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I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />City and County where g~nbllng Pmmt~eS is bcated OR Township and County where gambling premises is located if outside et city limits <br /> <br />NameandAddrassOfLagsiOwnerefPmmirms '.~,.'~,.i~' City ' ,. ~dam' _:i ZlpCOcle <br /> <br />NOTE: Organizations may not pay themselves rent if they own the building or have a holding company. A letter must be sub- <br />mitted showing rent payments as zero from gambling ~unds if the organization's holding company owns the premises. The <br />letter must be signed by the chief executive officer.) , fi.! ~ .... , _ '~ .. i <br /> <br /> · a copy of a sketch of the floor plan with dimensions, showing what portion is being leased. <br /> ' ..i~:,~- ' A lease' and sketch are not required for Class D applicantions.. <br /> <br /> .. For gambling with bingo $ 'Total square footage leased - " <br /> For gambling without bingo $ ~~ ,.'Total square footage leased <br /> <br />I <br />I <br />I <br /> <br />Address of storage space of gambling equipment <br /> Address ' State <br /> <br />~~*~~.~. ~;~*~:~<~:~:~:~:~:~:~:~:~i:~:$~$~:~::::~:::A:~::A~::::~¥::::~¥::~:~:~::::::::~:~::::~:~:~:~::~:~:~:~:~::~:~::~::~:;:::::::~::~:~::~ <br />· . .z . .. . ..~x :~ ;~::~ ~ . ..,.-2~l/~:~ ;->;~¢¢~-:¢-:~¢-1-~-:+x-.¢-~:-'~-:~- ' <br /> <br />(~ ~1~ gembling prem~ must have a ~te choking a~unt) <br />~ N~e ~ A~unt Numar <br /> <br />~ A~mss Ci~ S~m ~p ~ <br /> <br />Name, a~ldress, and gee of persons au~orized to sign checks and make deposits and wizhdrawaJs. <br /> <br />Name Aaclmss Title ... <br /> <br />a <br /> <br />I <br />I <br /> <br /> <br />