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Minnesota Lawful Gambling <br />LG214 Premises Permit Application <br />(see Required Attachments on Page 2) Annual Fee $150 <br /> <br /> 6/03 <br />Page 1 of 2 <br /> <br /> FOR BOARD USE ONLY <br /> <br />Check # $ <br /> <br />Organization information <br /> <br />Orga niz~jon name t <br /> <br />Name of chief execubve officer (CEO) <br /> <br />Organization license number <br /> <br />Gambling premises information <br /> <br />Name of establishment where gambling will be conducted <br /> <br />CiLy or township <br /> <br /> Does your organization own the building where the gambling will be conducted? <br /> <br />Daytime phone number <br /> <br />Street address (do nat use a P.O, box number) <br /> <br />County Zip code <br /> <br />__._Yes ~_No [f no, attach LG215 Lease for Lawful Gambling Activity <br /> <br />Gambling bank account information <br /> <br />Bank name Bank account number <br /> <br />Bank street address _ City State/Zip code <br /> <br />Address(es) of off-site storage space of gambling equipment related to this site <br /> (Do not use a P,O, box number) <br /> Address .. ' State/Zip code <br /> <br />Bingo occasions (including bar bingo) <br /> Enter day and beginning/ending hours of bingo occasions (indicate A.H. or P.M.). An occasion must be at least 1-t/2 <br /> hours, not to exceed 4 hours. No more than :tO bingo occasions may be conducted per week. <br /> <br />Day Beginning/Ending Hours ~ Beginning/Ending Hours <br /> to to <br /> to to <br /> to to <br /> to to <br /> to to <br /> <br />Noon hour bingo <br /> <br />Noon hour bingo must be conducted be[ween 11:00 a.m, and 2:00 p.m, on a leased premises which must have a <br />license for the sale of intoxicaUng beverages on the premises under chapter 340A, Check the day(s) that noon hour <br />bingo will be conducted, <br /> <br />. Sunday Monday .Tuesday Wednesday ~Thursday __Friday Saturday <br /> <br /> <br />