Agenda - Council - 10/27/1998 - Laserfiche WebLink

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ACKNOWLEDGME~ A/~BLING PREMISES AUTHORIZATION HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS F THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, 9 ENTER THE PREMISES TO ENFORCE THE LAW. ~ RECORDS INFORMATION .EE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT ~ENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. 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 INFORMATION HAS BEEN FULLY DISCLOSED; I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; I ASSUME FULL RESPONSIBILITY FOR THE FAIR A1TD LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MIN1w-ESOTA GOVERNING' LAWFLrL GAMBLING AND RULES OF THE GA24BLING CONTROL BOA/%D AND AGREE, IF ISSUED A PREMISES PERMIT, TO 2LBIDE THOSE LAWS ~ RULES, INCLUDING AMENDMENTS TO THEM; CHANGES IN APPLICATION INFOR/4ATION WILL BE SUBMITTED. TO THE GAMBLING CONTROL BOARD AND LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; I U1TDERSTA1TD THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. ~GNATURE OF CHIEF EXECUTIVE OFFICER · DATE THE CITY* MUST SIGN T ~PPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY LIMITS. THE COUNTY** AND TOWNSHIP** 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 GOLMERNMF/Uf (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY APPROVING OR DENYING THIS .APPL!C~TIO. N.. A COPY OF THE LOCAL'UNIT OF .GOVERNMENT' S RESOLUTION APPROVING THIS APPLICATION MUST BE ATTACHED TO THIS APPLICATION.' IF THIS APPLICATION IS DENIED. BY THE LOCAL UNI-T- OF 'GOVERNMENT, IT SHOULb'NOT BE suBMiTTED TO THE'-GAMBLINd"CO~R~L BOARD. NS}lIP: 9IGNATLrRE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A ~ISES PERMIT WITHIN TOWNSHIP LIMITS. :* OR COUI~TY** TOWNSHIP** ' OR COUNTY NAME TOWNSHIP NAME TURE OF PERSON RECEIVING APPLICATION \ SIGNATURE OF PERSON RECEIVING APPLICATION TITLE DATE RECEIVED REFER TO THE CHECKLIST FOR REQUIRED ATTACH/~ENTS M_AIL TO: GA/~BLING CONTROL BOARD 1711 W COU1TrY RD B - SUITE 300 S ROSEVILLE, M/~ 55113