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Page 2 of 2 <br />Application for Exempt Permit- ,LG220 , , . lo/98 <br />organization Name__~..--~---------- ........ <br />Local Unit of Government AcKnowleclgrnent (Required by Statute) <br /> <br /> On behalf of the city, I acknowledge this application On behalf of the county, I acklt'6wledge this application <br /> and three options for the city: and three options for the county: <br /> 1. Approve the application: By taking no action, 1. Approve the application: By taking no action, the <br /> the city allows the Board to issue a permit after county allows the Board to issue a permit after 30 days. <br /> 30 days (60 days for a first class city). 2. Waive the above-noted waiting period: The county <br /> allows the Board to issue a permit before 30 days. <br /> 2. Waive the above-noted waiting period: The Documentation attached. <br /> city allows the Board to issue a permit before 3. Deny the application by passing'a resolution within <br /> 30 days (60 days for a first class city). Docu- 30 days. <br /> mentation attached. Print name of county.' <br /> 3. Deny the application by passing a resoluf~on <br /> within 30 days (60 days for a first class city). (Signature of county personnel receiving application) <br /> Print name of city: ~---~'-/ . ~ 10~o..x~Glz.,-/ 'l-rue <br /> <br /> (~- ~ / Date /.~I__ <br /> <br /> (Signature of city personnel receiving application) · On behalf of the township, i acknowledge that t~e . <br /> TrUe ~':, .",c~'~.c...~,, (3~,c.~.<''- organization is applying for exempted gambling activity <br /> within the township limits. . <br /> Date ~ / J"l / ~ ~A township has no statutory authority to approve or deny <br /> an application (Minn. StaL sec. 349.213, subd. 2). ' <br /> <br /> Print name of township: " <br /> <br /> (Signature of township official acknowledging application) I <br /> T'rtle <br /> Date__I__/__ I <br />Chief Executive Officer's Signature <br /> <br />Mail Application and Attachment(s) <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 We~t 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 the <br />Gambling Control Board. <br /> <br />I <br />I <br />I <br />I <br /> <br /> <br />