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<br />,"B'OB ,,::::: ";Premise Permit Application _ Part 2 of 2
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<br />Bank Name Bank Account Number
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<br />Ban ddress ClIy tate Zip ode
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<br />Gambling,f)~te Authorization, ," ,."'.',, 'B' .' ',,1 amth,echief executiveofficarofthe organiziltion;i'" i
<br />I hereby consentthatlocaJ law enforcement officers, the .1 assume full responsibility for the fair and lawfui,opera-t
<br />board or agents of the board, or the commissioner of , ., ,tion of all activities to be conducted; , , ' , ,. 1-
<br />revenue or public s~fety, or agents of the con;miss!<>ners"lwill iamiliariz~ myself with th~ laws of Minnesota'.' t
<br />may enter the. premises to enforce.the law.' governing lawful gambling and r~les of the board and f
<br />Bank Records Information, , agree. 11 licensed, to abide by those laws and rules, r
<br />The boi'-rd is authorized to inspect the bank records of the' including amendments to them; ;l
<br />gan;~Ii~gllccount whenever n?cessary to fullill " , ., .any changes in ,application in)"r,!,ation will be sublTlitted " ,f
<br />requirements of current gambling rules and law. to the'board and local unit of government within 10?ays .I
<br />.oa!h.".", of the change; and, ,", ,,' '~
<br />I declare that: ' .1 understand that failure to provide required informalion-
<br />.1 have read this application andall information submitted or providing false or misleading information may resuit in t
<br />to the board is true, accurate and complete; the denial or revocation of the license. {
<br />.all other required information has been fully disclosed; '~
<br />Signat I'<l I f Xe utive officer Date I
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<br />.... . .0."".7.."... .'. 4. "A coDv""of the local unit of aov~-r~ment,s resolution ao--" -- I
<br />.1. ,T~e c~y'lJl~s.'~lgn ~h's,ar;plicatlO~lfthEl galTlblingpr?m- orovina this aoollcation must be attached to this aoolication ' ~
<br />.ses IS located w~hln City hm~s ' ,.,,", ,,,-,", h' "I'" 'B, 'd" "ed' b'th "10' 'I ~ "f 'l" t ~
<br />',' " --,c",..,',...., ..".'i'.',...,.,..,.,.....,..,.,,,,,,S.,,lft IS app Jcatlon IS em y e ca un.. 0 governmen. ,~
<br />" " ,.2. The couiifV"AND towlishi .~ri'lljslSighlhis"~"Iic'a:ticin If. """""',' '<". '", "!!''',,,r' ,...,".'"..' ",'.<c '''; ," __,,,,,,, "
<br />,r",,",' "', '," .' ,,"'\'W'~""~ , \ "~"~I "~,.J:l",-,,.,. ""'~ . ,", ',"'"'' ',';' ~ should,nolbesu,bmitted,, to t,)1e,Gambli~g COntn;>1 Bo, ard~ p" ,
<br />,-,'~',:~--...- .. .., "<:.'''.::l.'';'~_'_-'-.l '_..;\\,-.>.~~'-..-"r;.'-'.'.',.,'.-.,..'._."..- ',..'.._~'\:_~;.".',..,\:~.._ ''I'' '''',_' ,0 - '\' '_'_,,'" ~\:..'<=
<br />.. ",' ,"" ,the"gambIIQgprElmISeSJsJOOaled"",,~hlnca~ownS)1p._~ "~~'"=~"""";"'___~"-'''\''__-~,,,,>r,__.$_.\);}..\_.\,\.,.\lSc, ' ,.'"
<br />',''',. 3:rC;Th~r&at u~~governnien.t (cltYorco.Uhly) .m~st ~as~a'~,) 'jO~-@~hIP?~lsi9~a';u~e 'li~rO';".thetoivnship;;"knowledges ~
<br />reso,lutl,?!! ~P".?lf"'.""yappr~vJngorde~y!.ng1h,~~ llPPI~t\o~:, ; that the organization is applying for a premises permit within\:
<br />' , township limits. '.
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