Agenda - Council - 05/23/1995 - Laserfiche WebLink

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: ACKNOWLEDGMENT ~BLING P~ISES AUTHORIZATION HEREBY GIVECONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL .BOARD, OR AGENTS THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, ENTER THE PREMISES TO ENFORCE THE LAW. NK RECORDS INFORMATION E GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT ENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. DECLARE THAT: I HAVE READ THIS APPLICATION AND ALL INFOP~ATION SUBMITTED TO THE GAMBLING CONTROL BOARD; ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE;; ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; I'A~ THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; " I WILL FAMILIARIZE MYSELF WITH THE LAWS. OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF THE GAMBLING CONTROL BOARD AND AGREE,,IF ISSUED A PREMISES PERMIT, TO ABIDE THOSE LAWS AND RULES, INCLUDING AMENDMENTS TO THEM; ANY CHANGES~IN APPLICATION INFORMATION WILL BE SUBMIT~E~ T~ THE' GAMBLING CONTROL BOARD'AND LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE O2 MISLEADING INFORMATION MAy RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. I GNATUI/~ OF CHIEF ~IECU~ OFFICER -.. : . . . DATE O~ ~~ A~O~D~ THE CITY*~MUST SIGN THIS APPLICATION IF THE G~BLING P~MISES IS LOCATED WITHIN CITY THE COUNTY** ~D TO, SHIP** MUST SIGN THIS APPLICATION IF THE ~BLIN~ P~MISES IS LOCATED WITHIN A TO,SHIP... . . .., ..... . .... ... FOR TO~SHIPS.T~T'~ UNORG~IZED OR UNINCORP0~TED, THE COUNTY** IS ~QUI~D. TO ATTACH A LETTER TO THIS APPLICATION INDICATING THE TO, SHIPS STATUS. T~ LOC~UNIT OF GO~NT (CITY OR COUNTY) MUST PASS A ~SOLUTION SPECIFI~LY APPROVING~OR; DENYING, THIS APPLICATION. - ,. .%:~... .,. A COPY OF~ THE LOC~ UNIT OF GO~MENT'S ~SOLUTION APPROVING THIS APPLICATION ~ST BE I I I I ~T,TACHED ~O THIS APPLICATION .... . · . ~ .:..,. .~.,...~ IF THIS APPLICATION IS' DENIED BY THELOCAL UNIT OF GOVERNMENT, IT ~HOULD NOT BE SUBMITTED TO THE'G~MBLING CONTROL BbARD. ~' '~ ~WNSHIP~ ' ~. ~ SIGNATURE BELOW, THE TOWNSHIp ACKNOWLEDGES THAT THE' ORGANIZATION IS APPLYING. FOR A · ~EMISES PERMIT WITHIN TOWNSHIP LIMITS. ' ~ £~"/* OR COUNTY**. , . .... TOWNSHIP** TOWNSHIP NAME~.~ .'. '' £TY OR COUNTY NAME . ~TLE '.'- ' -·i:' · DATE RECEIVED TITLE ' " .. ' DATE RECEIVED REFER ~O ~ CRECKLIS~ FOR RE~IRED A~CI~q:I~I~S MAIL 1711W CO~ ~ B - SUITE 300 S ROS~I~, ~ 55113 I I I I I I I