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Gambling Control Board Fax:651-639-4073 <br /> <br />I ..... : .; .:..,Appllcaflort for',Exempt, Permi~- .LG220. <br /> <br />OqTanization Name~ <br />Local Unit of Government Acknowledgment <br /> <br />If the gambling premises is within city Ilmlts, the <br />city must sign this application. <br />On behalf of the city, I acknowledge this application. <br /> <br /> Cllecl( the action that <br /> the city is taking on this application. <br /> <br />DThe city approves the application with no <br />waiting period. <br /> <br />oThe city approves the application with a 30 day <br />wa~ng period, and allows the Board to issue a <br />permit after 30 days (60 days for a first class <br />city). <br /> <br />"~ The city denies the application. <br />.,,.4,-'. :~. .... 5-- - '.- .... ~-.,-~.~,~- ......... ,. ~, ._ <br /> <br />(Signature of ck'y personnel receivin9 application) <br /> <br />8 '01 13:49 P. 01-J <br /> <br /> Page 2 of.2, <br />~ ' ~" "~' 8/00 <br /> <br />if me 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 I~e action that <br />the county is taking on this application. <br /> <br />DThe county approves the application with no <br />waiting period. <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 />DThe county denies the application. <br /> <br />print name of county ...................................... <br /> <br />(Signature of county personnel receiving application) <br />Title <br /> <br />Date ___/ .... _j.~ <br /> <br />T;3~ISHIP: On behalf of the t°Wnsh~, l acknowledge that <br /> <br />the organizat~n is applying for exempted gambling activibj <br />:within the township llm~, [A township has no statutory <br />i authority t~ approve or deny an application (Minn. Stat. sec. <br />349,213, s~bd. 2).] <br /> Print name of township ~ ~_ <br /> <br /> (Signab;re of township official acknowledging appllcstion) <br /> <br /> ' Ti*Jo ......... <br /> <br /> Date / /.~ <br /> <br /> i ~.l.lt, ........................................................... <br /> <br />Chie! ExeCutive Offlcer"s Slgnatu~---.~ . <br />The information provided in this applica~Sn ~ c~, mplet.¢ and accurate to the best of my knowledge. <br /> .... ...... :" <br /> <br />If your application has not <br />been acknowledged bythe <br />local unit of 9overnment or <br />has been denied, do not <br />send the application to the <br />Gambr~ng Control Board. <br /> <br />Mail Application and Attachments <br />At least 45 days prior to your scheduled activity date send: <br /> · the completed application, <br /> a copy of your proof' of' nonprofit status, and <br /> a $25 application fee (make check payable t~ "State of Minnesota"). <br /> Application fees are not prorated, refundable, or transferable. <br /> <br /> Send to; Gambling Control Beard <br /> 171t West County Rood B, Suite 300 South <br /> P-,oseville, MN 'SS'113 <br /> <br /> <br />