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LG2~.0 Application for Exempt Permit <br /> <br />Local Unit of Government Acknowledgment <br /> <br />tf the gambling premises is within city limits, the <br />city must sign this application. <br /> <br />On behalf of the city, I acknowledge this application, <br /> <br /> Check the action that <br /> the city is taking on this application. <br /> <br /> Twhe city approves the applicalion with no <br /> ailing period. <br /> <br />[The city approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days (60 days for a first class <br />city) <br /> <br />[""~ The oily denies the applicatio~, <br /> <br />(S~g~b~re of city personnel re~iving a ppli~tion) <br /> <br />REC'D A PR 2 0 ZOOS <br /> Page 2 of 2 <br /> 6~3 <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 />BThe county approves the application with no <br />waiting period. <br /> <br />DThe county approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days. <br /> <br />DThe county denies the application. <br /> <br />Pdnt name of county_ <br /> <br />(Signature of county personnel receiving application) <br />Title <br /> <br />Date / I <br /> <br />TOWNSHIP:" On behalf of the township, I acknowledge that <br />the organization is applying for exempted gambling activity <br />within the township limits, iA township has no statutory <br />authority to approve or deny an application (Minn. Slat. sec, <br />349.213, subd. 2).] <br />Pdnt name of township. <br /> <br />(Signature of township official acknowledging application) <br />Title <br /> <br />Date t I <br /> <br />Chief Executive Officer's Signature <br />The information provided in this applicati~/l~ complete and accurate ~)o the be. st of my knowledge. <br /> <br />Mail Application and Attachments <br /> <br />Al bas145 days prior to your scheduled activity date send: <br /> - the ~mpleted application, If your application has not <br /> a copy of your proof of nonprofit s~tus, and been acknowledged by the <br /> · a $50 appli~tion fee (make check payable to "State of Minneso~"). local un~i of government or <br /> Application fees are not prorated, re~ndable, or transferable, has b~n denied, do not <br /> ~nd to: Gambling Control Board send the appli~tion to the <br /> 1711 West County Road B, Suite 300 South Gambfing Control Board. <br /> Roseville, MN 55113 <br /> <br /> <br />