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<br /> Minnesota Lamfu! Gambling <br /> Bingo Hall License Application (LG300) - Part 2 <br /> . <br /> 1 declare that this application is correct and complele 10 Ihe best 01 my knowledge and beliel. I willlamiliarize mysell wilh the <br /> laws ollhe slale 01 Minnesola and rules of the Board regarding gambling and agree, if licensed, to abide by Ihose laws and <br /> rules, including amendmenls to Ihem. Changes in Ihe inlormalion submilted in Ihis application will be submilled 10 Ihe Board <br /> and local governmenl unll within len days afler Ihe change occurs, <br /> 9, Si9 ture 01 chiel executive olfi""::1~:rJr ~ Name (please print) Title <br /> ()-I-.J ~ W .s~ ?:J. J..OU1 - UJAl.sL '7Rc'i>,"!)c-..., <br /> . Nam 01 person completing this form TiUe Phone . <br /> /..., 0<; J IE. u..IA L 'S~ ?I1C'S ,'j)..._T ( 'IoU 411 J-' ~ ~4~ <br /> i_4~i:~g~l:mfft!ff(t:~~kJij~mtg~g~rrf~n'fliiji;iilliiiJlliJiiiiiilJll,iiJiiiilliil'lijii:iiiiiiiiiil'iliiliJliiiiiilL:;;;;;:;n <br /> 1. The city' must sign if the bingo hall is located within 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 ropy of the resolution approving the application must be attached to the application. <br /> 5. An application which is denied by the locai governing body should not be submitted to the Gambling Control Division. <br /> Township By signature below, the township <br /> acknowledges that the organization is applying for <br /> a bingo hall license within township limits. <br /> City* or County** I TownshIp** <br /> 11. City or county name 112, Town,hip name <br /> . /7, <br /> G <br /> Sig 'tu I Signature of person receiving application <br /> , <br /> Date rec:::E:!ived Title - Township official Date received <br /> Is township? organized unorganized unincorporated <br /> 0 0 0 <br /> ~~~I~i.('1qI!!IJnr!~]1~nl~1!1(1gqIT~€~1IlR~!!g~~jliilljtlilljl~jjEil'iliil11ililjillliiiiiiijjJJ!!i!!ilili1ilfltiliii <br /> . Form LG300, Bingo 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 item 4 and 5 on form LG300) <br /> . Form LG316, Bingo Hall Affidavit, (for each person listed in item 4 and 5 on form LG300) <br /> . Check for license fee of $2,500, made payable to "State of Minnesota" <br /> <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 />