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<br />Minnesota Lawful Gambling
<br />Premise Permit Application - Part 2 of 2
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<br />!J,;nk Na";" " " , '" , Bank Accounl Number"
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<br />Ban ddress City tate Zip ode
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<br />Gambllng'slie AuthorkiiUon" .1 am the chief executive officer of the organization;
<br />I hereby consent that local law enforcement officers, the .1 assume full responsibility for the fair and lawful opera-
<br />board or agents of the board, or the commissioner of tion of all activ~ies to be conducted;
<br />revenue or public safety, or agents of the commissioners, .1 will familiarize myself with the laws of Minnesota
<br />may enter the premises to enforce the law. governing lawful gambling and rules of the board and
<br />Bank Records Information agree, H licensed, to abide by those laws and rules,
<br />The board is authorized to inspect the bank records of the including amendments to them;
<br />gambling account whenever necessary to fuHiII .any changes in application information will be submitted
<br />requirements of current gambling rules and law. to the board and local un~ of government w~hin 10 days
<br />. Oath of the change; and '
<br />I declare that: .1 understand that failure to provide required information
<br />.1 have read this application and all information submitted or providing false or misleading information may result in
<br />to the board is true, accurate and complete; the denial or revocation of the iicense.
<br />.allother required information has been fully disclosed;
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<br />Signal r<l0 I f xe utive officer Date
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<br />. ..... . 4. A CODY of the local unrt of aovernmenes resolution aD-
<br />1. The crty '~must sign thiS appiicatlOn if the gambling prem- orovina this aoolication must be attached to this aooiication ,
<br />ises is located ~!hincC<ity}imi!s:. " .. ,. ., . . . 5. If this application is denied by the. local un~ of government, j
<br />'o;,\" 2., Jh~co~nty . ~~.~J~w,n~.bIPl1'.u"! SI9~ thlsappl~~'~~ H,;:, ~ s~o~ld ~ot be submitted to the Gambli,~g Cont~~IS.~ard. ."., i
<br />'. ,thegambllng premlseS,lSlOCatedwrthln.atownshlp'.'_""".",_"m.,. ,. ,,_. .., ,..".,,_., ,,'.', ,
<br />3.".>Th~ local u~~ governmen.t (city or co~nty) .must ~a~ a Township: By signature below, the township acknowledg~s I
<br />resolutIOn specifICally app~().vlng or denYing thiS application:. that the organization is appiying for a premises permit within j
<br />township limits. :
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<br />" ,ell *", .'or' Count ** Townshl ** I
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<br />":co ' . ' Township, N,ame
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<br />..A~ ,:;' Signature of person rea3iving ~plication
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