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Premise P,. ,~rfit AppLication - Part 2 of 2 <br /> <br />Bank Nan;m Bank Account Number <br /> <br /> Name Addms~ Tide <br /> <br />G~nbllng Site ..6J.tthortzat/on <br />1 hereby consent that ~ I'~W enforcement officers, the <br />board or agents of the board, or the commissioner o~ <br />r~venue or public safety, or agents of the commissioners, <br />may enler the premises to enforce the law, <br />Bank Records Information <br />The board is authorized to inspect lhe bank records of the <br />gambling accounl whenever necessary to fulfill <br />requirements of current gambling rules and law. <br />Oath <br />I declare that: <br />-1 have read this application and all information subm~eL <br />Io Ihe board is true, accurate and complete; <br />· all other required information has been fully disclosed; <br /> <br />-I am the chief executive officer of the organization; <br />· 1 assume full responsibility for the fair and lawful opera- <br />tion of all activities to be c~nducted; <br />· I will familiarize mysell with the laws of Minnesota <br />governing lawful gambling and rules of the board and <br />agree, if licensed, to abide by those laws and rules, <br />including amendments to them; <br />· any.changes in application information will be submitted <br />to the board and local unit of government w~thin 10 days <br />of the change; and <br />· I understand thai failure to provide required information <br />o~ providing false or misleading inlormation may result in <br />the denial or revocation el the license. <br /> <br />Signalure el chie[ executive officer __ · ~ . Date <br /> <br /> ":~. ' " ' *>~.~.`~¢:::~'~:~2~:~:~.~:;:~:~:.~:~:~:~:~:.<~:~.<~;~::~ <br />_. ~ ............... ,.......IlT _ ,,..~,. .... ..,....= ....... ,..<.,. f.',,.,.~j ....--:.,/.-.-.-+.....-.,-.... ............. '~ .-,. ---..-~-.,..-..-.-.-~.,.,,..,.~>,,.....,~..........>. ,,.v..,.....,.A~..~..~,~. e~..~>..:..>:..-.'....;..:.;...~:~.:.~:.;..-:......~.....-...-:. <br /> ....... ( '/. 4. A copy of the Io~i~l vnil 9f g,overnment'$ re.soludon <br />1 The city 'musl slgr~ thru apphcatlon ~I lhe'gam'bhng prem <br />' ' Drovin~ Ibis aoDlicalion mu.t be altaqhe¢ I¢ this aoplication <br /> <br />ises is Iocaled within dty limits. <br />2. The county "AND township" must sign this application if <br />Ihe gambling premises is Iocaled wh. hin a township. <br />3. The local unit government (c~ or county) must pass a <br />resolution specifically approving or denying this application. <br /> <br />5. If this application is denied by lhe local unit ol government, <br />it should not be submiMed to the GAmbling Control Board. <br /> <br />Township: By signature below, lhe township acknowledges <br />that Ihe organization is applying for a premises permit within <br />township limits. <br /> <br />Cl_ty' or County" <br />City or County Name <br /> <br />Township'" <br /> <br />Township Name <br /> <br />Signature of person rec~vlng application <br /> <br />Tide I Dale Recei'ved <br /> <br />Refer to Ihe instruclians Ior required attachrnent~. <br /> <br />Mail Io: <br /> <br />Gambling Conlrol Eio.rd <br />~or~,wood PI',u Soulh, 3rd Floor <br />17ll w. County Road B <br />flo~ovllle, MN 55113 <br /> <br />LG214(Par! 2) <br /> <br /> <br />