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STATE OF MINNESOTA <br /> GAMBLING CONTROL BOARD <br /> PREMISES PERMIT RENEWAL APPLICATION <br />LG214PPR PRINTED:09/lO/93 ...... <br /> <br />FOR BOARD USE ONLY] <br />AMT RAJD_ <br />CHECK NO. <br />DATE <br /> <br />LICENSE NUMBER: A-02926-004 EFFECTIVE DATE: 05/01/92 EXPIRATION DATE: 02/28/94 <br /> <br />NAME OF ORGANIZATION: Ice Anoka Arena Asaoc <br /> <br /> GAM~LINO PREMISES INFORMATION <br /> <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />JRs Saloon & Food <br />6141Hwy 10 NW <br />Ramsey 55303 <br /> <br />COUNTY Anoka <br /> <br />IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br /> <br />DOES YOUR ORGANIZATION OWN THIS SITE?: No <br />IF NO, LIST THE LESSOR: <br />Jonathan Ro~s Inc <br />6141 Hwy 10 NW <br />Ramse~ M~ 55303 <br /> <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />Delores Gi,lbertson <br /> <br />SQUARE FEET PER MONTH: 36 <br />SQUARE FEET PER OCCASION: 5929 <br /> <br />LESSOR INFORMATION <br /> <br />AMOUNT PAID FOR RENT PER MONTH: 1000 <br />AMOUNT PAID PER OCCASION: 200 <br /> <br /> BINGO ACTIVITY <br /> <br />BINGO IS CONDUCTED ON THIS PREMISES: Yes IF YES, REFER TO-INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> <br />4881 142nd lm NW <br />Ramsey MN 55303 <br /> <br />STORAGE /%DDRESS <br /> <br />BANK INFORMATION <br /> <br />Northeast State Bank <br />77 Broadway Nb <br />~{n-eapolis MN 55413 <br /> <br />G~-u..~LING BANK ACCOUNT NUMBER: 10001691 <br /> <br />ON ~tE LINES PROVIDED BELOW LIST.THE. NAME, ADDRESS A/~D TITLE OF AT LEAST ~WO PERSONS <br />AUTHORIZED TO SIGN CHECKS AND MAKE.DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />THE ORGANIZATION'S TREASURER MAY NOT HANDLE G~BLING FUNDS. <br /> <br />. ~.IS..~Fo~~ WILL BE ~E AVAIL~LE '.IN ~TE~ATI~ FO~T. (I.E. ~GE pRINT, B~I~E) UPON ~Q~ST <br /> <br /> <br />