Agenda - Council - 07/27/1993 - Laserfiche WebLink

Home

Minnesota Lawful Gambling Premise Permit Application - Part 2 of 2 Bank Name J~ank Account Number ~ank Address City State Zip Code Name ~ress t Gambling Site Authorization I hereby consent that local law enforcement officers, the board or agents of the board, or the commissioner of revenue or public safety, or agents of the commissioners, may enter the premises to enforce the law. Bank Records I~¢ormation The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill requirements of current gambling ruJes and taw. Oath 1 declare that: · I am the chief executive officer of the organization; · I assume full responsibility for the fair and lawful opera- tion of all activities to be conducted; el will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the ~x~ard and agree, if licensed, to abide by those laws and rules, including amendments to them; · any changes in application information will be submitted to the board and local unit of government within 10 days of the change; and · I understand that failure to provide required iniormation 1. The city *must sign this application if the gambling prem- ises is located within city limits. - 2. The county **AND township*.* must sign this appiicaiion if the gambling premises is located within a township. 3. The local unit government (c~ or county) must pass a resolution specifically approving or denying this application. · l have read this application and all information submitted or providing false or misleading information may result in to the board is true, accurate and complete; . the denial or revocation of the license. · ali other required_irate ~m'~~been fully disclosed; ' ' ,. S ig ~ at u r e of_.-.chi ~f~gf'~-'~ ~' /~"" ~te. 4. A coo~ of the ~cal unit of ogvernment'~ resolution 9torino this aoolication must be attached lO lhi~ aoDlicatior~, 5. If this application is denied by the ioca~ unit of government, it should net be submitted to the Gambling Control B~ard. Township: By signature below, the township acknowledges that the organization is applying for a premises permit within township limits. City* or County** city or County Name I Dat~ Received.: .... : . ' Refer t~ the inStm~ons f~"required a~chments. Mail Gambling Control Board ' ' Rosewood Plaza South, 3rd Floor ' 1711 W. County Road B Rosevllla~ MN 55113 Township*' Township Namo .... Signature of person receiving application . - 'rifle ..... . .....: ~. [ Date Received :., LG214(Part 2) (Rev7~2g/91)