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Minnesota Lawful Gambling <br />Premise Permit Application - Part I <br /> <br />FOR BOARD USE'ONLY <br /> <br />FEE <br />CHECK <br />INITIALS <br />DATE <br /> <br />i; <br /> <br />LegaJ Name o. jkOrgamza~n , <br />lBu~ness Address of Organiza~on. Sli~eet or P. O Box (Do m3t use address of gambling manager) I <br /> <br />Name of chief executive officer {mmno~ I~ g~nbling m~m~er) <br /> Title ~ Business phone number <br /> ,. <br /> <br />Zip Code Courtly _ <br /> <br />Address of chief executive officer - Slzeet or P. O. Box <br /> <br />must I~e reflected by class of <br />the organization license. <br /> <br />Class of l~eml--e Permit Fee <br />[] Class A ~ Bingo, Raffles, Paddfewheels, Tipboards, Pull-tabs $200 <br />'J~ Class B ~ Raffles, Paddlewheels, TiPb°ards, Puli-tabs $125 <br />[] Class C~ Bingo only $100 <br />[] Class D ~ Raffles only $75 <br /> <br />Bingo Occasions <br /> If class A or C, flll in d~Fs and beginning and ending hours of bingo occasions: <br /> No more than seven bingo occasions may be conducted by an prganization per week. <br /> <br />D~y Beginn/ng/Ending Hour~ <br /> <br />Day Begi~ n-t-g/Ending Hours <br /> <br />Day Beginning/Ending Hou_~ <br /> <br />to, to ,to, <br />~.to. _. to ,to <br />m,tO <br /> <br />I' <br />I <br />I' <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br />-: :,~ ~ .:. :~ .: .; < ,x,~.::.': :.;~.'~'~.>.-,:-: ::;:'-: :; ,::: LA ,'..::~:~'::~ .::55.-:~: ~,,x:.'~.:-;:: ;; :; :; :: ~ :: ;.';: :,";;.~;5: ~ ~: ~:: :5: ~:~. :".~:: ;: ::~ ;: :,' ~,~:::::'2 :: ~ :: ;: ::: .::~:; :::::: :: :::,. :: ;; ;: :: :;: ::: :: :: :: :: :: ;: ::;: :: :: ;: :: ;:;:;: :: ;::::: :.-;:;:::::;: ~:::::::: :: ;: ;: ::::: :~: :::; ::: :~:::: ¥: :: :::::: ;: :; ;::::: ;:;: :::: :: ;::::::::: :::: ;:;:;:;::::: ::::::: :;:::;: ;:: :; :; ::::: :::; :: :::: ;::::::: :; :: :: :;;: ~ :: :; :: :: :: ;: :: :: ::;::;;: ::;:;::: ;: :: <br /> <br />Status of l~rem!se Permit. check one: <br /> <br />[] New premise -- Fill in .base organization premise permit number <br />[] Renewal of existing premise permit ~ Fill in comolete premise permit numbdJq~)O,/~=~=~=~=~=~=~=~=~=~D~ <br />[] Previously expired premise permit ~ Fill in comolete premise permit number <br /> <br /> <br />