Agenda - Council - 08/24/1999 - Laserfiche WebLink

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ACKNOWLEDGMENT I GAMBLING PREMISES AUTHORIZATION I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, T~E GAMBLING CONTROL BOARD, OR AGENT OF THE BOD3.D, OR THE COMMISSIONER OF REV]ENIIE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS.~ TO ENTER T~E PREMISES TO ENFORCE T~E LAW. BANK RECORDS INFORMATION THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT WHENEVER ATECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. I DECLA/{E T~LkT: I }{AVE READ THIS APPLICATION AND ALL INFORbU%TION SUBMITTED TO-THE GAMBLING CONTROL BOA/AD; · ALL INFORFiATION IS TRUE, ACCURATE AND COMPLETE;; · ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPER3%TION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MIN1TESOTA GOVERNING LAWFUL GAMBLING ~ RULES OF THE GAMBLING CONTROL BOARD A/TD AGREE, IF ISSUED A PREMISES PERMIT, TO /LBIDE THOSE LAWS ~ RULES, INCLUDING AMENDMENTS TO THEM; ANY CHA/~GES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CF~ANGE; I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFOP34ATION OR PROVIDING FALSE OR MISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. ~v~~ DATE 1. THE CITY* MTJST SIGN THIS Ai~PLICATION IF THE GA/4BLING PREMISES IS LOCATED WITHIN CITY LIMITS. ~E CO~Y** ~ TO,SHIP** ~ST SIGN ~IS ~PLICATION IF THE G~LING PREMISES IS LOCATED WI~IN A TO,SHIP. FOR TO,SHIPS ~T ~E ~ORG~IZED OR ~INCORPO~TED, ~E CO~Y** IS REQUIRED TO ATTACH A LETTER TO THIS APPLI~TION I~I~TING T~ TO,SHIPS STA~S. ~E LO~ ~IT OF GO~E~ (CITY' OR CO~) ~ST PASS A RESOL~ION SPECIFIC~LY ~PROVING OR DEWING THIS APPLICATION. A COPY OF THE LOC~ ~IT OF GO~~'S 'RESOL~ION APPROVING ~IS APPLICATION ~ST BE 3. 4. 5. ATTACHED TO THIS APPLICATION. 6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED TO THE GAMBLING CONTROL BOARD. TOWNSHIP: BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGA/~IZATION IS APPLYING FOR A PREMISES PEP34IT WITHIN TOWNSHIP LIMITS. CITY* OR COUNTY** TOWNSHIP** I I CITY OR COUNTY NAME TITLE TOWNSHIP NAME SIGNATURE OF PERSON RECEIVING APPLICATION REFER TO THE CHECKLIST FOR REQUIRED ATTACHiZENTS ~F~AIL TO: GA/4BLING CONTROL BOARD 1711 W COUNTY R/). B SUITE 300 S ROSEVILLE, P~N 55113 DATE RECEIVED I i I I I