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I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />LG220 - Application/f-IPr~xempt Permit__` <br />Organization Name ~(-'~~~ ~-~_ <br />Local Unit of Government Acknowledgment <br /> <br />If the gambling premises is within city limits, the <br />city must ,~Ign this application. <br />On behalf of the c~y, I acknowledge this application. <br /> <br /> Check the action that <br /> the city is taking'on this appllcatlon. <br /> <br />] The city approves the application with no <br /> waiting pe~d. <br /> <br />[The city approves the application with a 30 day <br />waiting period, and' allows the Board b3 issue a <br />permit after 30 days (60 days for a first class <br />city). <br /> <br />DThe city denies the application. <br /> <br />./ <br /> <br />Page ?. of 2 <br /> 3/01 <br /> <br />If the gambling premises is located in a township, both <br />the county and township must sign this application, <br /> <br />On behalf of the county, I acknowledge this application, <br /> <br /> Check the action that <br /> the county is taking on this application, <br /> <br />DThe county approves the application with no <br />waiting pedod. <br /> <br />BThe county the application with 30 <br /> approves <br /> a <br /> day <br /> wa~ting pedod, and allows the Board to issue a <br /> permit after 30 days. <br /> <br />DThe county denies the applicatfon. <br /> <br />Print name of county <br /> <br />(Signature of county personnel receMng application) <br />Tltle <br /> <br />Date.. /. / <br /> <br />TOWNSHIP; On behalf of th; i~W~s~ni~"i-~'C-I~t~wl~-dge that <br />the organization is app[ylng for exempted gamhllng acflv~ <br />within the township ]Lmits. lA townsh!p has no statutory <br />authority to approve ar deny an application (Minn. StaL sec. <br />349.213, subd. 2).] <br />Print name of township <br /> <br /> (Signature of township' official acknowledging application) <br /> <br /> Date i I <br /> <br />Chief Executive Officer's Signature <br />The information provided in this application is complete and accurme to the best of my knoWledge. <br /> <br />Chief executive officers signature <br /> <br />Mail Application and Attachments <br />At least 45 days prior to your scheduled activity date send: <br /> · the oompleted application, <br /> · a copy of your proof of nonpro~ status, and <br /> · a $25 application fee (make check payable to "State of Minnesota"). <br /> Application fees are not prorated, refundable,, or transferable. <br /> <br /> Send to;' Gambling Control Board <br /> ~711 West County Road B, Suite 300 South <br /> Rosevlile, MN 55'1'13 <br /> <br /> if your application has not <br />· been acknowledged by the. <br /> local unit of government or <br /> has been denied, do not <br /> send the application to the <br /> Gambling Control Board. <br /> <br />-17- <br /> <br /> <br />