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<br /> Minnesota Lawful Gambling <br /> Bingo Hall License Application (LG300) - Part 2 <br /> . <br /> I declare that this application is correct and complete to the best of my knowledge and belief, I will familiarize myself with the <br /> laws of the state of Minnesota and rules of the Board regarding gambling and agree, if licensed, to abide by those laws and <br /> rules, including amendments to them. Changes in the information submitted in this application will be submitted to the Board <br /> and local government unit within ten days after the change occurs, <br /> 9, Signature 01 chiel ecutive oHice of the lessor Date Name (please print) Title <br /> ~ <br /> 9 -9'- /f.. /. -vd ;;--e-5 <br /> 10. Name of person completing this form Ti~e Phone <br /> ( ) <br /> <br /> 1. The c~y' must sign if the bingo hall is located w~hin city limits. <br /> 2. The county" AND township"'must sign if the bingo hall is located within a township. <br /> 3. The local government (city 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, An application which is denied by the local governing body should not be submilted to the Gambling Control Division. <br /> Township By signature below, the township <br /> acknowledges that the organiza~on is applying for <br /> a bingo hall license within township limits. <br /> Ci!Y' or County" Township" <br /> 11. City or county name 12. Township name <br /> . Signature of person receiving application Signature of person receiving application <br /> Title Date received Title - Township offidaJ Date received <br /> Name of person delivering application to local government Is township? organized unorganized unincorporated <br /> D D D <br /> fi~I~IB:~lr~J1iI.~tftt!t~1!i1gil!lm~1l1illi~~~ltItlti~ft~lm~!~lillt1~i1t~i~~rl~@Iii~i1i~~i1Nltf.~~~!ili <br /> . Form LG300, 8ingo Hall License Application, Parts 1 and 2 <br /> . Form LG302, Bingo Hall Occasion List <br /> . Form LG315, Bingo Hall Personnel Information (for each person listed in ~em 4 and 5 on form LG300) <br /> . Form LG316, Bingo Hall Affidavit, (for each person listad in ~em 4 and 5 on form LG300) <br /> . Check for license fee of $2,500, made payable to "State of Minnesota" <br /> ii~~IYrJIIi.!t)~iitml~qIigilml:a~~lil%1fintitt}?1fmlt~11il~~~ltjlft~~~lit11t:iftillt~~l~i~~ <br /> Department of Gaming <br /> Gambling Control Division <br /> Rosewood Plaza South, 3rd Floor <br /> 1711 W. County Road B <br /> Roseville, MN 55113 <br /> . <br />