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<br /> , <br /> . <br /> LG214 <br /> Minnesota Law)Ul Gambling . <br /> Premise Permit Application - Part 3 <br /> it1~ifiail~iI'am~ltjiili;!i;iliilllili!iii..i;;:ii.i,:ii!ill:I!;;,!!!,!!!'!";;;i!:i <br /> Gambling Site Authorization <br /> I hearby consent that local law enforcement officers, the board or agents of the board, orthe commissioner of revenue or <br /> public safety, or agents of the commissioners, may enter the premises to enforce the law. <br /> Bank Recorda Information <br /> The board is authorized to inspect the bank records of the gambling account whenever necessary to fuffill <br /> requirements of current gambling rules and law. <br /> I declare that: <br /> I have read this application and all information submitted to the board; <br /> All infonnation is true, accurate and complete; <br /> All other required information has been fully disclosed; <br /> I am the chief executive officer of the organization; <br /> I assume full responsibil~y for the fair and lawful gambling and' rules of the board and agree. if licensed, <br /> to abide by those laws and rules, including amendments to them: <br /> A membership list of the organization will be available within seven days after ij is requested by the board; <br /> Any changes in application infonnation will be submitted to the board and local government w~hin 10 <br /> days 0( the change; and <br /> A tennination plan will be submitted to the board w~hin 15 days of the termination of all premise perm~s. . <br /> Failure te provide required information or providing false information mdY resuli in the denial or ".vocation of the <br /> license. - <br /> Signature of chief executive officer <br /> ~~~;IBI:~mmgllll~!i~pll~~g~m~'I~..II..I.' ,..,',.,..'..............lif,'iii,il!I!'ll;l;i:lii1i.ll1..11,11111;1;11111111,." <br /> 1. The c~y 'must sign if the gambling premises is located wlihin cijy lim~s. <br /> 2. The county "AND township" must sign if the gambling premises is located wijhin a township. <br /> 3. The local government (c~y or county) must pass a resolution specifically approving or denying the application. <br /> 4. A copy of the resolution approving the application must be attached to the application. <br /> 5, Applications which are denied by the local governing body shouid not be submitted to the Gambling Control Division. <br /> Township: By signature below, the township acknowledges that the organization is applying for a premises permij w~hin <br /> township limits. <br /> C~y' or County" Township" <br /> City or County Name Township Name <br /> Signature of person receiving application <br /> Title Date Received <br /> Is township. 0 Organized o Unorganized o Unincorporated . <br /> th& Instructions for the required sttachments Mail to. Department of Gaming <br /> Gambling Control Division <br /> Rosewood Plaza South, 3rd Floor <br /> 1711 W. County Road B <br /> Rose~ille, MN 55113 \ <br />