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J0214Ppil ‘pliliim 107/11/95 <br />STATE or MIVVESOTA <br />GAMBLIEG CONTROL BOARD <br />PRSHJSES PERNIT RENEWAL APPLICATION <br />TOR BOARD USB OWLT <br />ANT'PAID <br />CHECK NO, <br />DATE <br />LICSNSX NUMBSPt S-OOS42-177 EFFECTIVK DATS: 01/01/94 EXPIRATION DATE: 12/31/95 <br />JCAXE or ORCAHIZATIOMt Mttltipl* Sclsrosis MinnaapoliB Chapt North Star Soc <br />rsaM«T.TNQ PPW4ISES IKTORMATION <br />KAMI OP ESTABLISi <br />JlMiiaa Ziouaga <br />3340 ShoraliM Dr <br />T WHERE GAMBLING WILL BE CONDUCTED <br />55392 X . <br />3UNTY Eanaapia IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: V <br />IK: ORMATION <br />DOBS YOUR ORGANIZATION OWN THIS SITE?: Mo <br />r NO, LIST THE LESSOR: <br />mmm» Bolta <br />233 Bartlatta Bird <br />louad KN 55344 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />QUARE FEET PER MONTH: 41 <br />SQUARE FEET PER OCCASION: 0 <br />AMOUNT PAID FOR RENT PER MONTH: 1000 <br />AMOUNT PAID PER OCCASION: 0 <br />BINGO IS CONDUCTED ON THIS PREMISES: Mo <br />HTWGO ACTIVITY <br />IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br />STORAGE ADDRESS <br />i380 Shorollno Dr <br />i^ararra KN 55392 <br />BANK INFORMATION <br />lat National Bank of Tha <br />U45 Shady Wood Rd <br />iavarra MM 55392 <br />Laka <br />J . - ? <br />lAMBLING BAJTK ACCOUNT Nt^BER: 7433896 <br />- TTwrs provided below LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />JTHORIZED TO SIGN CHECl^ AND HAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />KS ORGANIZATION’S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br />v'lCdkf Sv».cA <br />VV /t V\ <br />(BB SURB TO COMPLETE THE REVERSE SIDE OF THIS APPLICATION) <br />■HIS FORM WILL BB MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST