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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 /> ! <br /> I <br /> <br />Application for ExemptPermit- LG220 <br />organization Name <br /> <br />Page 2 ~f 2 <br /> 8/00 <br /> <br />Local Unit of Government Acknowledgment ... <br /> <br /> If the gambling premises is within city limits, the <br /> city must sign this application. <br /> <br />On behalf of the. c!ty, J acknowledge th-is 'a'pplication. <br /> <br /> Check the action that <br /> the city is taking on this applicat/on. <br /> <br />[ The city approves the application with no <br /> waiting period. <br /> <br />DThe city approves the application with a 30 day <br />waiting pedod, and allows the Board to issue a <br />permit after 30 days (60 days for a first class <br />city). <br /> <br />DTh¢ eib! denies the ~ppl~atien. <br /> <br /> _ ~. _O~,~..'~.. . <br />(Gignature of city personnel receiving appl{cation) <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 applicatior~. <br /> Check the action-that " <br /> the county is taking on this application. <br /> <br />E The county approves the application with no <br /> waiting pedod. <br /> <br />DThe county approves the application with a 30 day <br />waiting pedod, and allows the Board to issue a <br />permit after 30 days. <br /> <br />E]The county denies the apPlication. <br /> <br />Pdnt name of county <br /> <br />(Signature of county personnel receMng appi~cation) <br />T'~e <br /> <br />Date . /__..~/~ <br /> <br />TOWNSHIP: On behalf of the township, I acknowledge that <br />the on:janizadon Js applying for exempted gambling activity <br />within the township r~its, iA township has no statutory <br />authority to approve or deny an appl[ca~on (Minn. S{at. sec. <br />349.213, s,_~-d. <br /> <br />Pdnt name of ~wnship <br /> <br />(Signature of township official acknowledging application) <br />T'~e <br /> <br /> Date ./ . ./ <br /> <br />Chief Executive Officer's Signature~__~ ' <br />The information provided in this app,ica~ ~/..,p,ete ~_d__a_ccur~ate/~e best of my know,edge. <br />Chief executive officefs~_sign ature' <br />Name (please pdnt). :.J<~ &. ~y2/..,-'~u/,.~.~c,,~_~ //~/'&-' Date ~.~__/. <br /> <br />Mail Application and Attachments <br /> <br />At least 45 days prior to your scheduled actMty date send: <br /> · the completed application, <br /> a copy of your proof of nonprofit 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 /> Sand to: Gambling Control Board <br /> 1711 West County Road B, Suite 3110 South <br /> Roseville, MN 55113 <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 applica~n to the <br />Gambling Controi Board. <br /> <br />-55- <br /> <br /> <br />