Agenda - Council - 07/22/2003 - Laserfiche WebLink

Home

~plication~ for Exempt Permit ~ LC220 Organization Name Local Unit of Government Acknowledgment If the gambling premises is within city limits,,~he city must sign this application. On behalf of the city,. I acknowledge this application. Check the action that the city is taking on this application. , e city approves the application with no waiting period. DThe city approves the application with a 30 day wai~ing period, and allows the Board [o issue a permit after 30 days (60 days for a first class city). Ed The city denies the application. Print name of city C-.-;4~'~/^ o'~- ~. ~,,~.¢¢,.~ (Signature of city personnel receiving application) Page 2 of 2 8/00 :If the gambling premises is located in a township, both the county and township must sign this application. On behalf of the county, I acknowledge this application. Check the action that the county is taking on this application. DThe county approves the application with no waiting period. D The'county approves application with a 30 day the waiting period, and allows the Board to issue a permit after 30 days. DThe county denies the application. Print name of county (Signature of county personnel receiving application) Title Date / / TOWNSHIP: On behalf 0fthe township, I acknowledge that the organization is applying for exempted gambling activity within the township limits. [A township has no statutory authority to approve or deny an application (Minn. Stat. sec. 349.213, subd. 2).] Pdnt name of township (Signature of township official acknowledging application) Title Date / / Chief Executive Officer's Signature The information provided in ?~s .... '; ......~ . · i,,¢~,,,,.¢.,, ..... complete and'accurate *o ~he best of my knowledge. Ohiefexecutiveoffioer'ssignature ¢FYt,~,-.~/J '.~~/~'-'--~ Name (please print-) Crt t~,_~,~ O /mL -~-~,, v~ jd_~ Date ") //~ Mail Application and Attachments . At least 45 days prior to your scheduled activity date send: the completed application, · a copy of your proof of nonprofit status, and · a $25 application fee (make check payable to "State of Minnesota"). Application fees are not prorated, refundable, or transferable. Send to: Gambling Control Board 1711 West.County Road B, Suite 300 South Roseville, MN 55113 If your application has not been acknowledged by the local unit of government or has been denied, do not send the application to the Gambling Control Board. --7--.