Agenda - Council - 06/14/2005 - Laserfiche WebLink

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LG220 Application for Exempt Permit tocal Unit of Government Acknowledgment if fha .qambling prenlises is within city limits, the city must sign this application. On t'><~.half of the city, I acknowledge lhis application. Check the action that the city is taking on this application. ,~city approves lhe applicalion wilh no ~r,.waitin9 period. E]'I he cily approves the application with a 30 day waiting period, and allows lhe Board to issue a permit after 30 days (60 days for a first class city). r-]-i, he oily denies the application. (Signature of city personnel receiving application) Pa.qe ? ~J~ 2 i 2103, __. ............. If the gambling premises is located in a township, both the county and township must sign this application. On behalf of lhe c. ounly, I acknowledge this application Check the action that the county is taking on this application. DThe county approves the application with no waiting period DThe county approves a day the application with 3O waiting period, and allows the Board to issue a permit after 30 days. DThe counly denies the applica, t!on. Print name of county (Signature of county personnel receiving application) Title Date / / :I'OWNSHIP: On behalf of the township, I acknowledge that the organization Is applying for exempted gambling activlty Within the township limits. [A townehlp has no statutory euthoflty to approve or deny an application (Minnesota Statute 349.213, subd. 2).] Pdnt name of township (Signature of township official acknowledging application) Title Date / / Chief Executive Officer's Signature' The information provided in this application Is complete and accurate to the best of my knowledge. Chief executive officer's signatu re //~- Name (please print) /~.~5'/~ . /¢~/¢/"'/¢'~,'~11 Date ,~- I,.~ Mail Application and Attachments At least 45 days pdor to your scheduled activity date send: · the completed application, · a copy of your proof of nonprofit status, and a $50 application fee (make check payable to "State of Minnesota"), Application fees are not prorated, refundable, or transferable. Send to: Gambling Control Board 1711 West County Road B, Suite 300 South Roseville, MN 55113 ' · tf your application has not been acknowledged by the local unit of government or has been denied, do not send the application to the Gambling Control Board.