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>rtflea8t <br />i.j, <br />COMMUNICATIONS.MEDIA DIVISION <br />ORIGINAL DOCUMENT <br />OR QUALITY <br />'*«»**; <br />121'iPPR PRINTED f 't-ir - • • - -• ■ <br />------ <br />PQR>Vo^ USB ONLY <br />amt ^^dz ^ <br />ilJK• • • * JY <br />DATEiSs^:^^ - - <br />r-var. <br />iME^OF ESTABLISBffiHT WHEREXOTTOLING WIl^H&OJJPS^ <br />^i. Loung,"-^- <br />JSO'^Shoreline'Dr ‘ <br />30NTY Bennepin . <br />f. ■.■• ■... <br />., __________-■- <br />-•f* -Ol V -.' <br />---- <br />- *.*;v - t.v.'ri^inftrin’rrit^ ,r. •~r% -c <br />SSf '-- .- ” xUf <br />>,r:. <br />ils\raE PREMISE^CATED?HI^N ^Ti:r <br />-:fgBSi5 Tr.; ■■ . ~:^^:*g8S26rfe.-- ■ <br />;,TI:E CITY^iIMITS?;;..Y...^^ • <br />; "TSrii-'i <br />3Es!{your organization own ■,T^^^;SITE? <br />F NOT list THE^LKSOR; <br />3UBAS'EoltZ ~ <br />233.\Bartlette Blvd <br />jund KN 55364 -■ <br />• f* . <br />-;.'-*>•••• • • --Z^7rP^2L ■ n - . ■•••.-“ <br />• >r'-» r<- • — - .“ <br />AMB OF PROPERTY OWNER (WHEN NOT LESSOR) ;.^.t <br />---vfeir.. .. <br />' i«‘i<1S^*■ TT;: * • ^ -rr ***?- •• - --fe: <br />.-^vtj'-*7^. * <br />• •• ' • .M* . .... . <br />•- 35i^^S5 ' .• <br />., :V!^:6cS5 .-• ■ <br />■ *■ V ~ ■ <br />• ■ <br />^.i4 <br />- - - - - - - -:■ <br />■t <br />••• .. <br />QOARE FEET PER MONTH: <br />QOARE FEET PER OCCASION:I ':EI.;;a . X'JiiwS.:. <br />AMOUNT PAID FOR RENT PER MONTH: <br />. AMOUNT PAID .PER OCCASION: , <br />-------- -----------'• <br />-‘-^.BTNGQ ACTIVITY <br />TOGO IS CONDUCTED OH THIS PECTISES: HO --a^.S- IHSTROCTIOHS FOR HEQUIREP^ ATTACHMEHT ^ <br />.li^STORACB ADDRESS ^, .• -<>•/ <br />•■ . • ■",?>.•■: :'XA.\zirT.“' :z'" <br />^virre MN 55392 , <br />)80 Shoreline Dr r.^rr*... <br />.Bt^National Ba^ Of The Lake <br />UlTlShady Wood Rd <br />avarre MN 55392. <br />4.’X- <br />*5i. <br />.AMBLING BANK ACCOUNT NUMBER <br />* -----*•<.--- <br />.....^:- cs^UgasLi:. : <br />>»- *.* <br />. ,^:t- <br />. > ■* r »•- • <br />LINES PROVIDED BE^'^ISt'.THE N^^DRES sJ^^^LE ™ pS^^- <br />tTHORIZED ToTsIGN^CHECKS,:AND1MAKE DEP0SIJSi^.:WI,T®R^W^^S.-F0RxTIffi,^I3LING^^^ <br />•IE lORGANI ZATION,' S ^TREASUR <br />V’■- <br />fTHS <br />2344VNlSollet ^ ^ <br />___ ' ’ ' «» » ----- _i -.r-r— .;' -trr.-r •* ' - *• <br />Leslie Ogg ‘.2 <br />1 Stephen Claypatch 2344 <br />' • /.vV . 'iMH: <br />\ . - <br />(BE-'i <br />:aIS FORiM WILL BE MADE AVAI^LE IN P^TER^TI^