Laserfiche WebLink
~Yem <br /> <br />26. Does the orgsn{zation lease the entire premises? If no, attach s sketch of - 27. Amount of Monthly Rant <br />the premises indicating whet portion is being leased· A lease and sketch i$ 3* °° i ' <br />is nol recruited for Cia.ss D ape)cat)dna. ~ ~ ' " <br />28, Do you plan on conducting bfngo with this license? if yes, give days andtimemofbi~ooccasion~: . - : i~ ': . <br /> <br />~r ~'e--~--~--N~----29 ~;S th--e i"~ ~)~ ~i(;li~¥ bOn~ required by Minnesota Ststutea 349.20 been obtalned7 A~ach ~opy Of ~nd. <br />30. [nsur~nceCompany. Name / ~ ~31. BondNumber <br /> <br />32, _Le,ssor Name/.--,/' ~ ...... ~ ~ Address .. 'J ~. _City, Stete,~p <br /> <br />35, GamblingMana~erNarne f36. Address ~/ . : 137. ~.~tate, Zip <br /> <br />38. Gambling Manage~ Busineas Phone 3[~, Date 9mnbling manager bec~mm . . ' ' .. / / ~ "' :' <br /> <br /> (;AMBLING S~E AUTHORIZATION ........ - <br />By my signature below, locar la w enforcem~:m c~fficers or agents of the ~ard are hereby authorized to enter u~n the see, ' ' <br />at any time, gambling is h~ing conducted, ~o observe the gambling and m enforce the law for any una~horized game m -.. · <br />practice. · ' <br /> E~ANK RECORDS AUTHORIZATION' ' '- "' ' '. <br />By my signature below, ll~e Board is hereby .~uthorized to inspect the bank records of the General Gambling Bank Account <br /> <br />whenever necessary ~-o fldfill requhem, ents :)f current gambling rules and law. <br /> <br /> OATH <br />I hereby declare that: <br />1, I have read this application and all in for nation submitted to the Board; <br />2. All information submitled is true, accu~ ate a~d complete; <br />3. All other requiredinfnrmation I~as been fully disclosed <br />4. I ~m the chief executive O ffiCe~r ()¢ the O g~dzation; ,, <br /> <br />5. I assume full responsibility for the fair a~d lawful operation of all activities to be conducted; · <br />6. 'I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, '. <br /> iffi~ce_n~se_d_:_t_o_abi~ ~¥ those I_a _W S_ _a n d _r ur%s, inclu.ding .amendments tt)ereto. '~/,) . <br />40. Official, Leg~.LI Name o~.~rgar2~t;o. / '--~ t41. Sig~att~r'~r~ast be s._~ned~/~efA'F._~e~Sutivs Officer) .: <br /> <br />~tle of Signer ' -- '" t Date ,. . <br /> <br /> ' ' ACKNOWLEDGE;'~E~'¢T OF ~OTICE BYLOCAL GOVERNING BODY · .- ' ::: ..... <br />I hereby acknowledge receipt of a copy o~ ~his application. By acknowiedBing receipt, I admit hGvlnB ~n <br />notice that this application will ~ reviewed by the Charitable Gambling Control ~ard and if approved by <br />become effective 30 d~v s from the date of receipt (noted below), unless ~ resol~ion of the local governing ~ il p~s~ ... '-. <br />which s~cifically disallows such activity and ~, copy of that resCution is r~eived by t~ 0h~ritabl~ 6amblin~ <br /> <br />If site is located within a township, item 43 must be completed, in <br />addition to the county signature. <br /> <br />43. Name of Township <br /> <br />· . % <br /> <br />Signature of person receiving application .... <br /> <br /> ,,11 - ' ,~ <br /> <br />Tide <br /> <br />Board within 30 day_Ae_f_t he ~elaw__[%o~_e_d~_d_a;(e_. <br />42. Name of City or County (Local Go~erninfl <br /> <br />E~ignatur/e%f, perso~ re¢;¢~inr¢ .e. pplicftion <br /> <br />Tide ' [Date received (30 ,:~y period <br />d'2 x ?" [begins <br /> <br />44. Name of Perm. on dc4ived~ ~pp4icatio¢, to Local <br /> <br />CC-Od01-02 {~881 Whit e Copy-Bo*rd Canary.Applicant pr~k&.m:el Governa~ Bo~f~ <br /> <br /> <br />