Agenda - Council - 08/24/1993 - Laserfiche WebLink

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LG240B <~.v. (~Minnesota Lawful Gambling Application for Authorization to Conduct Excluded Bingo Part 2 of 2 Organization Name //~ ~ /- ^/ / t "'-/'%' ,o ' Chief Exe cutire 0.~ :cer.'s :l;ig'ature i:::i:~I :'i: .:. :i:: i:ii :;.;i :'::i :i:..'"" ':'" The information provid, d in ,'h;s apl,lication is complete and accurate to the best o Chief Executive officer's signature 'I Name (please print) ~ '.ocal ~:: 7nit Of G~l,ernment ~knoWl~iitgrnen t and.:~.p.j~r, ~al; ~ The must this application if the gambling premises is located within limits. : c~y sign city The co If this ~ Board. The information provided in this appfication is complete and accurate to the best of my Imowledge. IDate .LocaI ~:Unit oS Govern ment ~knoWl edgment :and.i;ApprovaI · The county AND township must sign this appliCation if the gambling premises is located within a township. · If this application is denied by the local unit of government, it should not be submitted to the Gambling Control Township: A township has no statutory authority to approve or deny an application (Minn. Stat. 349.213, Subd. 2). Name of City OR County Name of Township I I :1 I ! ~'J-~, sign,.~ture below, the local unit of government hereby appro yes this application for excluded bingo activity at the premises IiO~ate~withi~ their jurisdiction. of government. (Sign a~ve) Title By signature be/ow, the township acknowledges that the organization is applying for excluded bingo activity within the township limits. Signature of person acknowledging application for for township. (Sign above) Title Date Received Township is: Organized [] Unorganized [] Attach letter Unincorporated [] ~ I I I Send the completed registration form with your organization. 's proof of nonprofit status to: Gambling Control Board -. White-Original 1711 W. County Road B, Suite 300 South Yellow- Board Roseville, MN 55113