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Local Unit of Government Acknowledgment <br /> <br />Page <br /> <br />2of2 <br /> 3/01 <br /> <br />If the gambling premises is within city limits, the If the gambling premises is located in a township, both <br />city must sign this application, the county and township must sign this application. <br />On behalf of the city, I acknowledge this application. <br /> <br /> Check the action that <br /> the city is taking on this application. <br /> <br />[Z} .~he city approves the application with no <br /> waiting period. <br /> <br />[The.city approves application a day <br /> the <br /> with <br /> 30 <br /> waiting period, and allows the Board to issue a <br /> permit after 30 days (60 days for a first class· <br /> city). <br /> <br />r~The city denies the application; <br /> <br />(Signature of city personnel receiving 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 />BThe county approves the application with no <br />waiting period. <br /> <br />DThe county approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days. <br /> <br />D' The 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 township, I acknowledge that <br />the organization is applying for exempted gambring activity <br />within the township limits. [A township has no statutory <br />authority to approve or deny an application (Minn. Stat. sec. <br />349;213, subd. 2).] <br />Print name of township <br /> <br />(Signature of township official acknowledging application) <br />Title <br /> <br />Chief Executive Officer's Signature- <br />The information provided in this application is comnlete and accurate to the best of my knowledge. <br />Chief executiveofficer'ssig~n~ture_~ ~~-~- ~'_~~'/ ---' , <br />Name (please pdnt) ~ ~_~.~ ~. '~, ¢'~ * (~'~"'/_' ..... Date..._~___/___~__'~_ <br /> <br />Mail-Application and Attachments <br /> <br />At least 45 days pdor to your scheduled activity date send: <br /> · the completed application, <br /> a copy of your proof of. nonprofit status, and <br /> · a $25 application fee (make check payable to "State of Minnesota"). <br /> Application fees are not prorated, refundable, or transferable. <br /> <br /> Send to: Gambling Control Board <br /> 1711 West County Road B, Suite 300 South <br /> Roseville, MN 55113 <br /> <br />If your application has not <br />been acknowledged by the <br />local unit of government or <br />has been denied, do not <br />send the application to the <br />Gambling Control Board, <br /> <br />-24- <br /> <br /> <br />