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<br />Mfnnesot4 Lawful. Gambling
<br />I . Premise Per.mit Application - Part 2 of 2
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<br />BanK Addr8S$ CUy. StaIB .Zip Code
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<br />I Betty Gree~~~~~' 699-' Oh;tJ~S€~~-paul.' Mn 55107 . President ..~.~<~- ',--
<br />I Sheila WhiteEagle 33l Webster St. Paul Mn 55102 Bingo Manager"
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<br />1~~~9J.tl~?;~~mi.m;i;llii~'i<' ..' tc'd'
<br />.. Au 011.. oj am tile clrief 8X8Clllive atfic8rat theorganizaliDn~. . ..
<br />. I hereby c:ansent tlIar fcx:aj law enIoIcament oiIIcets, tile .. - ., assume IuD responsibilily fer tile fair and IawfuJ opera- '...
<br />board or agents of the boaId. or the c:ammissianer at . ticn of all acliYitlIls 10 be c:onduc:l8d;
<br />revenue or public safety. oragenlS of the COlIllIIission8Is,. .1 will lamiliariza myself with the laws at M1n_ ...
<br />may emer the ptIlmises to enlon:e the law, .,. , governing lawful gambRng and rules 01 the board and
<br />I Bank Reeords lDfonnatlon agr.... illicensed, to abide by those laws and rules.
<br />The board is authorized to inspect the bank records at the including amendments 10 them: . ,
<br />gambling a=unt when..,.... necessaty 10 lulflll _ 'any changes in appJicalion intonnalion WID be submitted
<br />_ requirements of current gambf'"9 rules and 1_. to the board and 10cal unt at government within 10 days . 0
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<br />. . ~~ that;:-.. h_____ ,--- - -. ~ :=~~ai/ure to provide required in1o....4..n ::::.-i
<br />.1 have read. this appIicatlOn: and all information submitted . or providing 1alse or misleading intonnatJon may ruuJt in . .
<br />I to the board is true. accurate and complete;. the denial or revacatiDn of the license..
<br />.alI other rsquited information has been fully <1iodoMd;
<br />SignalUre of chiel ~e alfle." , . . Date _
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<br />,,::;;::-::,:t'., . "" .. ......: .,. .. ....:<<~w;:.'::;~mii;illriI;IZ4I_r...... .
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<br />4. A r.mw of tMA local un" of oovamm&nrs r&scfution aDo-
<br />I :. ~8 c:tty .m~t ~n ~is. ~ication if the gambling pram.. omvina tt1is MWic:mnn must b8 Ri'tar-n9d m thig aoolication
<br />lSe. IS located within dly iunilS. 5. ilthis application is denied by the local unt 01 government.
<br />2. The c:aunty -AND tcwnstrip- must sign this ~ ~ ~ should not be submilled 10 the Gambling Control Beard.
<br />the gambling ptIlmises is locaIed within a townshill-
<br />I 3. The /ocal unt government (dly ct c:aunty) .must ~ a Township: By signature below. the township ackncwiedges
<br />resolutIOn speciflCaily approVIng or denymg thIS appticalion. that the organization is applying fer a premlS8S permit withm
<br />township limits.
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<br />I CIty" or Countv- TownshlD- .'.
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<br />City 0< County Name TawnsIrip Nln1e
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<br />I Signa..re 01 parsen recoiving appJicalion Signa""" of person receiving applicalion
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<br />I Title I Oale"l.,,'_ Title I DaB__
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<br />I - ReIer 1l> the insuudions for requited allachrnenlS.
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<br />Mail 1l>: Gembllng eon"". BOIIrd
<br />RoMWOOd PI.ZII Saudi, 3rd Floor
<br />I 1711 W. County ROIId B
<br />ROII_IIl_, UN 55113 LG214(l'1In 21
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