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Minnesota Lawful Gambling
<br /> · . Premise Permit Application - Part 2 of 2
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<br /> Bank Name .:.., :~/: .:.: .,,... ,.. , [Lank Account Number ..... . ,.~: . , ._
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<br /> Bank Address :,:. ::: :;:::'..;:.~'i'. .... .-. ~::: ..~ ~. · :.,'-1 _ :~ City .:.. ' ' ;L' State .:::., .... ' ,,.Zip Code ........... :~ ............. ~:'
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<br /> ..... .:': .1 am the chief executive officer of the organizat on; .}~:":.
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<br />GambLL~g Site ~tt~or~t. ton. r '' ~ ~ ' ' ' --, ,~' ' '
<br />I hereby consent that local law enforcement officers, the
<br />board or agents of the board, or the commissioner of
<br />revenue or public safety, or agents of the commissioners,
<br />may enter the premises to enforce the Jaw.
<br />Ba~ Records I~Lform~tton
<br />The board is authorized to inspect the bank records of the
<br />gambling account whenever necessary to fulfill
<br />requirements of current gambling rules and taw.
<br />Oath
<br />I dectare that:
<br />-I have read this application and a-]J-information submitted
<br />to the board is true, accurate and complete;
<br />· all other required information has been fully disclosed;
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<br />· I assume full responsibility for the fair and lawful opera-.;::.:i. '=' --
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<br />tion of all activities to be 'conducted; ."":~' ::'!i', ..... '::':"" -~'
<br />ot will familiar/~.e myself with the laws of Minnesota. ' .....
<br />governing law/ul gambling and rules of the board and
<br />agree, if licensed, to abide by those laws and rules, :
<br />including amendments to them; '~
<br />· any changes in application information will be submitted
<br />to the board and local unit of government within 10 days
<br />of the change; and
<br />· I understand that failure to provide required information
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<br />or providing false or misleading information may result in
<br />the denial or revocation of the license.
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<br />Signature of chief executive officer . - -. ,,-, "Date .... ', ..!,i.' 2?
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<br />"'~' ........... :' ":'-':~::. ' ...... 4, A CODY of the bcal unit of cgyernment's resolution aQ- ~:'/'~'"'~"'
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<br />1..The c~ *must sign this application if the gambling prom- Drovinc this aoolication must be. attached to this aoolication. '~:~, '-...
<br />sos Is located within city im ts.' -:-' ~,',-",',":., ' ' : .... '?' 5, If this appliCation Is denied by the local unit of government,
<br />2, The county **AND township*' must sign this application if it should not be submiiled to the Gambling Control Board,
<br />the gambling premises Is located wifhin a township, : ..... ::, , - ....... '
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<br />3, The local unit government (city or county) must pass a Township: By signature below, the township acknowledges ._
<br />resolution specificaliy approving or denying this applioatJcn, that the organization Is applying for a premises permit within
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