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Feb. 21. 2006 8:30AM ~o. 3855 P. 6 <br /> <br /> LG2Z0 Application f/el <br /> Organization Name / /~ ~'~ ) l~" <br />~ ~ocal Unit Of govern~t A~n 'o;ledgment <br /> If the gambling premiss ~ within ci~ limit, the <br /> c~ must sign this <br /> <br /> On behalf el ~he ci~. ~ ackna~ge ~is <br /> <br /> Ch~k ~e ~on ~at <br /> the ci~ ~ ~king on this application. <br /> <br />  The cJ~ approves the appiicat~n ~ no <br /> ~ifing peri~. <br /> <br /> ~The c~ approv~ ~e a~lJ~flon ~ a-30 day <br /> ~ltJng period, end ello~ ~e Board to issue a <br /> pe~Jt a~er 30 da~ (80 days for a Emt class <br /> ~The c~ denies the appli~t[on. <br /> <br />If the gambling premises is located in a township, both <br />the county and township must sign t~is application. <br /> <br />On behalf of the county, I acknowledge this application. <br /> <br /> Check the action that <br /> the county Is ~ak[ng on this application. <br /> <br />D The county approves the application v~th no <br /> waiting period. <br /> <br />D The county approves the application with a 30 da <br /> waiting period, ard allows the Board to issue a <br /> permit alter 30 days. <br /> <br /> D The county deni~s the application. <br /> <br />Pdnt name =f county. <br /> <br />Signatur~ of county personnel receiving aoplicafion <br />Title <br /> <br />Data__ /__ I__ <br /> <br />TOWNSHIP.' On behaff of the townshlp. I acknowledge that <br />t~e organiZation i~ applying for exempted gambllng a c'Jvlty <br />wi~in ~he township lim~t~. [Atownship has no s~lutory <br />authority ~o approve or deny an applica~en <br />(MJnneeota Sttatuta 349.213, subd. 2).] <br />Pdnt name of tov~shJp <br /> <br />Sigrt~ ture et ~3wnsh[p O/1~C~1 acC'new, edging applica~on <br /> <br />'~tle <br /> <br />Data I <br /> <br />Chief Executive Officer's Signature <br />Theinf~mat~npr~videdin~sapp~ic~n~mpietaandaccur~te~thebest~fmy~v~edge~ J acknov, dedcje t~at ~he <br /> <br />Mail application and attachments <br /> <br /> Complete an application ~or each <br /> gambling activ~y: <br /> · one day of gambling activity <br /> · two or more consecutive days o ( <br /> gambling activity <br /> · each day a raffle drawlng is held <br /> <br />Send: <br />- the completed a ppi[cation, <br />· a cody or your prooi'of ~onprofit status (see instructions), and <br />- a $50 application fee, Make check payable ~o "SLate of Minnesota". <br /> <br />Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Rosevllle, MN 55113 <br /> <br />-37- <br /> <br /> <br />