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I <br /> <br />Application for Exempt Permit - LG220 <br /> <br />Page 2 of 2 <br /> 7/98 <br /> <br />Local Unit of Government Acknowledgment (Required by Statute) <br /> <br />ilf.the~a~bling :premises:is !vdthln 'city~limitsi:th e:~! <br /> <br /> On behalf 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 /> <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 />(Signature of city personnel m~iving i~pplieation) <br /> <br />J:' ff the:gam~ bllng~remises iS' Iocate. d tin :a.lt~wnship,. both. <br /> <br /> On behalf of the county, I acknowledge this application <br /> and three options for the county: <br /> <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 ab0¥~-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 />Print name of countyi <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 I / <br /> <br />Chief Executive Officer's Signature <br />I The information provided in this appli .cationjs' comj31ete an, d/accurate to the ~est of my knowledge. <br />JChiefE,,~ecutiveOfficer, ssignature'/,-,~t,~~ ~/~7/"~ "'-~~' " <br /> <br />IName(p,ease print) '"', <br />Mail Application and Attachment(s) <br />At least 45 days prior to your scheduled activity date send: <br /> · 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 /> 17'11 West County Road B, Suite 300 South <br /> ,.' Rosevllle, MN 55'113 <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 />Date <br /> <br /> <br />