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LG220 Application for Exempt Permit <br /> <br />Local U nit of Government Acknowledgment <br /> <br />If the gamblim] prr_:mises is within city limits, the <br />city must sign this application. <br /> <br />On behalf ~f the. ciiy. I acknowh:~9~:; it,is aoplication. <br /> <br /> Chf;ck [he action that <br /> the cily is taking on this apphcation. <br /> <br />The city ~qX)l-O~,m [he ;fl)plic~tion ,'.,itl~ :~o <br /> <br /> rhe city ;q~pro,,es d~e af)l¢licatio¢ ,..,itl, :~ 30 day <br /> waitinfl p :nod. x~d allowx thr Boa d ~o issue a <br /> permil after 3U h~y:; (60 clays For a firs~ class <br /> city). <br /> <br /> Page 2 of 2 <br /> 12~03 <br /> <br />If the gambling premises is located in a township, both <br />the county and township must sign this application. <br /> <br />On behalf of the county, I acknowledge this application. <br /> <br /> Check the action that <br /> the county is taking on this application, <br /> <br />DThe county approves the application with no <br />waiting period. <br /> <br />DThe county the application with a 30 day <br /> approves <br /> waiting period, and allows the Board to issue a <br /> permit after 30 days. <br /> <br />DThe county denies the application. <br /> <br />Print name of county <br /> <br />(Signature of county personnel receiving application) <br />Title <br /> <br />Date / / <br /> <br />TOWNSHIP: On behalf of the township, I acknowledge that <br />the organization is applying for exempted gambling activ:,ty <br />within the township limits. [Atownship has no statutory <br />authority to approve or deny an application <br />(Minnesola Statute 349.213, subd. 2).] <br /> <br />Print name of township <br /> <br />(Signature of township official acknowledging application) <br />Title <br /> <br />Date / / <br /> <br />Chief Executive .'Officer's Signatdre <br />Tine, inforn:-~tio~, prove, t~;,1 in this appticati mi:; complete and accurate to the best of my knowledge. <br /> <br />Chief exm;t~tive offi(x,, "~ sig~ature __ ~ <br />blame (ph-~a:;r~ fxi~ ~t) .......... Date / <br /> <br />Mail Application and Attachmeni:s <br /> <br />At t~-.m:d ,i5 rl~yr; prim h~ your sch~cduled ~ctiv~iy date send: <br /> <br /> a (;r)py ~)f '!mn proof o{ not,profit: ~a~us. and <br /> a $50 ;tlff¢licaiicx~ fee (make chec:( pdyable ~o "State of Minnesota"). <br /> Applies'itoh fie::; are not prorated refl~ndable, or transferable. <br /> <br /> Send to: Gaml)ling Control Boat d <br /> t711 West County Roa~l B, Suite 300 South <br /> Rose,tile, MN 55113 <br /> <br />If your application has not <br />been acknowledged by the <br />local unit of government or <br />has been denied, do not <br />send the application to the <br />Gambling Control Board. <br /> <br /> <br />