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

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Garnhtlzt~[ Site Aut.~orL=atton , r i he~y ~nse~ th~ I~ law e~or~me~ o~:e~, the ~d or ~en~ ~ the ~d, or the ~mmissioner ~ revenue or ~bl~ s~e~, or age~ of ~e ~mmJ~ionem, may enter the prem~s to enfor~ the law. ~ Reco~ ~n~o~on ~e ~ is a~o~ to insp~ the bank re~rds of ~e g~bling ~unt whenever necessa~ to fu~ill ~uiremen~ of ~ent g~b~ng roles and law. :'. I d~e th~: I have read this ~n ~d ~1 info~a~n subm~ to the ~d; AI~ info~n ~ tree, ~r~a ~d ~mplete; AI~ o~er r~uir~ I~o~ton hM b~n lul~ di~ed; I am the chief ~e~e ~mer of ~e o~on; I ~ume full ms~nsi~ ~r the f~r ~d I~ul g~bling ~d roles of the ~a~ and agree, if license, ~ ~ide by ~ose la~ ~d roles, including ~endmenm to ~em; A membemh~ I1~ of ~e o~alon will be av~l~le ~in ~ven days after ~ is r~ue~ed by the ~ard; Any ch~ges in ~l~n info~n will ~ su~ ~ ~e ~a~ ~d I~l government w~hin 10 days~the~ge;~ : . A te~in~n pl~ will ~ subm~ to ~e ~d wEhin 15 days of the terminat~n of ail premise perm,s. F~lure to provue r~uired info~on or pm~ing f~se info.etlon may r~uR in the denial or rev~n of the i~nse. Signature of c~ief execmive offioer Date I I I I I I I I I I I 1. The city 'must sign if the gambling premises is located within city limits. 2. The county **AND township'* must sign if the gambling premises is located within a township. ;3. The IocaJ government (c. Jty or county) must pass a resolution spec~cally approving or denying the application. 4. A copy of the resolution approving the application must be attached to the application. 5. Applications which are denied by the local governing body should not be submitted to the Gambling Control Division. Township: By signature below, the township acknowledges that the organization is applying for a premises permit within township limits. City" or County'* Township" Township Name C~__~or County Name Signature of person receiving applica~on Title Dam Received Person Oslivsnng Rppl~ca~on to local g°~rning l~dy Date Signature of person receiving application Date Received Is township: [] Organized [] Unorganized [] Unincorporated Refer to the instructions for the required attachments Mail to: Department of Gaming Gambling Control Division -Rosewood Plaza South, 3rd Floor _ .1711 W. County Road B : · ';-~" .... ' ' ..... : .:- ~'~ :'~': Roseville, MN 55113 '"E '. :.., ' :-' .?:.:!.~;!!. ': ,_~..:,':':.: ;.:::,i - . ,~:..~: :. : :.:':-?: '- .. :!i': ii .... : '!:....: :,: