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luth STATE OF MINNESOTA <br /> GAMBLING CONTROL BOARD <br /> PREMISES PERMIT RENEWAL APPLICATION <br />14PPR PRINTED:05/10/95 <br /> <br />FOR BOARD USE ONLY <br /> <br />AMT PAID <br />CHECK NO. <br />DATE <br /> <br />LICENSE NUMBER: B-03035-003 EFFECTIVE DATE, 11/01/93 <br />~ OF ORGANIZATION: Hockey Anoka Area Asso¢ <br /> <br />EXPIRATION DATE: 10/31/95 <br /> <br /> GAMBLINO PI~4ISES INFORMATION <br />L OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br /> <br />~Rs Saloon & Food ' <br /> 1 Hwy 10 NW"." <br /> sey <br /> <br />IUNTY Anoka <br /> <br />55~n3 · .... :, . ..- . .~.. .. ~.. ~' <br /> <br /> IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y. <br /> <br /> ,ES YOUR oRGANIzATiON OWN THIS SITE?: No <br />ES You: ..... <br /> NO,~'LIST'THE LESSOR:' '.' ..-:'" '.~i-;" · : ..-(..; . ' <br /> <br />la'"'"""____55303 -.' ..... ~:.' '..' .... <br /> <br />N~ O~'PROpERTY"OW~ER (WHEN NOT LESSOR): <br /> <br />S~ARE'(.FEET PER MONTH: <br /> <br />PER OCCASION,' <br /> <br />AMOUNT PAID FOR RENT PER MONTH: 1000 <br />AMOUNT PAID PER OCCASION: 0 <br /> <br />BINGO IS CONDUCTED ON THIS PREMISES: No <br />I '~ '' ' :' :?"'i:i''f;'" "' STORAGE ADDRESS . ~'~' ~ ;"': ::' - " <br /> <br /> say, MN 55303 j...; ' ' :i;[:~!.:! i~ ' '..' . '..' ' ')? :: '"'" "i" ;;':' . ".?.:i;'~."";':i i'I <br /> <br /> BINGO ACTIVITY <br />IF YES, REFER TO INSTRUCTIONS FOR' REQUIRED ATTACHMENT <br /> <br />Norwest~ ' Bank ',.' <br />)15 3'rd Ava N .- . .'j.-::.:..,.-:...(.:~ . <br /> zoka' .MN 55303'' ' '.. ': . ' :t"/",."'"' <br /> .:-. ~'".::'?;~'i .'. . :'..~...'~ '.-" ~.-'.:'. ..... .. <br /> BANK ACCOUNT NUMBER:' 125310100 <br /> <br />fLING <br /> :.::'-'-...'.'~i..~J.',:~.>;'..; ',' 3.(':,'.:".:'~.~.'(:~'.~....~::..,:' ...: .... :"i': '":' i":'., <br />ON THE'LINES pROVIDED'BEI%O_W.LIST. THE.NAME, ADDRESS AND'TITLE OF AT LEAST TWO PERsONs <br />HORIZED'TO SI?N CHECK~AND'MAKE DEPOSITS AND'"WITNDRAWALS FOR THE GAMBLING ACCOUNT. <br /> ORgaNIZATION S"iTREAS~ ~Y ~6.T:'.H~N~DLE~LIN~.'~UNDS, i ""/:': '-i ':': <br /> '°' /ct uoi'. ..... m 2'"- <br /> <br />liS <br /> <br /> (BE SURE TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />FORM WILL BE MADE AI~AILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br /> <br /> <br />