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ACKNOWLEDGMENT
<br />GAMBLING' pREMIsES AUTHORIZATION
<br />I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS
<br />0F<,.THE. BOARD/. OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGE~TS OF THE COMMISSIONERS,
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<br />THEjGAMBLING 'CONTROL'.BOARD .IS AUTHORIZED TO.:INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT
<br />WHENEVER~NECESSARY TO' FULFILL.'REQUIREMENTS~ OF.;: CURRENT %' GAMBLING RULES AND STATUTES'~' '
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<br />· I PIAVE'~ THIS AFPLICATION A/TD' ALL INFORMATION SI/BMITTED TO THE GAMBLING CONTROL BOARD;
<br />· . ALL~INFOR/VL~TION IS TRUE,: ACCURATE AND' COMPLETE;; ~:.: '" -.
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<br /> I'AM THE;CHIEF EXECUTIVE 'OFFICE~ OF THE ORGANIZATION; .~ · : .' '-...
<br />· ~:-I ~SSUME 'FULL RESPONSIBILITY-FOR THE FAIR A/TD' I_J~WFUL' OPERATION..OF ALL GAMBLING
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<br />· ' I;~ ~h~ 'F~£IA~I~.E ~ZSW, LF' 'Wi~a' '~['" ~WS. OF MINNESOTA GOVEmWING LAWFUL' GAM~LING'ANO RULES
<br /> J::'O~.J:~Ei..'GA~BLING .CONTROL' BOARD AND AGREE/ i~[ISSUED '~ PREMISES. PERMIT, -.. TO ABIDE THOSE LAWS'.
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<br />· ?if"~.RsTAND THAT FAILURE ...TO..[PROVIDE REQUI~RED':'jINFORMATION'OR PROVIDING FALSE 'OR' MISLEADING
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<br />~,oc~'"~6W'~'~' ~C~o~o~'i'~/: .... .'">" ":,--',." '"-,.,' ",'. ' .",('.~::.: ~':f, ....... '- . ,: 'i.' '~ :,,i-: -~ ~.:. ," ' -
<br />~.-"~. ~..THE:[CITY* MUST, S~GN ~IS.. ~PLI~TION IF.:~E. G~LING PREMISES IS. LOCATED'WITHIN 'CITY '
<br /> LIMITS, ' .~".-~...'.[, .';'~,..~ ( ..... ': .. , '. : .:....." . . .
<br />2 ~ ].[:. ~E .' CO~* ;.,' ~ [.TO,SHIP**. ~sT' SIGN,:' ~IS ~P~I~TION. IF -'~, G~LING PREMISES IS -
<br />-)?/.~oc~b· ~.'~' [~0~S~.:..)~. f:~ ~: '": ,...:../.,.-~..~ ~....,.'~ .::~.:/, ,..' .~:, ~:.:..'~.,:~'-'-:.:)?:' ..:, .-~-. ..: .: '[~ [_ .
<br />3..'~..' FOR TO'SHIPS-T~T '~E ~ORG~IZED OR ~INCORPO~TED, ~ CO~** IS REQUIRED TO ATTACH
<br /> '~ J"A" LETTE~ TO ~IS ~PLICATION I~I~TING'~ TO'SHIPS STA~S; , ....~ '. ..
<br />4'~-'-...)/~E LOC~.~IT.'OF Go~~...(CITY, OR CO~)' ~ST PASS A'.RESOL~ION[ SPECIFI~LY/
<br /> '" ': ';'~P~O~IN~ O~ DEWING ~ S ~PL[ C~ ~O~ :~''' ' /:',.': ',': ' ~ ,/:' .. ~,,: ~ '.,..:.:., ~, ,.'.'....,~ ....... ':.',:/,., ' ?"'... ,~' :~ .' .,~,." ... ~' '. ,..~(~.["['.j j.:[ [ [.".. ? ~':j
<br />~:~?[~':"C~' ~F:""THE LOC~ '~IT '0F" ~o~~: ~ "~~ION ~PPROVIN~ THIS '~PLIC~TION ~ST BE
<br />"~/'::?,~ ~T~CHED :TO THIS ~P~LZC~TmON~-:.(.::':":~'[ ~).~" :'~,:'~. ?:';: ?'j?([.~.)?:~'~. ,.....: ..~ -, .; .,'.~ ? ~-;:.[ ;'-:'/'.-:.::~?.:/~[:[(~.~ .'.'. ~ '/ ~ . .'.'" · . ::,:':-..:'-:.- : . .:
<br />6.'-'."'.IF: ~IS ~PPLIC~TION IS 'DBNIBD' BY.THE LOC~'-~IT OP ~O~~," IT SHOED NOT BE S~ITTED
<br /> :~ [:-:'~ TO. ~E G~LING CONSOL B0~..":,:~' ~'-;~'??'?',~ ~.:~'.~;,(:?"/'/.: '/ ,~: : ~'-.'.':.~' -'.- .-:' '.-. )'?'. '.,..:(1: :' (-:::'~-.%':':'./,.- ,. ~'.. . '..'.'::.~ ~? :i.. .,'. ';,.:
<br />TO~s~P ~ :?.?~?..~:'.>:.:~: ?..?'::'::'; .,.....::.',.' ?..,~ ~,.~,.?:..~;~ /~ ;.: )[ ,.~ :::: ':..-.'~.?~: .;-'"...?:,,~.f.::?.f.'.'.:":.-:: -, '-::' .'?.;:.??'j-.:._'-. :: ?:(<~:-/'- ~f. ?"?? :.:C.:_--"::,~.~~, :~.. '.'. '
<br />BY.- SIGN~E,':BELOW, THE TO.SHIp' ~C~O~EDGES ~T.'.~E'O~G~IZ~TION~-IS. ~PLYING FO~"~ ~(-: ~..
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<br /> .:.:..:.Cy/..(-~, .. ;.-[f. ..,., :...,,..:~..:...... ... f~.' .... ~ -..[:':.'...'-'3-..'... '." :' : . J, :.: ':. :..: -':-)[.[",~-> ':.: . -?.-'.'::' :' ::'f .? :'~.'? ;...' '..'. ):: ,'./'.¥..,} -.' ' ' .':". '. '
<br /> ~ '-.'.:':".'_ ".' "':"' ' ..... "f '" j 7..' [ .,:' .~ .'~.' . .'',- ':.:~- : .~ .... :~-~-.:_ 31-.-'~....' ~_.2:-' .... -'-' "~ ".-'-.-¥ ¥.'"~"
<br />CITY*' OR' CO~Y** '. TM" ........ ..'" '- '-':<'";'" :',' '". ": :':.": TO~sHXP**-" ' (' "-:. :".' '. ....... ""-' ' / ";" "' ,'.' ' ' '
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<br /> [G~A~ ~F. ~ERS~O~ i~E~EIV.ING ~L".i.~ION--.':c.'.-:'::~:.' '[:':['SIGNATURE. OF' pERsoN RECEIVING APPLICATION
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<br />TIT --"'--" ~LE ::" '": .... '-'. ........ D~TE' RE~EivE~/' "'1 .... T'~LE '! "'"' .... DATE '~EcEIV~D
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<br /> i :-'-: REFER TO' THE CHECKLIST FOR REQUIRED ATTACHMENTS
<br /> .... MAIL TO: GAMBLING"CONTROL BOARD '
<br /> · ' ""-' "' ..... ' ....... ~711 W' COUNTY RD B '-' SUITE 300 S ~'.' '. ~''
<br /> ':' ROSEVILLE, ldN 55113
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