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<br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 2 of 2 <br /> <br />Gffiribfttr:!HaiiIe~trri....o..iI..Jt101i~rnM2t41iif#tiii!l;:ill%Y~~1g~'ThfhW@m%0@1 · <br />Bank Name Bank Aa:aunl Numllllr <br /> <br />Bank Address cuy Slate Zip Code .. _ . <br />"-::'~.:'.._--. <br /> <br />~ "}~~.L' <br />Betty GreenCrow'699~Oh.to--Si~'-Paul Mn 55107 President .,;"'; .,~,;,. <br />Sheila WhiteEagle 331 Webster St. Paul Mn 55102 Bingo Manager., <br /> <br /> <br />!~A,!!!!~!!!!~;j;llli~it.4i~i!t&.\if{!!!~~!!!::;;~~~~~lwll~ <br /> <br />I hereby consent tIlat local law enfon:ement officers, the -, - .1 assume full responsibility for tile fair and lawful opera. -.:. <br />board or agenlll of tile board, or tile commissioner of tion of all activities to be conducted; <br />revenue or public safely, or agents of the commissioners, . .1 will famirlarize myself with tile laws of Minnesota . <br />may enter the premises to enfon:e the law.' . governing lawful gambUng and rules of tile board and <br />Bank. Records Information agree, If licensed. to abide by these laws and rules, <br />The board is authorized to inspect the bank I'IlCOrds of tile indOOing amendments to them; <br />gambUng account whenever nscessaJY to fulfill .. 'any cI1anges in application information will be submitted <br />requirements of current gambling rules and law. to the board and local unij of government within 10 days .' c. _ <br />Oath of the cI1ange; and <br />I declare that;:-- ------ ~. _... . ---.' -- . . ---'.1 understand that failure to provide required information ~-'::i <br />,1 have read this application: and all information submitted or providing false or misleading information may result in . <br />to the board is true, accurate and complete; 1I1e denial or revocatlon of the license.. <br />.all other required Information has been fully cfoscfosed; <br /> <br />Signatureofcl1iefe~ ~ ~ _~; .... q ;- <br />::~lr{~~l~~~~I.II\\.AII["~:'::_:':':..':_:"':'. <br /> <br />.... . . .,. . 4. A COm' of thA jnea! unit of Q0V8rnmenf!l resolution ao. I <br />.1. ~e city mus.t ~gn ~hlS. 3J7PJlcaUon if the gambUng prem.. oravina this aMlication must be attached to thjg aDOli~ion <br />lSes IS located :dhrn city Itm~:. . . ... 5. lf this application is denied by the local unij of government, <br />2. The county AND townshIP must sign thIS application lf d should not be submitted to the Gambling Control Board. <br />the gambling prem ises is located within a township. I <br />3. Th~ iocal un~ government (city or co.unty) .must ~ a Township: By signature below, 1I1e township acknowledges <br />resolutIOn sp8ClficaJly apprOVIng or denYIng thIS app''''''''lOn. that the organization is applying for a premises permit within <br />township limits. <br /> <br />Cltv" or County'" 'TownshlD" . , I <br />City or County Name Township Name - <br /> <br />. S' f ., pi'. I <br />Signature ot person receiving application tgna.ture 0 perscn r&C8lVlng ap tcancn <br /> <br />Tide I Dare -- Tolle I Date Received I <br /> <br /> <br />Ref.... 1D the ins1rudians for rgquired aaaclvnents. .. <br /> <br />Mail 1D: Gambling Conlral Board <br />Ro_ Pia.. SouUl, 3rd Floor <br />1711 W. Counly Road B I <br />Roaavllle, MN 55113 tG214(Parl 2) <br />(A.112Q'11} <br />