Agenda - Council - 12/14/1999 - Laserfiche WebLink

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Acknowledgment Page 2 of 2 I I I '1 I Gambling Site Authorization I hereby consent that local law enforcement officers, the board or agents of the board, or the commissioner of revenue or public safety or agen~ of the commissioners, may enter the premises to enforce the law. Bank Records Information The board is authorized to inspect the bank records of thc gambling account whenever necessary to fulfill rcquirerncnts of current gambling rules and law. Organization License Authorizati0 n I hereby authorize the Gambling Control Board to modify thc class of organization liceru~ to be condstent with thc class of permit being appllcd for. Oath I declare tha~: 1. I have read this application and all 6. any changes in application information will be submi~d to the board and local unit ofgovcmmmt within t~n days of inform~ion submitted to thc board is t~uc, thc change; and accurate, and complete; 7. I understand that failm to provide all other required/nformadon has been required information or providing false or fully d/sciosed; misleading information may result in the lam the c,ecu.veo cero, tbe d 'or organization; I assume full responsibility for the fair and lawful opermion of all activities to be ~' · conducted; ~ ~ ~' ~ I will familiari~- myself with the 1 .~. ~.~>~~,~f~, the ~h~er Minnesota governing lawful gamblia~nnd officer (Des~gnce may not s~gn) abide by those laws ~nd rol~, including Local Unit of Government Acknowledgment and Approval I I On behalfofthe city, I hereby acknowledge this application for lawful gambling activity a~ thc premises located within thc city's jurisdiction, and that a resolution specifically approving or denying thc application will be forwarded to thc applying organization. For the townshiv: On behalf of thc township, I acknowledge that thc organization is applying to conduct lawful gambling activity within the township limits. A township has no statmory authority to approve or deny an application (2vfinn. Stat. sec 349.213, subd. 2). Print name of township Signature oftown~ip official rcccivin§ application ! / Title Da~ For the county; On behalf of thc county, I hereby acknowledge this application for lawful gambling activity the premises located within the county's jurisdiction, and that a resolution specifically approving or denying application will be forwarded to the applying organization. Print name of county Signature of county personnel receiving application / / Tiflc Da~e The information requested on this form (and Your name and address will be public Board whose work assignment requires that any attachments) will be used by thc Gambling Conlrol Board (Board) to determine your qual/fications to be involved in lawful gambling activities in Minnesota, and to assist the Board in conducting a background investigation of you. You have the right to refuse to supply the information requested; however, if you refuse to supply this information, the Board may not be able to dctermine your qualifications and, as a consequence, may refuse to issue you a license. If you supply the information requested, the Board will be able to process your application. information when received by the Board. All th~ other information that you provide will be private data about you until the Board issues your license. When the Board issues your license, all of the information that you have provided to thc Board in thc process of applying for your licens~ will become public. If the Board docs not issue you a license, all the information you have provided in the process of applying for a license remains private, with the exception of your name and address which will remain publ lc. Private dam about you arc available only to thc following: Board members, staffofthc they have access to thc information; the Minnesota Department of Public Safety; the Minnesota Attorney General; thc Minnesota Commissioners of Administration, Finance, and Revenue; the Minnesota Legislative Au ditor, national and international gambling regulatory agencies; anyone pursuant to court order;, other individuals and agencies that are specifically authorized by state or red,al law to have access to the information; individuals and agencies for which law or legal order authorizes a n~v use or sharing ofinforrnafion after this notice was given; and anyone with your written consent.