Agenda - Council - 04/22/1997 - Laserfiche WebLink

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Is this gambling premises located within city limits? .1~ Yes F-'71 No If Yes, write the name of the City: City Name "~.¢t,C/~e~ :.... ..... -' - .... v' - , . : ~'~."y,'.;'."? :":,",':::.~:! If No, wri.te .th.e name of the d6untya:nd 'th&.'l~s'~n~;hipj''' " C.?unty Name. ....... · ...... · ..... .Tqwnship Name ... Check the appropriate status of the Township: ['-'-[ org~.nlzed [Z:] 6rioi:g riiz'ed I, ~`~&;~;~;~``~`..;`~.~;.9~'?`~.~.tr~.~;~`J~.T~&~9~.~.~`.~:~:`~¢~''~;~q~'-:'':~','.''':~5~t~"' '; ~: "," ' '"']~!~'&~t'~: ;'t~l~'~:i'~ux~:h~"~ h41~"i;["¢;~,' ~"~:;":~:'~""~'~x"~,*~,'~i~ ' :'~" 1. The city must sign th/s application if the gambling premises is within city limits. 2. The'county and tovmship must sign this applica- · tion if the gambling premises is not within city limits.. 3. DO NOT submit this application to the Gambling Control Board if' it is denied by the local unit of government: 4. NOTE: A Township may not deny an application. Upon submission'of this ~pplication to the Gamblin~ Co'nt..r_ot Boa,rd, .th_e e_x.emp:t, i°q. will .be issued not more than 30 days (60 days for cities of the 1st class) fr~m the' d~te the' Io~.~,l uhit of government ' signed the application, provided the application is complete and all necessary information has been received, unless the local unit of government passes a resolution to specifically prohibit the activity. A copy of that resolution must be received by the Gambling Control Board within 30 days of the date filled in below. Cities of the first class have 60 days in which to disallow the activity. City or County Acknowledgment of Receipt of Application S ignatu re of person receiving'application Township Acknowledgment of Awareness of ,.:Applicatio. n'. ....: ...., ... ...... 'Signature 6f p'e?bon'a. 6k~.ioW!edging api>licafi0n ~" ' Date Signed: Title oc~person receiving a.~pp~on '. ' · '.: : '.' ' 'Title'iSf 15iri6ri ~idknbC/I~gin~¢/~pplieation "' ";"" I I I have read this application and all information is true, accurate and complete: .... . :;..i:3 ..: :..": '..' · ' Date: I Submit'the application at least 45 days prior to you'r'.scheduled date of activity. Be sure to attach the $25 application fee and a copy of your proof of nonprofit status. Mail the complete application and attachme'nts to: Gambling Control Board 171t W. County Rd B Suite 300S ; :... Ro.seviIle, MN 55113 This publication will be made available in alternative format (i.e. large pdnt, braille) upon request. Questions on this form should be directed ~o the Licensing Section of the Gambling Control Board at (612)639-4000. Hearing impaired individuals using a TDD may call the Minnesota Relay Service at 1-800-627-352g in the Grea[er"Minnesota'Area or 297-5353 in the Metro Area. The information requested'on this form will be used by the Gambling Control Board (GCB) to determine your compliance with Minnesota Statues and rules governing lawful gambling activities. All of the information that you supply on this form will become public information when received by the GCB.