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~G220 Applicati~,,~ for Exempt Permit <br />, t' Od <br />Local Unit of Government Acknowledgment <br /> <br />If the gambling premises is within city limits, the <br />city I'llLIst sign this application. <br /> <br />On I)~,ll;ilf of the city. I acknowledge this application. <br /> <br /> Check tile action that <br /> the city is taking on this application. <br /> <br /> "l~t~r; city approves the application with no <br /> w,'uti~ pe, riod. <br /> <br />DTt~,. ~;ity approves the application 'with a 30 day <br />waidng period, and allows the Board to issue a <br />permit after 30 days (60 days for a first class <br /> <br />DTI~; city rlenies the application. <br /> <br />11/04 <br /> <br />If the gambling premises is located in a townshi'p, 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 townsMp, I acknowledge that <br />the organization is applying for exempted gambling activity <br />within the township limits. [A township has no statutory <br />authority to approve or deny an application <br />(Minnesota 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 Signature <br />TI ,o ~ ~to~l nation prowdod ~n this application is complete and accurate to the best of my knowledge. I acknowledge that the <br />liuan~:ial rel)O~t ,t,/~tl l)e completed and returned to the Gambling Control Board within 30 days of the date of our gambling <br />;iclivll7 ~ ~ , / ---- <br /> <br />Mail application and attachments <br /> <br />Cornph;r,r; ;~n ~q)plication for each <br />!_j~unhlin!j ;ictivity: <br /> one,, day r)f yambliny activity <br /> two ~)r more consecutive days of <br /> !j~l~ nhlir~y activity <br /> e;l~;h day a raffle drawing is held <br /> <br />Send: <br /> the completed application, <br />· a copy of your proof of nonprofit status (see instructions), and <br /> a $50 application fee. Make check payable to "State of Minnesota". <br /> <br />Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 <br /> <br /> <br />