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MinnesotaJ~Wf~r l Gambling <br />LG214 P ernises Permit Application <br /> (see Required Attachments on Page 2) Annual Fee $150 <br /> <br />Organization information <br />Organization name <br /> <br />Name of chief e×ecutfve officer (CEO) <br /> <br />Gambli~ ~r~mi~s information <br />~ame of ~llS~man~ where ~amblin~ will be conduced <br /> <br />Ci~ or township <br /> <br /> 6/03 <br />Page 1 of 2 <br /> <br /> FOR BOARD USE ONLY <br /> <br />Check # $ <br /> <br />Organization license number <br />Daytime phofie number <br /> <br />Street address (do not use a P.O. box number) <br /> <br />County Zip code / <br /> <br /> Does your orga~zation own the building where the gambling will be conducted? <br /> Yes ~ Nd If no, attach LG215 Lease for Lawful Gambling Activity <br />Gambling b;nk account information <br /> <br />Bank name Bank account number <br />BanR street~addr~ Ci~ State/Zip code <br /> <br />Address(e~) J~f off-site storage space of gambhng eqmpment related to this site <br /> Address (~ no~ u~ a P.O. box number) CiW S~a~e/Zip Code <br /> <br />Bingo occasions (including bar bingo) <br /> <br />Enter day andil~ginning/ending hours of bingo occasions (indicate A.M. or P.M,). An occasion must be at least 1-1/2 <br />hours, not to ex-~.eed 4 hours. No more than 10 bingo occasions may be conducted per week. <br /> <br /> Beginning/Ending Hours Day BeainninalEnding Hours <br />:1,'/5 ?into 13 £n, to <br /> <br /> to to <br /> to to <br /> to to. <br /> <br />Noon hour bingo <br /> <br />Noon hour bingomust be conducted between tl:00 a,m. and 2:00 p,m. on a leased premises which must have a <br />license for the sale of intoxicating beverages on the premises under chapter 340A. Check the day(s) that noon hour <br />bingo will be conducted. <br /> __Sunday _ ~ Monday Tuesday Wednesday Thursday __Friday __Saturday <br /> <br /> <br />