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· ~- ,,,¥~-:.- ..:' ~,.-~- ::~ .... ~ i.-:. ' ..... "' ~'-~:~. .<:~.~..': "'¢~ ~:~:~::. i :~o~.~,:~'~- ..! ....... ,. -.~:~i:'-'--'--.-. ,. ?.~:' :i ~.E~ ...... :~'" '.
<br /> ':'.-:~:, G~mb~g Site ~o~n ..r ';':.:~ '1 am the chief ex~e offi~r of the ogan~at~n;- -.~ ::~ ~
<br />
<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 enlorce the law.:-. :- - "~:.
<br /> -':-:~,:~.~: Bank Record~ Information.: t :':: :' _. ';'
<br /> -:~fi?,E~:7.The board is authonzed to inspect the bank records of the
<br /> ' ::~>..,::~:i' gambhng account whenever necessary to fulfill
<br />.:..'.t':~'(:, ~ requirements of current gambling rules and law ..... . ....
<br />-..,--~-~ .... Oath :',"t'::-~, · ~ ·
<br />
<br /> · :_ I declare that: .
<br />
<br /> -:.. oi heve read this application and all information submitted ....
<br /> to the board is true/accurate and complete; · : -
<br />
<br />· I assUme full responsibility for the fair and lawful opera- ?~
<br />tion of ~I activities t~ b~, conducted;-. ~-'." ~-~:' ' ~',Pi ..'.
<br />ol wilt familiarize myself with the laws of Minnesota ;:,,:.~.~-.. ':'~i:
<br />governing lawful gambling and rules of the board and ~-~..
<br />agree, if li~:ensed to abide by those aws and rules,' ?':~""::.
<br />including amendments to them; : :.: :---~- :-' ,?:}:il ~?:
<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 .. ·
<br />or providing false or misleading information may result in
<br />the denial or revocation of the license.
<br />
<br />· all other required information has been fully disclosed;
<br />
<br />. .,-.. Sigr)zC~e of chief executive officer..) ...... ,- . - ~.. , Date
<br />
<br />:i:':-,,~..ll. The city 'must sign this application if the gambling prem-. ::
<br />
<br /> p:. The county **AND township** must sign this application if-'
<br /> =;:.the gambling I~remises is located within a.township.
<br /> 3.' The bcal unit government (c~ or county) must pass a
<br /> resolution specifically approving or denying this application.
<br />
<br />4. A cgDv of the local unit of oovernment's resolution
<br />orovino this aoolicafion must be attached to this aoDlication.
<br />5. If this application is denied by the local unit of government,
<br />it should not be submitted to the Gambling Control Board. ':.
<br />
<br />Township: By signature below, the township acknowledges
<br />that the organization is applying for a premises permit within
<br />township,, limits.,,. _ -'..: ,.. ... /',~!:~:~,. .:'~ .:
<br />
<br /> i-.':' Cl..ty*- or County** .
<br />.'~ . ' . . ..::;.
<br />:;.i~::."iL '. -' ''
<br />
<br /> · ,-,----
<br />
<br /> Refer m t~ ins~aions f~ ~uir~ a~men~, .
<br />
<br /> ~1 ~; ~a~bling ~nlrol ~oa~d '
<br />._- ~ 1711 W, ~un~ Road B '-'
<br />
<br />Township**
<br />
<br />Signature of person receiving application
<br />
<br />Date Received
<br />
<br />LG214(Part 2)
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