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<br /> _,,~:.,,_ ,. . . . ,,,,¢. ,:...,, ~,~ . . .~: . . . ., . - . ,-:~:
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<br /> -:: ..... ,: Premise Permit cation - Pa.rt 3 -
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<br />-,,. ~ ,. .:, ~ ~ ~. -.~ . . ,.
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<br /> that looal haw ~nforo~mem'~r~em, the ~ard or agents ~ the board, or the commissioner of revenue or
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<br />public safety, or. agents of the commissioners, may enter the premises to enforce the law.
<br /> ,. i .,::.: i' ;r,~:.:.'.:>',: :,:.~::'::~.,. .... .. :'' ..: "~. ''~ .... ::'": "~ .....
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<br />Bank Records l'-¢ormatton .... "
<br />The board is authorized to inspect the bank r~cords of the gambling account whenever necessary to fulfill
<br />requirements of current gambling rules and law.' :.~ .r ' ....
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<br />I dectare that: .... -.' ....
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<br /> I ha~e read this application and all informaIion sUbmitted~to the b~ard;
<br /> AJI information is true, accurate and complete; ~
<br /> Alt other required information has been fully disclosed;
<br /> I am the chief executive officer of the organization;
<br /> I assume full respons~r~ for the fair and lawful gambling and rUles of the board and agree, if licensed,
<br /> to abide by those I~ws and rUles, including amendments to them;
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<br />A membership list of the organization will be available within seven days after it is requested by the board;
<br />Any changes in application information will be submitted to the board and local government within 10 :' .
<br />days of the .change; and :~
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<br />A termination plan wB be submitted to the board within 15 days of the termination of all premise permits,
<br />F~ilure to provide required information or providing false information may result in the denial or revocation of the
<br />license. ..- ,': :.;..~ .,
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<br />1. ~e ~ *must. ~gn E ~e g~bling prem~es ~ I~ted wEhin ~ lim~s.
<br />~ ~e ~u~ ~D ~ship- must s~n if the gambling ~em~es is io~ed wkhin a township.
<br />3. ~e I~ government (~ or ~un~) must ~s a re~l~ s~i~ly approving or denying the application.
<br />4. A ~py ~ the resol~on ~pm~ng the ~pli~n must be ~ to the appli~t~n.
<br />5. ~pli~ons wh~h ~e deni~ ~ the ~1 g~eming ~y shouM not be subm~ to ~e Gambling Control Divisbn.
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<br />To.ship: By s~n~re ~w, the tow~hip ~now[~ges ~e o~afian is applying for a premises perm~ w~hin
<br />~wnship lim~.
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<br />City' ar County"
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<br />Ci~ o~ Coun~ Name
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<br />Signature of person receiving appiica~on
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<br />Tide [ Date Received
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<br />,.~__.on delivering ~,p.[:~c~ t~ mai governing booty Dam
<br /> aro' . - ..,
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<br />Township**
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<br />Township Name
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<br />!Signature of person receiving application
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<br />] Date Received
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<br />Is t~wnship: [] Organized [] Unorganized
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<br />[] U nincorporal~Kt
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<br />Refer t° ti1' Instruction's for the requlred attachme~ts .... Mailto: Department of Gaming
<br /> ~.-' .... ~- . ......:;~., .. Gambling Control Division
<br /> ::... ... ::i: ........ ,. -::;:::-..::>':,~.:.: .:. :;" Rosewood Plaza South, 3rd Floor .':.::.-. - . .
<br /> ,' .. '.' "::i~;'~:"' ' "' ::: · '"-"~'~;"L-.:.:;: :~-':::-6.:,9'j£':"-;~-. . . ....~., :-:i. ':,,.,,. :. - .
<br /> ":~::.::: ....... .:,~:~: ;..:..-:~¢~,-;.;, :, .:...;:. 1711 W, County Road B ...... ;:~:. - -. :
<br /> ....~ . .....~j'_..,,.,~. ;... - ::i~':'::. : .-':::-.L~';.ii::: ..-_.:[~-',:';(';.X':',:~,~.::,. Rose~411e, MN 55113 .'.,;!:::.,, ' .... :' '-:;, '-:':~:-.'.._:~, .':.&~ .~-.,"
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