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Page 2 of 2 <br />Application for Exempt Permit - LG?-20 <br /> <br />Local Unit of Government Acknowledgment(~equired by Statute) <br /> <br />~ffthegambling premises [s within-ci~ limits;:the i i <br /> <br /> On behalf of the city, I acknowledge this application <br /> and three options for the city: <br /> <br />1. Approve the application: By taking no action, <br /> the city allows the Board to issue a permit after <br /> 30 days (60 days for a first class city). <br /> <br />2. Waive the above-noted waiting period: The <br /> city allows the Board to issue a permit before <br /> 30 days (60 days for a first class city). Docu- <br /> mentation attached. <br /> <br />3. Deny the-application by passing a resolution <br /> within 30 days (60 days Ocr a first class city). <br /> <br />Print name of city: <br /> <br />(Signature of city personnel receMng a¢~lication) <br /> <br />:: E~the::gambling premisesis:located!in a.,~W~shiP, both::, <br />:the~;~n~:andi~liipimus~:sigh. th iS iappli~0~:,i.;:!¥.; <br />On behalf of the county, I acknowledge this application <br />and three options fqr the county: <br />1, Approve the application: By taking no action, the <br /> county allows the' Board to issue a permit after 30 days. <br />2. Waive the above-noted waiting period: The county <br /> allows the Board to issue a permit before 30 days. <br /> Documentation attached. <br />3. Deny the application by passing a resolution within <br /> 30 days. <br /> <br />Pdnt name of county:, <br /> <br />(Signature of county personnel receiving application) <br />Title <br /> <br />Date ,/ /__ <br /> <br />On behalf of the township, I acknowledge that the <br />organUZation is applying for exempted gambling activity <br />within the township limits. <br /> <br />A township has no statutory authority to approve or deny <br />an application (Minn. Stat. sec. 349.213, subd. 2). <br /> <br />Pdnt name of township: <br /> <br />(Signature of township official acknowledging application) <br />Title <br /> <br />Date / / <br /> <br />Chief Executive Officer's Signature <br />IThe information provided in this applicat~is c~om~lete and accurate to the best of my knowledge. <br />Chief Executive Officers signature,. // , ,' <br /> <br /> amelpleasep nt) <br /> <br />Date 0-7 /E:)C¢ / Ob <br /> <br />Mail Application and Attachment(s) <br /> <br />At least 45 days prior to your scheduled activity date send: · 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"). Application fees are not prorated, <br /> refundable, or transferable. <br /> <br /> Send to: Gambling Control Board <br /> ~711 West County Road B, Suite 300 South <br /> Roseville, MN 55113 <br /> <br />If your application has not been acknowledged by the local unit of government, do not send the application to ~he <br />Gambling Control Board. <br /> <br />-16- <br /> <br /> <br />