Laserfiche WebLink
DePt. o;' i~evenu~ - ~aming <br /> <br />St. Pau..~ MN 55]~6-3315 <br /> 612/297-5300 <br /> <br /> ONE DAY OF~-SITE <br />LAWFUL GAMBLING APPLICATION <br /> <br />· A licensed organization may, upon ~pproval of this application, conduct gambling on a <br /> premises other than a licensed site one day per calendar year for not more than ]2 hours. <br />· If there are fewer than 60 days between the date that the city/county signs the <br /> application and the date of the off-site gambling, include a waiver from the city/county <br /> waiving its 60-day disapproval period. <br />· Print clearly or type. Attach a copy of the lease for the off-site premises. <br />· After review, the application will be returned to the organization wit]~ approval or <br /> denial indicated below. <br /> <br />Oroan~zation j Lice~se No. <br />Address {st:[..~et or P.0. box, number) <br /> <br />OFF-SITE INFORMATION <br /> <br />1, Name of premises where off-site lawful gamblina will be c~)nducted <br /> <br />2. Address of off-site~_~remises <br /> <br />3. Date of one-day event <br /> <br />IC~.~N' or township <br /> <br />IState J Zip.....go~e~ .-'-- <br /> <br />4. Has your organization conducted off-site gambling this year? ~_JYES ~N0 I If YES, give date of event <br /> <br />5. Attach a lease for the one Uay off-site lamful gambling. <br /> <br />6. Name of chief executive officer~(please print) <br /> <br />J Signature~.?~m //f <br /> <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br /> <br />I hereby acknowledpe having been served with notice that this application will be reviewed by the Charitable <br />Gambling Control Board and, if approved, will become effective 60 dab's from the da'to of receipt <br />(noted below) unless a resolution of the local governing body is passed that specifically disallows such <br />activity and a cop), of that resolution is received by the Charitable Gambling Control Board within 60 days of <br /> 1~ '~ m ~ od My r~O1UtiOn. <br />the be~o~'~ noted data m~- city or count)' ma5, choose to wa~ve +~ ~r,_~., ackno,..,,,_e~e..,en~ peri <br />Attach the written waiver to this request. <br /> <br />7, Name of city or county (local governing body) <br /> <br />18~ignature of person r ' ' -- ication J/llit, ie , /~ Z' j Dat~ rece~ved,~ <br /> <br /> , /, <br /> <br /> If site isJ/loc/a~ed within a township, items 9 and 10 must be completed in addition to the county signature. <br /> <br />9. Name of township <br /> <br /> O. Signature of person receiving application I Title <br /> 1 <br /> <br />FOR BOARD USE ONLY J <br />Approved J J Denied j J <br /> <br />Executive Secretary <br />Charitable Gemblin~ Control Board <br /> <br />Date <br /> <br />foffsite.doc(7/25/88) <br /> <br /> <br />