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Gambling Control Board Fax:612 Oct, 7 '97 12:18 P. 03/03
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<br /> If Yes, ~te ~ ~ of ~ Ci~:
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<br /> Ifl'4o, va-ire the name of the Cowry m~d the Township:
<br /> County Nsme Township Nmme
<br />Check thc approp:datc status of the To~ns~p: [~] orgazAzcd F-fl unorganized [Z~] unincorporated
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<br />1. %he city must sign this appHcatbn if the gaznbling 3. DO NOT submit this application to the Grumbling Control
<br />pr~mises ~s ,~with[n city ]imks. Bosrd i£i'~: iS denied by the loom! unit of[]rovernment.
<br />2. ~he county amd to~nslfip must sign this appJlca- 4. Notre: A Town.~"dp may not deny mn application.
<br />don if the gambling premises is not ~Fithin
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<br />Upon submission of this application to the Gambling Control Board, the exemption, will be issued not
<br />more than 30 days (60 days for cities of the 1st class) from the date the local unit of government
<br />signed the application, provided the application is complete and all necessary information has been
<br />received, unless the local unit of government passes a resolution to specifically prohibit the activity. A
<br />copy of that resolution must be received by the Gambling Control Board within 30 days of the date
<br />filled in below. Cities of the first class have 80 days in which to disallow the activity.
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<br /> City or Count~ Ad~owledgment of Receip~ of Town.~p Acl~owledgmeat of A~e~ of
<br /> Ap~fion Appli~
<br />~re~5on S~e of person ac~owledging appH~don
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<br /> Da~ ~ec~ved- ~ ~ -/¢¢ ~ ~te 8i~ed' '
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<br /> ~e of p~Co: reee~g appli~ao~ J ~e of pezso: ~ow]~ app~
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<br /> I have read this application and all information is trna, acetate and complete.
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<br /> '~Sub~he application at least 4.5 days prior to your scheduled date of activity.
<br />Be sure to attach the $25 application fee and a copy of your proof of nonprofit status.
<br /> MaiI the complete appIication and attachments to;
<br /> GambIlng Control Board
<br /> 1711 W. Coun[y Rd B Suite 300S
<br /> Rosevilla, MN 55113
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<br />This publication will be made available in alternative format (i.e. large print, braille) upon request.
<br />Questions on this-form-~houtd-be diracted tc~ the..Licensing Sec'don of. the. Gambling Control Board at
<br />(612)639--4000.
<br />Hearing impaired individuals using a TDD may call [he MinnesoYa Relay Se~ice at 1-800-~27-3529 in the
<br />Greater Minnesota Area or 297-5353 in the Metro Area,
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<br />The information requested on this form .will. be used b.y th,e G.a,mblin.g..Cont~[ .B..oard (GCB) to determine your
<br />compliance with Minnesota Statues and ru~es governing ;aw"~u~ gamou,ng acuwt~es. Ali of the information
<br />that you supply on this form will become public information when received by the GCB.
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