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<br />;I... <br /> <br />~ , <br /> <br />. <br />, <br /> <br />East <br /> <br />STATB OF MINNESOTA <br />GAMBLING CONTROL BOARD <br />PREMISES PERMIT RENBPiAL APPLICATION <br /> <br />IFOR BOARD <br />IAMT PAID <br />I CHECK NO. <br />I DATE <br /> <br />USB ONLY I ' <br />I <br />I <br />I <br /> <br />LG214PPR PRINTED: <br /> <br />LICENSE NUMBER: A-00541-001 <br /> <br />EFFECTIVE DATE: 06/01/96 <br /> <br />EXPIRATION DATE: 05/31/98 <br /> <br />NAME OF ORGANIZATION: Eagles Aerie 3718 New Brighton <br /> <br />GAMBLING PREMISES INFORMATION <br /> <br />NAME OF ESTABLISHMENT WHERE GAMBLING WILL BE CONDUCTED <br />Eagles Aerie 3718 <br />563 Old Hwy 8 NW <br />New Brighton 55112 <br /> <br />COUNTY Ramsey IS THE PREMISES LOCATED WITHIN THE CITY LIMITS?: Y <br /> <br />LESSOR INFORMATION <br />DOES YOUR ORGANIZATION OWN THIS SITE?: Yes <br />IF NO, LIST THE LESSOR: <br /> <br />NAME OF PROPERTY OWNER (WHEN NOT LESSOR) : <br /> <br />o <br /> <br />AMOUNT PAID FOR RENT PER MONTH: <br />AMOUNT PAID PER OCCASION: <br /> <br />o <br />o <br /> <br />SQUARE FEET PER MONTH: <br />SQUARE FEET PER OCCASION: <br /> <br />o <br /> <br />BINGO ACTIVITY <br />BINGO IS CONDUCTED ON THIS PREMISES: No IF YES, REFER TO INSTRUCTIONS FOR REQUIRED ATTACHMENT <br /> <br />STORAGE ADDRESS <br /> <br />761 1st St SW <br />New Brighton MN 55112 <br /> <br />BANK INFORMATION <br /> <br />Firstar Bank of Minn <br />1550 79th St E <br />Bloomington MN 55425 <br /> <br />GAMBLING BANK ACCOUNT NUMBER: 160530 <br /> <br />ON THE 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 />C I,.tlcnr J... Ja..c...ol~ tJ",(JD._~/'~J /1.IJ~ 5 ~1-11 4..~ )/w./'tw/J.r, SS"//7- <br />(2('(,el'1/){'( ~~. , CrE-o, ..51/,(,1<-..,'1 ,C/~. Sh~I"c.(j'(('G.lIMll. S-f/2.C- <br />16 Ct,.. ~W r/~~ Pr.t.s. 1../0 q3 f!vifu.,\ M,~,,~~..h'r 111'( ()S'~/t. <br />.ZJ 0 h tJo. f j 1I(~/r!:~S(11') '/r '" J -1 (' _ <3 1 d 0 Ale. WOCJO (},.,'ve. &.Jt(I5.rA S~fllZ. <br />(BB SURB TO COMPLETB THE REVERSE SIDE OF THIS APPLICATION) <br /> <br /> <br />THIS FORM WILL BE MADE AVAILABLE IN ALTERNATIVE FORMAT (I.E. LARGE PRINT, BRAILLE) UPON REQUEST <br />