Laserfiche WebLink
LG220 Application for Exempt Permit <br /> <br />Local Unit of Government Acknowledgment <br /> <br />Page 2 of 2 <br /> 3f01 <br /> <br />I <br />I - <br />I <br />I <br />I <br />I <br />I <br /> <br />If the gambling premises is within city IJmits,.the <br />city must sign this application. <br /> <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 />[ 'The city approves the application with no <br /> waiting pedod. <br /> <br />DThe city approves the application With a 30 day <br />waiting pedod, and allows the Board to issue a <br />permit after 30 days (60 days for a first c~ass <br />city). <br /> <br />BThe city denies the application. <br /> <br />Pdnt <br /> nature <br /> of <br /> city <br /> <br />(Signature of city personnel receMng application) <br /> <br />If the gambling premises is located in a township, 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 />D The county approves the aPpliCation with no <br /> waiting period. <br /> <br />DThe county the application with 30 da, <br /> approves <br /> a <br /> waiting :period, and allows the Board to issue a <br /> permit after 30 days. <br /> <br />The county denies the application. <br /> <br />Print name of county <br /> <br />(Signature of county personnel receMng application) <br />Trde <br /> <br />Date /.~/.~ <br /> <br />TOWNSHIP: On behalf of the township, 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 (Minn. Stat. sec. <br />349.213, subd. 2).] <br /> <br />Pdnt name of township <br /> <br />(Signature of township official acknowledging application) <br />Title. <br /> <br /> Date ' L__J <br /> <br />Chief Executive Officer's Signa~'~ <br />The information provided in this applica~oT~;~ompleTa, nd acc~~est of <br />Chief executive officeds signature <br /> <br />Name (please pdn,) <br /> <br />my knowledge. <br /> <br />Date 3 / ? /?..~_ <br /> <br />Mail Application and Attachments <br /> <br />At least 45 days prior to your scheduled activity date send: · 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 />Ioca[ unit of government or <br />has been denied, do not <br />send the application to the <br />Gambling Control Board. <br /> <br />-45- <br /> <br /> <br />