Laserfiche WebLink
P PP LG220 <br />Exempt Permit <br />O <br />• <br />rganization Nam h <br />Local Unit of Government Acknowledament <br />If the gambling premises is within city limits, the <br />city must sign this application. <br />On behalf of the city, I acknowledge this application. <br />Check the action that <br />the city is taking on this application. <br />(The city approves the application with no <br />waiting period. <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 />❑ The city denies the application. <br />Print name of city -c-. t , 4 of" R-" 5� <br />Signature of city personnel receiving application U <br />Title <br />Date <br />is <br />Date t-1, <br />Signature of township official acknowledging application <br />Title <br />Date <br />1 � <br />u <br />Chief Executive Officer's Signat <br />The information provided in this applic®retu lete and accurate to the best of my knowledge. I acknowledge that <br />the financial report will be completed an l the Gambling Control Board within 30 days of the date of our <br />gambling activity. f'\ <br />Chief executive officer's <br />Name (please <br />Page 2 of 2 <br />2/06 <br />If the gambling premises is located in a township, both <br />the county and township must sign this application. <br />On behalf of the county, I acknowledge this application. <br />Check the action that <br />the county is taking on this application. <br />The county approves the application with no <br />waiting period. <br />The county approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days. <br />The county denies the application. <br />Print name of county <br />Signature of county personnel receiving application <br />Title <br />TOWNSHIP: On behalf of the township, I acknowledge that <br />the organization is applying for exempted gambling activity <br />within the township limits. [Atownship has no statutory <br />authority to approve or deny an application <br />(Minnesota Statute 349.213, subd. 2).] <br />Print name of township <br />Dat 7 <br />Mail Application and Attachments <br />Complete an application for each <br />Send <br />gambing activity: • the completed application, <br />• one day of gambling activity • a copy of your proof of nonprofit status, and <br />• two or more consecutive days of • a $50 application fee. Make check payable to "State of Minnesota "). <br />gambling activity <br />• each day a raffle drawing is held To: Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 <br />