Agenda - Council - 05/14/1991 - Laserfiche WebLink

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LG2~3 Minnesota Lawful Gambling I Gambling M n ger 2, idavtt (Attach to the Gambling Manager Application, LG212) STATE OF Y'v~t ,~..),',.J,~-.~-.~6,3 ) COUNTY OF. _~.~~:~ ) AFFIDAVIT OF QUALIFICATION FOR GAMBLING MANAGER LICENSE AND CONSENT STATEMENT (Pursuant to Minnesota Statute 349.16 Subd. I I (type/print name) , under oath state that: 1. I have never been convicted of a felony. 2. I have not, within five years, committed a violation of law or board rule that resulted in the revocation of a license issued by the Lawful Gambling Control Board. 3. I have never been convicted of a criminal violation involving fraud, theft, tax evasion, misrepresentation, or gambling. 4. I have never been convicted of assault, a criminal violation involving the use of a firearm, or making terroristic threats. In addition, I understand, agree and hereby irrevocably consent that suits and actions re/ating to the subject matter of the attached gambling manager license, or acts or omissions adsing from such application, may be commenced against me in any court of competent jurisdiction in Minnesota by service on the Minnesota Secretary of State of any summons, process or pleading authorized by the laws of Minnesota. I I I I I By signature of this document, the undersigned authorizes the. Department of Public Safety to conduct a criminal background check or review and to share the results with the Lawtut Gambling Control Board. Failure to provide i'equired information or pr~viding'.false or' mi.~ieading information. may result in the denial or revocation of the license. ' Subscribed and sworn to before me this ,.~°r'r'' day of ~/~./ / /~)/v~ K~ County My commission expires ~n,J 19qt ~ applicant - gambling manager) (Name of organization) License number I I I I I I