Agenda - Council - 04/14/1999 - Laserfiche WebLink

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ACKNOWLED G~HENT GAMBLING' PREMISES AUTHORIZATION I HEREBY GIIrE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS OF THE BOARD, OR THE COMMISSIONER OF REVENI/E OR PLrBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, TO ENTER THE PREMISES TO ENFORCE THE LAW. BA/TK RECORDS INFORMATION THE GAMBLING CONTROL BOARD IS AL~I~HORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. I DECLARE THAT: I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; · ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE;; · ALL OTHER REQUIRED INFO.~MATION ~_n~S BEEN FULLY DISCLOSED; I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; I ASSUME FULL RESPONSIBILITY FOR TI{E FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF THE GAMBLING CONTROL BOARD AND AGREE, IF ISSUED A PREMISES PERMIT, TO ABIDE THOSE LAWS AND RULES, INCLUDING AMENDMENTS TO THEM; · A~/ CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD ~ LOCAL IINIT OF GOVER/TMENT WITHIN TEN DAYS OF THE CHANGE; I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. SIGNATURE OF CKIEF EXECUTIVE OFFICER DATE LOCAL GOVERNMENT ACKNOWLEDG~ENT 1. THE CITY* MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY LIMITS. THE COUNTY** AND TOWNSHIP*e MUST SIGN THiS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN A TOWNSHIP. FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY APPROVING OR DENYING THIS APPLICATION. A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE ATTACHED TO THIS APPLICATION. 6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVEP. NMENT, IT SHOULD NOT BE SUBMITTED TO THE GAMBLING CONTROL BOARD. TOWNSHIP: BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A PREMISES PERMIT WITHIN TOWNSHIP LIMITS. CITY~ OR COUNTY** TOWNSHIP** CITY OR' COUNTY NAMm TOWNSHIP NAME SIGNATURE OF PERSONRECEIVING APPLICATION TITLE TITLE DATE RECEIVED 7m REFER TO THE CHECKLIST FOR REQUIRED ATTACS{MENTS MAIL TO: GAMbLInG CONTROL BOAd%D 1711 W COUNTY RD B - SUITE 300 S ROSEVILLE, M/~ 55113 ! !