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STATE OF MINNESOTA <br />OAMBLINQ CONTROL BOARD <br />PREMISES PERMIT RENEWAL APPLICATION <br />LG214PPR PRINTED:08/13/93 <br />POR BOARD USB ONLY <br />AMT PAID <br />CHECK NO. <br />DATE <br />LICENSE NUMBER: B-01B30-001 EFFECTIVE DATE: 02/01/92 EXPIRATION DATE: 01/31/94 <br />NAME OF ORGANIZATION: Lions Mound Northwost Tonka Cl\ib <br />OAMBLINQ PREMISES IMFORMATIOW <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Eavarro Lanas <br />3429 Shorollna Or <br />Navarra 55392 <br />;X)ONTY • ♦ . f V lEPXN IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br />LESSOR IMFORMATIOM <br />DOES YOUR ORGANIZATION OWN THIS SITE?: No <br />IF NO, LIST THE LESSOR: <br />Oonald Scharvan <br />3495 Bhoralina Or <br />Navarra MM 55392 <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR): <br />cm OF Dim <br />Fm>iCE OFFICE <br />1313400000 <br />01 CES 10,00 <br />TOIM. „ ,^.00 <br />*^.00 <br />90,00 <br />.^EC£IFT~fHm YOU <br />BINGO ACTIVITY U2Ss950 COOl Ml 70S:4 <br />BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHt^Hf^^^^J <br />SQUARE FEET PER MONTH: <br />SQUARE FEET PER OCCASION: <br />AMOUNT PAID FOR RENT MONTH: <br />AMOUNT PAID PER OCCASUM^ru nmnru <br />STORAGE ADDRESS <br />2339 COMNBRSE BLVD <br />MOUND NN 55344 <br />BANK INFORMATION <br />Marquatta Bank <br />2220 Co—area Blvd <br />Mound NN 55344 <br />GAMBLING BANK ACCOUNT NUMBER: 0031419 <br />ON TRE LINES PROVIDED BELOW LIST THE NAME, ADDRESS AND TITLE OF AT LEAST TWO PERSONS <br />AUTHORIZED TO SIGN CHECKS AND MAKE DEPOSITS AND WITHDRAWALS FOR THE GAMBLING ACCOUNT. <br />THE ORGANIZATION’S TREASURER MAY NOT HANDLE GAMBLING FUNDS. <br />/?.^ f7 A <br />(BE SURE TO COMPLETE TBE REVERSE BIDE OP TRIS APPLXCATZOM) <br />.TIlS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST