Agenda - Council - 06/25/2002 - Laserfiche WebLink

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I I I I I I I I I I I I I LG220 - Application for E×empt ~,Permit Organization Name .... Local Unit of Government Acknowledgment If the gambling premises is within city limits, the 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. w he city approves the application with no airing period. DThe city approves the application with a 30 day waiting period, and allows the Board to issue a permit after 30 days (60 days for a first class city). DThe city denies the application. Print n.~;(Sig~e~.~fy~e r~'°n~} application) Page 2 of 2 3/01 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. DThe county approves the application with a 30 day 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 of the township, I acknowledge that the organization is appiyincj 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).] Print name of township (Signature of township official acknowledging application) Title Date / I I I I I Chief Executive Officer's Signature The information provided in this application is complete and accurate to the best of my knowledge. Chief executive officer's signature Name (please print) 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. -59-