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

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i I 1. The city must sign this application if the gambling Ipremises is within city limits. 2. The county and township must sign this applica- tion i£the gambling premises is not within city limits. Is this gambling premises located within city limits?l~ Yes F-I No If Yes, write the name of the City: City Name ~ ~ ~ ?, q y / If No, write the name of the County and the Township: County Name Township Name Check the appropriate status of the Township: 1--'1 organized {~ unorganized I--I unincorporated .:~:, ' 'i i ~::..':¢:'h'::'" ': .' : ~ :.'; 'i~" ,:, ':" "L ' -t~,¢~¢.[:~:'.!; ~::,.:,;;i:; .::-.,;-:; :!~i/.~' ::~',.:'iii:~ .. ,.~i:.' .;' .':::~':':~:-..%,-~,i.~ ¢-,,. · '!'.!'~:~' :,-.:~ , ::,:.h ::~'::!;.-~;~ii;ihh- :' i~-::;;.!: '.!:.~:'~:~::!: :i!~!;i::"~:f!:~i':¢i;;:i~i~l!; %:',:-:::: I I I I I I I I city or County Acknowledgment of Receipt of ,Application icgnature of person recc, iving application 3. DO NOT submit this application to the Gambling Control Board if it is denied by the local unit of government. 4. NOTE: A Township may not deny an application. 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 disallow the activity. Township Acknowledgment of Awareness of Application. Signature of person acknowledging applic ation Date Signed: Tire of person receiving~ apl Tide of person acknowledging application ii have read thi~pplication and all information is true, accurate and complete. / , Submit the application at least 48 days prior to your scheduled date of activity. Be sure to attach the $25 application fee and a ¢op¥ of your proof of nonprofit status. Mail the complete application and attachment~ to: Oambling Control Board 1711 W. C?unty Rd B Suite 300S :.:..~. ':',. Roseville, MN 55113 This publication will be made available in alternative format (i.e. large print, braille) upon request. Questions on this-form.should-be directed to the..Licensbg Section of. the. Gambling Control Board at (612)639-4000. Hearing impaired individuals using a TDD may call the Minnesota Relay Service at 1-800-627-3529 in the Greater Minnesota Ama or 297-5353 in the Metro Ama. The information requested on this form will be used by the Gambling Control Board (GCB) to determine your compliance with Minnesota Statues and rules governing lawful gambling activities. All of the information that you supply on this {~orm will become public information when received by the GCB.