Agenda - Council - 12/09/1997 - Laserfiche WebLink

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I I I I I I I I I I I I I I I I ! 6amblin9 Con%Col Board Fa×:612 0c% 7 '97 12:18 P. 05/05 Is ~ g,mbl~g F~ Io~ted M~ 4~ 1~9~ Y~ ~ No If Yes, ~m ~e ~e of ~e C~: If No, ~te ~e ~e of ~e Com~ ~d ~e Tom,p: Com~ N2me To~p Nme Check ~e appropfiat¢ ~ of ~e Tomhp: ~ orcM ~ morg~ed ~ ~~omted 1. ~e oi~ ~m ~i~ ~is applitadon ~ gb~g 3. DO NOT ~ubmit $~ appli~don to $~ Ombling Consol pzmises b ~$i~ elm ii~. ~ord if it ~ Ce~e~ by ~t 1o~I lit of government 2. ~e ~mV md tomsl~p mm si~ ~s app~,a- 4. NO~: A To, flip my not deny m applimtion. fion if~e gamblig prembes is not ~ia d~ lbi~. Upon submission of this application to the Gambling Control Board, the exemption will be issued not more than 30 days (60 days for cities of the 1st class) from the date the local unit 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 disaIlow the activity. City or £omaty akclmowledgment of Receipt of Applieution ~jgnamre of person receiving application r~ Town_~hip Acknowledgment of Awareness o1' kpplic~tio~ Sign~are of person acknowledging application ~~~~~n ~ ~e ofpe~on ~owI~ appH~n I have read ~is application and all info~at~n is t~e, ac~mto and complete. Sub~ the~~fion ie~t 4S days prior to your scheduled date of Be sure to a~ch ~e $2S applica6on ~e and a copy of your p~of of nonpro~t s~tus. ~ai] ~e comple~ appli~on and a~chmen~ to; G~bling ConSol Board 17tl W, Coun~ Rd B Suite 300S Rosevilla, ~N 55113 This publication will be made available in alternative format (i.e. large print, braille) upon request. Questions on this-form..hould-be directed tc~the.,Licensin9 Section of the. Gambling Control Board at (612)639-4000. Hearing impaired individuals using a TDD may c:alJ the Minnesota Relay Service at 1-800-627-3529 in the Greater Minnesota Area or 297~5353 in the Metro Area. The information requeste.d o.?.tt2, is form.will, be used b.y th.e G.a.rnblin.g..Contrr?l B...oard (.G.C.B) .to determine your compliance with Minnesota ~tatues aha rmes governing tawro~ gemming actiwues. ^n of the information that you supply on this form will become public information when received by the GCB. 55