Agenda - Council - 10/26/1993 - Laserfiche WebLink

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Minnesota Lawful Gambling Premise Permit Application - Part 2 of 2 Bank Name Bank Account Number Bank A~ress .... Ci~ S~te ' Zip Co~ Nam~ A~mss Tide / '1 I I I I I GambLL~g Site AuthozdzatJon I hereby consent that local law enforcement officers, the board or agents of lhe board, or the commissioner of revenue or public safety, or agents of the commissioners, may enter the premises to enforce the law. Bank Records Information The board is aulhorized lo inspect the bank records of the gambling account whenever necessary to fulfill requirements of current gambling rules and law. Oath I declare that: · I am the chiel executive officer of lhe organization; · I assume full responsibility for the lair and lawful opera- tion et all activities to be conducted; · I will familiarize myself wilh the laws of Minnesota governing lawful gambling and rules of lhe board and agree, if licensed, to abide by those taws and rules, including amendments to them; · any changes in application information will be subm~ed to the board and local unit of government within 10 days of the change; and · I understand thai failure to provide required information · 1 have read this application and all information submitted or providing false or misleading information may result in to the board Is true, accurate a complete, i e e ' , accu~c~ · . the denial or revocation of the I'c ns . · a, other requ r U tio, d sc osed; I I I I I 1. The city *must sign this application if the gambling prem- ises is located within city limits. 2. The county **AND townshipS* must sign this application if the gambling premises is located within a township. 3. The local unit government (city or county) must pass a resolution specifically approving or denying this application. 4. A CODY of the local unit of aovernment'~ resolution Bp- : brovino this aoD!ication must be attached to lhis aDolica~ion, 5. If lhis application is denied by the local unit of government, it should not be submitted to lha Gambling Control Board. Township: By signature below, the township acknowledges that lhe organization is applying for a premises permit within township limits. I I City* or County** city or County Name Signature Jol person r. eceiving appli.c~ '~- Title .. 1 Date Received Township** Township Name · Signature of person receiving application Title [ Date Received I I I Refer to the instructions for required attachments. Mail lo: Gambling Conlrol Board Rosewood Plaz~ South, 3rd Floor 1711 W. County Road B Rosevllla, MN 55113 LG214(Part 2) (Rav7~I) I I