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<br />. .. Minnesota Lawful Gambling
<br />'n Premise Permit Application - Part 2 of 2
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<br />funk Name Bank A=unt Number,
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<br />'(i;;;;iilliig Site Aiii:horlZatlon ,- .1 am the chief executive officer of the organization;
<br />I hereby consent that local law enforoement officers, the .1 assume fuli responsibility for the fair and lawfui opera-
<br />board or agents of the board, or the commissioner of tion of ali activtties to be conducted;
<br />revenue or public safety, or agents of the commissioners, .1 will familiarize myself wtth the laws of Minnesota
<br />may enter the premises to enforcelhe law. governing lawful gambling and rules of the board and
<br />Bank Records Information agree, if 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 fulfill .any changes in application information will be submitted
<br />requirements of current gambling rules and law. to the board and local untt of government wtthin 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 ali 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 license.
<br />'allother required information has been fuliy disclosed;
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<br />Signal '" ,f Xe utive officer Date
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<br />.. . . '" . 4. A CODV of the local unit of aovernment's resolution a~. ,
<br />.1. T~e ctty ,mu~t~,gn ~hls.a~licallOn ff the gambling prem- orovina this aoolication must be attached to this aoolicat,on !
<br />lSes ,s located w~h'n.qty}'m'!s;. " .. . '. '; c . ". .' 5. If this application is denied by the iocal untt of gov?rnment,j
<br />,. 2.. Th~county:'flf;'ID, t?w,ns.~lp ,must SIQ~ thl~ applic~tlon if" tt should not be submitted to the Gambling Control Board. I
<br />' . \ h ' 'bl" '., \'1 '.!~-t d' "h' t 'h" '\" .. , " . ' , ,
<br />1'-'. t egam 109 premises. s"-"",, e .w" In"a owns 'p",.,_".:;,..~," ., ., -- ,_. -0., ._-',: '
<br />3."Th~ local u~~ goverrimen.t (city or co.untY) .must pa$~ a Township: By signature beiow, the towns~ip ackno~le?g?s :
<br />resolut,on spec,flcally appr~vlng or denYing thiS applicat,on. that the organization is applying for a prem,ses permit Within i
<br />township limits. ,
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<br />elt ',,'or' Count .. Townshl .. j
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<br />City orCounly /'jame ..-. Townsh,p Name
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<br />"', '.., .,' ., ,,', ;,!c'i'k'h;$:~{!i.i~ ,s~~~re 01 Per:o~ "';i,~ng~~~tian
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