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;V <br />* : <br />.f <br />k <br />R BOARD USE ONLYLG214 <br />rroMi) <br />Minnesota Laxvjul Gambling <br />Premises Permit Application - Part I of 2 <br />FEE <br />CHECK <br />INITIALS. <br />DATE <br />li^.tn|nrin rr);m-j-liWl-Tn nTr:7X '■ • ■ * . . / <br />f" v.v; - s :•'• y y '• • •*'' ‘ X • • *•■ '*<• '/I '’’s * •• ••'* ^ . -v ».* • *A • ••’ '••..•vyv ^,•^/.•. r ...# - . ..< <br />y. A <br />a R«n«M>il <br />Organization basa reanta numbar <br />Clast of pranusas pamut <br />(ehaek ana) <br />[ A ($400) Pull-iabt. tipboards, paddlawhaals, raffias, bingo <br />Pramisaa parmii numbar <br />□Now <br />^ B(S250) PuS>tabs. tfpboards. paddawhaals. raffles <br />I I C ($200) Bingo only <br />Q 0($fS0) Raffles only <br />•j <br />MulClpltt Sclerosis Society <br />III Ann I*iftrlfett o^ froa«»«i>a«« • Saim a# a o Ba« (Do not use me address of your oamOUng manager) <br />dH^y Stato ZpCodo County <br />Mlanoapolls, Minnesota 55404 Hennepin <br />Daytime phone number <br />(612) 870-1500 <br />Nsmo o( ehiaf easeulive offieor (cannoi bo your gambEng managar) Tde <br />Villard M. Hunger» Jr. Executive Director <br />Daytime phona numbar <br />(612)870-1500 <br />BtBfO OeCMlOBS <br />If applying for a A or C pennlt. fill in days and beginning & ending hours of bingo occasions: <br />No more than seven bingo occasions may be conducted by yourjusgDlzallQiI per week. <br />Day naj|nnln|j T«****"| Hou*-.* Osgr Bcglnnlna/Eadtnc Houra Day Begin - g /Ending Hours <br />.to__ <br />-tP, <br />.to. <br />.to. <br />.to. <br />If blage wflU set ba eendnetad, chack hare ^_| <br />fTrr.mr <br />Stfoat Adoresa (do not usa a post oitioa ooa numoar) <br /><k/vrrUw^ -f/r imr\ «^±f <br />ligiSpWSisssleusiedwISOialyaiitoT I^Yaa C3No Hno.ittownship qorganizad q unorganizad a unineorporaied <br />Cl^ wd Csun^ whsrs gsmbing prsmisai ia toca tad OH Township and Cowiiy whars gambfng pramisas is Incatad if outsida of city Emits <br />__________ ^SMT of pnenisoa aiy Staio Zip Coda <br />Slug V^Quod nir> <br />dS^uf^StSrionswwtibiiifl&igwhoreOYES CS <br />H no. aSK.'s Ota Mowing: <br />iiauaiBggaajmgi^gHBffaagisijAj:^^ <br />^ ^ Civ ” SMO ZipAddrooo <br />.'V; <br />..:.-j.------------I-....