Agenda - Council - 07/24/1990 - Laserfiche WebLink

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Ic *'C;~t~:.:::~i' "Depa~'tme~t of Re{/~:~i~;;; GaT ng [~ivision :i-' ' ~r ;2"'~-' " ':" -.': _ · : ~:~~. Mail Stat,on ~15 ~;'~ '-~~~' St. Paul, MN 55146.3~'5. I~ ~::::~: ~!~'~i~?:.?~:~.' '"L"~':L':T~ ' '. '~',' : ." ::r~'.:'=~' :~?~'?~:'' ~r~' r...;. 8, Name of Treasurer 0r ~ers~ Whd'A~Counts for Revenues · ' ' ' I 9. Business Phone '~ .'. 10 Name of Gambl n M~flager '.?~,~'"' '' 11 BondNumber I 12 Bus ness Phone ~ . 13. Name of Establishment Where Gambling Will Take Place 14. County I 15. No. of Active Members -' 18. If Bingo ~ill be conducted with this license, please specify days and times of Bingo. ~. Has liconso evor beon::;. ' ~ R~6kod Date: D Suspondod Dato: .... ~ Doniod ~ate: ' .~: ' 20. Have internal controls'boon submitted provi~uslv~:" ' ~Yos ~ ~o (If "~o," attach copy) : :'~: '~: ~'- 22. Has current skotch'B00~ filod with ~h'~boar0? . ' D. Yes ~o (If "~o," attach copy) ' ' .' ' ...y. ~g~my sf~at~rs bo~ow, local law on,ore'merit officors 0r a~¢nts of the Board aro horobg authorized to enter upon th~ site, at any bein~ conducled, to obsorvo the ~ambH~ and to onforco tho law for any unauthorized ~ame or practieo. .~ ~ . · ~'~Y my si~nat~ro below tho Board ~s h0r~by authorizod ~o inspect the Bank rocords o[ tho Genora} Camblin9 Bank Accouht whonevor necessary to ? ~ 1. I have read this application and all information submitted to the Board; .. ~.~.~;~ ' 2~ All information suBmittod is truo, acc0~ato and complolo; - ~ ' - ~ ' '~:);~-"" ~:. ~11 othor'roquir0d information has ~een ~ullg disclosod; · 4/ I am the chic[ executivo officor o[ ih~ 0r~anizafion; ' ' 5. I assumo full rosponsiBilitg [or lbo fai'r'and law[ul oporafion of all activitios to bo conducted; fl. I will [amilladzo mgsolf with ~ho law~ of'the Stato o~Minnosota rospoctin~ ~amblin~ and ru~es of the board and a~roo, la~s and rules, includin~ am~ndm~o~s'~horoto . - 23. Official Legal Name of Organization'.... I Signature (Chief Executive Officer) Date I Title - ..'ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy. of this application. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling. Control Board and if approved by the Board, will become effective 60 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activi~ and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of the below noted date. ~ 24. CitY~Dunty Name (Local Governing Body) ~¢ '.' Township: If site is located within a township, please complete items 24 Signature of Person Re~g ~p~t'on: ~ . ' 25. Signa~re~ ~son Receiving Application ' Title ....... D~'Re~ei~e~(t~date begins 60 day period) Title: ~ "- ~' '~ ~/ ' :" Name of Person ~_e_elivering ~pplication lo Local Governing Body: 0G-00022-01 (4/89) ':i'::': t Township Name White Copy%Board Canary--Applicant Pink--Local Governing Body .