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ACKNOWLEDGMENT <br />LING PREMISES AUTHORIZATION <br />I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS <br />r THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, <br />ENTER THE PREMISES TO ENFORCE THE LAW.. <br />BANK RECORDS INFORMATION <br />tGAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT <br />NEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. <br />(ECLARE THAT: <br />HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; <br />L INFORMATION IS TRUE, ACCURATE AND COMPLETE;; <br />ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; <br />AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; <br />ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING <br />ACTIVITIES TO BE CONDUCTED; <br />tWILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES <br />F THE`GAMBLING•CONTROL.BOARD AND.AGREE;;:IF.ISSUED APREMISES PERMIT, TO ABIDE THOSE LAWS <br />AND RULES,' INCLU35ING`AMENDMENTS TO THEM;` <br />CHANGES IN APPLICATION INFORMATION.WILL BE SUBMITTED,TO THE GAMBLING' CONTROL°BOARD AND <br />CAL UNIT ' OF.' GOVERNMENT • WITHIN TEN DAYS., OF' THE- CHANGE; :. , <br />UNDERSTAND.THAT.FAILURE TO PROVIDE REQUIRED INFORMATION -OR PROVIDING FALSE OR MISLEADING <br />INFORMATION MAY RE T'IN THE.DENIAL OR REVOCATION OF THE.PREMISES PERMIT.'- ` <br />TURF IVS OFFICER - .'' •; AT" <br />• <br />OVE ACKNOWLEDGMENT <br />1. THE CITY*. MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY• <br />LIMITS <br />Z THE COUNTY*,*:.: • A•ND TOWNSHIP**, MUST SIGN -THIS :APPLICATION •IF THE GAMBLING PREMISES IS <br />LOCATED WITHIN ' A:TOWNSHIP .-.. ; <br />. .;�•; • _ . ... .� -.`.. <br />3. FOR TOWNSHIPS THAT ARE UNORGANIZED OR•UNINCORPORATED, THE COUNTY** IS'REQUIRED TO ATTACH <br />A LETTER TO THIS APPLICATION INDICATING.THE TOWNSHIPS STATUS. <br />THE LOCAL UNIT OF GOVERNMENT (CITY. OR* COUNTY). MUST PASS -A RESOLUTION SPECIFICALLY'.•'. <br />APPROVING OR DENYING THIS APPLICATION.::_- <br />3 A•'COPY OF THE LOCAL -UNIT OF'GOVERNMENT IS*RESOLUTION APPROVING -THIS APPLICATION MUST BE <br />ATTACHED TO THIS APPLICATION. <br />�. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT,•IT SHOULD NOT BE SUBMITTED <br />..TO THE GAMBLING CONTROL BOARD. - <br />SHIP : <br />3� SIGNATURE • BELOW, THE TOWNSHIP ACKNOWLEDGES .THAT THE ORGANIZATION IS APPLYING FOR A <br />?REMISES -PERMIT WITHIN TOWNSHIP LIMITS.. <br />4ORY_ <br />COUNTY**:. TOWNSHIP** <br />I <br />I&TYOR COUNTY NAME �`: `'� TOWNSHIP NAME ` <br />fATURE, F PERSO RECEIVING APPLIION;. <. SIGNATURE OF,.PERSON RECEIVING APPLICATION <br />PITLE. _... ' . ` DATE RECEIVED"- ( TITLE ; :: ` : DATE RECEIVED ' <br />REFER TO THE CHECKLIST FOR REQUIRED ATTACHMENTS <br />MAIL TO: GAMBLING. CONTROL BOARD• <br />1711 W COUNTY'RD B SUITE 300 S /tii� <br />- ROSEVILLE, MN 55113 /0. <br />