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<br />ACKNOWLEDGMENT
<br />'AMBLING. PREMISES AIITHORI`LATION''
<br />REBY.,GIVE CONSENT TO LOCAL.'LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS
<br />THE'BOARD;:OR THE ...
<br />COMM iSSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS,
<br />TO..ENTER�.THE PREMISES,, TO, ENFORCE, THE LAW.''
<br />RECORDS. INFORMATION _
<br />1i, 'GAMBLING_'CONTROL BOARD IS AUTHORIZED TO INSPECT.THE BANK RECORDS OF THE GAMBLING ACCOUNT
<br />ATHENEVER NECESSARY ,TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES.
<br />ECLARE TTHAT t -..
<br />I:HAVE.READ,..THIS :APPLICATION AND'ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD;
<br />INFORMATION• IS,TRUE "..ACCURATE, AND. COMPLETE;;:
<br />...,.-
<br />I;`:OTHER? REQUIRED INFORMATION-, HAS, BEEN FULLY DISCLOSED; '.
<br />_....,....,',.. ...... _ ER'OF THE ORGANIZATION; . '
<br />THE: CHIEF EXECUTIVE. OFFIC
<br />'p.SgL7ME'FCTLL RESPONSIBILITYFOR,THE FAIR_AND-.LAWFUL OPERATION OF ALL GAMBLING
<br />CTIVITIES :•TO;.BE ; CONDUCTED,• t . ,•• '�,; ,
<br />SWILL FAMILIARI.ZErMYSELF'WITH.THELLAWS OF MINNESOTA,GOVERNING LAWFUL GAMBLING AND RULES
<br />•� .lr +.,w.r..,,.•,-•' ...•, ..� y I (1,....- .Yl:r\. tl 1 M1l.
<br />OF_,;a<TFIE`GI'iMBLINGr CONTROL•'•BOARD ,AND AGREE, z IF ISSUED -A. PREMISES PERMIT, TO ABIDE THOSE LAWS
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<br />._- S', r.•INCLUDINGrAM NDMENTS.'*TO�.•_�•%.'�'�21• f.APPLICATION.?INFORMATION�,WILLr'-BE SUBMITTED TO THE GAMBLING' CONTROL BOARD AND, ,1�..�-Rr u ,u it rw::�a: ,••. .,J.;.. .�, ., .JL .,.+hi'.. T-, .. ..r,.. ...: n,•.:,.,,-
<br />:I�OCAL.�,UNIT•'OFGOVERNMEN `'WITHIN.�TEN;DAYS,rOFTTHE;.CHANGE, r, ,
<br />,r.,aat%t: > ..i!.'u J� La•a: I "S. fki uG.T u•.r� r..
<br />-��;,UNDERSTAND.i�THAT��FAILU��.�„TO;�.PROVIDE *�REQIIIREDNIN_FORMATION OR PROVIDING., -FALSE OR"MISLEADING -
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<br />ORMATION�'MAY •RESULT;; CN;THEI DENIAL`�.OR,JRfs'VOCATION OF- THEE PREMISES PERMIT , r ,i ,� .,
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<br />3 GN ' OF`' CHIEF;i�SXSCIITVS� OFFICER �� ,z yi
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<br />LOCAL GOVERNMENT- A
<br />:.. r b'`t ".. :. .,.r.9c'Fy. tS..J..!!• 4 Kr.;7l .: ?- ' °,�- ,. rs
<br />" THE CITY*.-.MUST.'SIGN T•iIS'=APPLICATION)IF THE; GAMBLING PREMISES`IS LOCATED WITHIN CITY'
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<br />LIMITS�'..j"i :_
<br />PY' r•f` �1!`M1/• '** • TOWNSHIP** MUST SIGN --THIS APPLICATION IF THE GAMBLING� PREMISES IS
<br />2 y THE COUNTY AND: , . r� .`
<br />LOCATED .,WITHIN'W TOWN6H_IP
<br />FOR'a TOWNSHIPS:'THAT :A :,.UNORGANIZED. OR
<br />UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH
<br />J.•Piii'.J,='. .y... y...1 Y M.f •r"'J1
<br />1.'A?. LETTER'ST0 =THIS .APPLICATION INDICATING- THE;; TOWNSHIPS - STATUS .' =
<br />4 `s°THE`LOCAL*:UNIT OF GOVERNMENT•; (CITY' OR'COUNTY) MUST ,PASS A RESOLUTION SPECIFICALLY
<br />APPROVING':OR DENYINGYTHIS'APPLICATION ; :`:`,
<br />,, to "COPY OF?:THE I,OCAI� IT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE
<br />i `ATTACHED TO THIS"APFLICATION.'':; t �' rr ,` ::_ 'y`.. ,>.,• ,
<br />�• '
<br />IF: THIS: APPLICATION;Iu'; DENIED'BY, THE LOCAL UNIT OF GOVERNMENT, ` IT SHOULD NOT BE: SUBMITTED
<br />TO.THE GAMBLING CONTROL BOARD.
<br />By.'SIGNATURE.-BELOW:`,;THE TOWNSHIP ACKNOWLEDGES. THAT THE ORGANIZATION IS APPLYING FOR A
<br />MISES:PERMIT.WITHIN TOWNSHIP LIMITS _
<br />7.
<br />.ITY*,OR::'COUNTY** ' ' TOWNSHIP**
<br />Mid
<br />CIJFYOR COUNTY, NAMETOWNSHIP" NAME ,
<br />�/�`�. ,''. .t ;�'a'LiSis.:J/ �. jig-. !.... •t ..,d;t+l .,J - 1 s I , `+� fl F• 1 <.-r•-•'�.-• ` •`' ,1
<br />S NATUREi OrF'rPERSON..RECEIVING' ICATION.'-<.=. �,� :'�� 3IGNATQi2E OF, PERSON -RECEIVING. APPLICATION '
<br />RECEIVED
<br />REFER' TO THEL,, CHECKLIST , FOR REQUIRED ATTACHMENTS
<br />� • :.*.•:: •' •;`•' •MAI' TO : GAMBLING . CONTROL BOARD
<br />1711 w COUNTY RD B SUITE 300 S '
<br />ROSSVILLS, MN 55113
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