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State of Minnesota For Board Use Only <br /> Gambling Control Board Amt. Pd <br /> Premises Permit Renewal Application <br /> Check# <br /> LG214PPR Printed: 12/9/1999 Date <br /> License Number:B-01635-001 Effective Date: 5/1/1998 Expiration Date: 4/30/2000 <br /> Name of Organization: Chamber of Commerce Pequot Lakes <br /> Gambling Premises Information <br /> Name of the establishment where gambling will be conducted <br /> Butcher Block Note: Our records show the premises <br /> Hwy 371 Box 250 is located within the city limits <br /> Pequot Lakes, MN 56472 <br /> County: Crow Wing <br /> Lessor Information <br /> Pequot Lakes Lounge & Liquor Inc. <br /> Box 250 <br /> Pequot Lakes, MN 56472 <br /> Name of the property owner(If different): Square footage leased per month: 72.00 <br /> Steven Tufte Rent paid per month: 750.00 <br /> Square footage leased per bingo occasion: <br /> Rent paid per bingo occasion: <br /> Bingo Activity <br /> Our records indicate that Bingo is not conducted on these premises. <br /> Storage Information <br /> Bank Information <br /> Norwest Gambling Bank <br /> Box 398 Account Number: 101022609 <br /> Pequot Lakes, MN 56472 <br /> On the lines provided below list the name,address and title of at least two persons authorized to sign checks and make deposits <br /> and withdrawals for the gambling account. The organization's treasurer may not handle gambling funds. <br /> Name Address City, State, Zip Code Title <br /> (Be sure to complete the reverse side of this application) <br /> This form will be made available in alternative format(ie.large print,braille)upon request. Page 1 of 2 (Continued on Back) <br />