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Application for Exempt Permit - LG220 <br /> <br />Organization Name <br />Local Unit of Government Acknowledgment (Required by Statute) <br /> <br />Page 2 of 2 <br /> 10/98 <br /> <br />If the gambling premises is within city limits, the.:; <br /> <br />On b6J~alf 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 for a first class city). <br /> <br />Print name of city: <br /> <br />(Signature of city personnel receiving application) <br /> <br />Title '~, ."'~(::,--¢',q.-~__ <br />Date /Ik <br /> <br /> If the gambling premises is located in a township, both <br /> the countY and townShiP must sign this application.- <br />On behalf of the county, I acknowledge this application <br />and three options for 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 />Print 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 />organization 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 />Print name of township:. <br /> <br />(Signature of township official acknowledging application) <br />Title <br /> <br />Date / / <br /> <br />Chief Executive Officer's Signature <br /> <br />The information provid;d in this applirca~~?_~?nd accurate t-o the best of mY knowledge. <br />Chief Executive Oh~cer s signature ~~/~-'~~ <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 /> 1711 West County Road B, Suite 300 South <br /> Roseville, MN 55113 <br />If your application has not been acknowledged by the local unit of government, do not send the application to the <br />Gambling Control Board, <br /> <br /> <br />