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Minnesota La~,fu! C, am~b lini~ <br />P~emi~e Pe~t Application - Part 2 of 2 <br /> <br />bi,oak Name Bank Accounl Number <br /> r~'s~ ...... gib' SI. ale <br /> <br /> Name ~re~ <br /> <br /> ":-':: ":::' ':? >':':; :' ":":'"' ?::: ;:: ::'¢.: ? ¢:F!":::~~' ": ':' ': ?:: "! v.',',::. '-',~::::-¢::-' ~ ~:'r;-::::':*::.?:~:?-?:'::.: :: %:t':~::~',',~ :~:~Z:::::~'r: :?' '?'~: '~';: :':: :? :~'?':;~:: ~:::~:"::": t.:': ~ v-??'t~ ~'::F:?:?~:~:?:'""~":-:~-'~'"~ ' .:+ ?:?"~?:~: V: ?'"'(':ok':':?' :::'"'"": ..... <br /> <br />I Imroby ~nsont lhat ~cal law enfomemont offJ~rs, the <br />board 'or agenls of the ~ard, or t~e ~mmissioner of <br />revenue or publ~ safety, or agents el the ~mmiss~nem, <br />may enWr Ihe premises to enlorce the law. <br />~k ~ccords ~o~a~o~ <br />Tho ~ard i$ aulhorized Ia inspe~ lbo bank r~rds of the <br /> <br />· I am the chief execulive officer of the organization; <br />· I assume lull responsibility for Iha fair and lawfi¢l opera- <br />lion of alt activities to be conducted; <br />· I will familiarize myself with the laws of Minnesota <br />governing lawful gambling and rules of/he board and <br />agree, if licensed, to abide by those laws and rules, <br />including amendments to trmm; <br /> <br /> gambling am..ounl whenever necessary to tuJfill <br /> requirements of current gambling rules and law. <br />O~t;b <br />I doctaro lhat: <br />-I have read Ihis application and all information submifled <br />Io the board is true, accurale and complete; <br />· all olhor rocluired intormalion has been fully disclosed; <br />Sigr/a~t~ro ot chief executive officer <br /> <br />· any changes in application information will be submilled <br />to the board and local unit el government wilhin 10 days <br />el fha change; and <br />el understand Ihat failure !o provide required inlormatidn <br />or providing false or misleading intormation may result in <br />the denial or revocation of I.he license. <br /> <br />Date <br /> <br />I. Tho city "must sign this applica~)On if the gambling prem- <br />ises is located wilhin c~ty limits. <br />2. The county "AND township'* must sign this apl31ication if <br />tim gambling premises i.s loCaled within a township. <br />3. The Jocat unit government (city or county) must pass e <br />resolution specipCally approving or denying this appi~c-.ation. <br /> <br />4. A cody of lbo local unit of ooyernment's resolution aD- <br />~rovim3 this application musl be attached to Ibis aoDlir;'atlon. <br />5. Il Ibis apDlication is denied by the local unit of government, <br />it should not be submitted Io the GamBling Control Board. <br /> <br />Townshil~: By signature below, the township acknowledges <br />that Ina organization is al)plying for a premises permit within <br />townsh~ lim~. <br /> <br />I <br />I <br /> <br />Clly· or County** Township°" <br />Oily or Ceunly Name j Townr,~ip Name <br /> <br />Signature ~1 per, on receiving apphcabon i Signature of pef'~on re¢eiving applicati~ <br /> I <br /> <br />TitJe Dam lAeceived ~ 'r'i~ Dam Received <br /> i <br /> J <br /> <br />Reler ~ the insl3-uctions tar require,ci attacttrnent~. <br /> <br />Mail <br /> <br /> Gambling Control Board <br /> Roaewood Pl.,za South, 3rd Floor <br />4L 1711W. Counlylqo.dB <br /> Re-critic, MN 5511= LG214(P,,rt 2) <br />',,~',~ )~ ,,'1~' <br /> ~"~--'..~cC~L~LfT)~.K~ -¢"6.E"5-. m,c,.'-~.L',,~,~ ..--~iL. =...=,.-,-,~ o..,p.,~p._~. ..~ ,...' ~.- -= ~u. <br /> <br />I <br />I <br /> <br /> <br />