6 '20 138th Ave NW <br />sey 55303 <br /> <br />COUNTY Anoka <br /> ! . <br /> <br />IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?:' Y <br /> <br />DOES YOUR ORGANIZATION OWN THIS SITE?: No <br />6~7:NO, LIST THE LESSOR= <br /> _)er Bowl Inc <br /> <br />seF MN 55303 . <br /> <br />N~iE OF PROPERT¥'OWNER (~EN NOT LESSOR)= <br /> F ~ % '- ~ _~.. <br /> <br />ARE FEET PER MONTH: 224 <br />SQUARE FEET PER OCCASION:~ 0 <br /> <br /> GO IS CONDUCTED ON THIS PREMISES: No <br /> <br /> , <br /> )0 Riverdale Dr NW ' <br />Ramsey. MN 55303 <br /> <br />LESSOR' INFORMATION <br /> <br />AMOUNT PAID 'FOR RENT PER' MONTH: 1000 <br />AMOUNT PAID PER OCCASION: 0 <br /> <br /> BINGo ACTIVITY <br />IF YES, REFER TO .INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> <br />..... sTORAGE ADDRESS <br /> <br />1at Bank" <br /> <br /> se~ MN 55303 <br /> <br />BkNK INFORMATION <br /> <br /> · ~ '(BE SURE TO CO~LETE THE ~VERSE SIDE OF THIS ~PLI~TION) <br /> <br />liS FORM WILL BE MADE AVAILABLE IN ~TE~ATI~ FORMAT (I.E. L~GE PRINTt BRAILLE) UPON REQUEST <br /> <br /> ! <br /> <br />GAMBLING BANK ACCOUNT' NUMBER: 3858333803 '.. ' ' <br /> <br /> THE LINES PROVIDED' BELC~W LIST THE N~ME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />AUTHORIZED TO SIGN CHECKS iAND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />ORGANIZATION'S TREASURER. MAY NOT HANDLE 'GAMBLING FUNDS. . <br /> <br /> <br />