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MINNESOTA LAWFUL GAMBLING 6/15 Page 1 of 2 <br /> LG214 Premises Permit Application Annual Fee $150 (Nom-REFUNDABLE) <br /> REQUIRED ATTACHMENTS TO LG214 <br /> 1. If the premises is leased,attach a copy of your lease. Use LG215 Mail the application and required attachments to: <br /> Lease for Lawful Gambling Activity. Minnesota Gambling Control Board <br /> 2. $150 annual premises permit fee,for each permit(non-refundable). 1711 West County Road B,Suite 300 South <br /> Make check payable to"Slate of Minnesota." Roseville,MN 55113 <br /> Questions? Call 651-539-1900 and ask for Licensing. <br /> ORGANIZATION INFORMATION <br /> Organization Name: American Legion #49 Auxiliary License Number: 02957 <br /> Chief Executive Officer(CEO) Nina Hedstrom Daytime Phone: 218-839-9373 <br /> Gambling Manager: Sharon Higgins Daytime Phone: 218-820-4230 <br /> GAMBLING PREMISES INFORMATION <br /> 134 — 9R�;5 tr 5 rn SRN 5 + ( r,LI- <br /> Current <br /> L <br /> Current name of site where gambling will be conducted: FR a 415 e-rePt,la 5 L-C <br /> List any previous names for this location: <br /> Postello's -- Re jh.s-- (34.2-4-( ,$)L(_ <br /> Street address where premises is located: *3/2 9A Fro Gc�'j.PD1Lse/ /OA) 5-(o` T <br /> (Do se a P.O.box number or mailing address.) <br /> City: OR Township: County: Zip Code: <br /> L, cel lam/A� 5a4.71/ <br /> 4.71/ j <br /> Does Air organization own the building where the gambling will be conducted? <br /> ElYes No If no,attach LG215 Lease for Lawful Gambling Activity. <br /> A lease is not required if only a raffle will be conducted. <br /> Is any other organization conducting gambling at this site? Ekes ElNo [IDon't know <br /> Note: Bar bingo can only be conducted at a site where another form of lawful gambling is being conducted by the applying organi- <br /> zation or another permitted organization. Electronic games can only be conducted at a site where paper pull-tabs are played. <br /> Has your organization previously conducted gambling at this site? IDYes IIINo Don't know <br /> GAMBLING BANK ACCOUNT INFORMATION; MUST BE IN MINNESOTA <br /> Bank Name: 1st National Bank Bank Account Number: 0337196 <br /> Bank Street Address: PO Box 366 City: Pequot Lakes State: MN Zip Code: 564572 <br /> ALL TEMPORARY AND PERMANENT OFF-SITE STORAGE SPACES <br /> Address(Do not use a P.O.box number): City: State: Zip Code: <br /> 4206 Laugenbau Rd Pequot Lakes MN 56472 <br /> 4435 Main Street Pequot Lakes MN 56472 <br /> MN <br />