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` - 2 - <br /> nesota Charitable Gambling Control Board GAMBLING LICENSE APPLICATION <br /> - (Class A, B, or C) <br /> GAMBLING SITE AUTHORIZATION <br /> By my signature below, local law enforcement officers or agents of the Board are hereby <br /> authorized to enter upon the site, at any time gambling is being conducted, to observe <br /> the gambling and to enforce the law for any unauthorized game or practice. <br /> BANK RECORDS AUTHORIZATION <br /> By my signature below, the Board is hereby authorized to inspect the bank records of the <br /> General Gambling Bank Account whenever necessary to fulfill requirements of current gambling <br /> rules and law. <br /> i <br /> 1 OATH <br /> i <br /> i <br /> I hereby declare that <br /> 1. I have read this application and all information submitted to the Board; <br /> 2. All information submitted is true, accurate, and complete; <br /> 3. all other required information has been fully disclosed; <br /> t 4. I am the chief executive officer of the organization; <br /> E <br /> ! 5. I assume full responsibility for the fair and lawful operation of all activities to be <br /> i-. <br /> conducted ; <br /> f 6. I will familiarize myself with the laws of the State of Minnesota respecting gambling <br /> I and rules of the Board and agree, if licensed, to abide by those laws and rules , <br /> t <br /> t including amendments thereto. <br /> i <br /> F <br /> t <br /> } Official, Legal Name of Organization <br /> ST. JOSEPH'S SOCIETY FOR THE LITTLE SISTERS <br /> E Signature (Must be signed by Chief Executive Officer) <br /> i OF THE POOR <br /> Title <br /> CHIEF EnCUTIVE OFFICER <br /> Date <br /> i <br /> ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br /> F I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I <br /> admit having been served with notice that this application will be reviewed by the <br /> �. Charitable Gambling Control Board and if approved by the Board, will become effective 30 <br /> ----- - - -- - -- - - <br /> �— days-- fr-om--the--date—o-f receipt--(note- -- <br /> d b e low) , unless a r-esolution of the local governing <br /> body is passed which specifically disallows such activity and a copy of that resolution is <br /> r <br /> received by the Charitable Gambling Control Board within 30 days of the below noted date. <br /> - LOCAL GOVERNING BODY <br /> Name of Local Governing Body _ <br /> Signature of Person Receiving Application <br /> _1 ORGANIZATION <br /> ate Received (This is date from which the 30 day Name of Representative for Gambling License Applicant <br /> approvaI begins) `j'/ / (serving notice) <br /> CC-00001-01 (12/84) White - Board Canary - Board Pink - Applicant Goldenrod - Governing <br /> (data entry) Body <br />