|
<br />~l+lBI\ A.?t ".
<br />
<br />ACKNOWLEDGMENT
<br />GAMBLING PREMISES AUTHORIZATION .
<br />I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS
<br />OF THE BOARD, OR THE COMMISSIONER OF,REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS~
<br />TO ENTER THE PREMISES TO ENFORCE THE LAW. ~II
<br />
<br />BANK RECORDS INFORMATION .
<br />THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT I
<br />WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING,RULES AND STATUTES. .
<br />
<br />I DECLARE THAT: , ., " , "
<br />I HAVE READ THISA~Pi.ICATION ANDJ\LL INFO~TlciNSUBMITTE?TO:'I'HE: :GAMBLING ...
<br />ALL INFORMATION .ISTRUE, ACCURATE,ANDCOMPLETE;; ',', -",'-,',' ,:::, '. ,'." ",' ',.
<br />. ..' . ""'_" ,_.J _.', . _, _. ,', ,''', ,0'. . . , . d....._ " _', '"".,,' :__~' " ,", . '?':'<
<br />ALL OTHER REQUIRED 'INFORMATIONHASBEEN,FULLYDISCLOSED; ",:{", " ,},
<br />. '. .', ., .... '.. '.; ,,'-,,- , .', _ - C._.._ .,": ,,': .' -', ;_ . ... "u ~~i-
<br />I AM THE CHIEF EXECUTIVE OFFICER OF THE 'ORGANIZATION; , " , ' '1
<br />I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ,ALL '
<br />, ACTIVITIES TO-BE CONDUCTED; ,...,.."..:.,:.>;,;;':::.. ." ,..":L.L-;',."~.',,,_,, --::<',.....,..., "-..c.....,'",,. . ' ..
<br />I WILL FAMILIARIZE MYSELF WITH THE 'LAWS OF,'MINNESOTA GOVERNING LAWFUL GAMBLING "
<br />OF THE GAMBLING CONTR,OL BOARD AND AGREE, ,IF ISSUED A PREMISES PERMIT, TO "",' I"
<br />AND RULES, INCLUDING AMENDMENTS TO THEM;, , ,'.'::"r' ..
<br />ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD 'MID i~
<br />LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OFTHECHANGE;'}i:n: "I:
<br />I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR 'MISLEADrgg"}
<br />INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. ''.;'tl,~,:',' >:\
<br />....,,:..,' --"?:."i!
<br />
<br />SIG" ~ATUREOFCHIEF,EXECUT~,VE 'FFICER" ',' '. ,DATE/" ",. ,;' '!i;ft~,il
<br />'~ '.../1"7,';" ',','" 'A//<7"'9J"";""''''' '.
<br />. '_: ' -:--,V':<', "-,:, _ '.:' . - . .'.- -. J. . 'O.i<::::, '<.':::'" }1
<br />L~L GOVERNMENT ACKNOWLEDGMENT " , ,', t ' ! fl."
<br />1. THE CITY* MUST SIGN TH'IS 'APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY ,.{: ,
<br />LIMITS. "
<br />2. THE COUNTY** AND TOWNSHIP** MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS I
<br />LOCATED WITHIN A 'TOWNSHIP. .'
<br />3. FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH '
<br />A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS. .
<br />4. THE LOCAL UNIT OF GOVERNMENT (CITY OR CO, UNTY, ' ) MUST PASS A RESOLUTION SPECIFICALLY.::. ',',;' . '.
<br />APPROVING OR DENYING THIS APPLICATION. ;<'.. """"i' '
<br />5. A COPY OF THE LOCAL UNIT OF GOVERNMENT'S' RESOLUTION APPROVING THIS APPLICATION MUST BE - ,',
<br />ATTACHED TO THIS 'APPLICATION. '.' ".;,;"";:!,:.";,,,.....",,, ,':" ; ,,":-."'; I
<br />6 . IF THIS APPL,ICATIONIS pENIED_BYTHE:r:O'C~.L.UVIT~O~ ..,q9?~NT,I:r':SHOULIl.NOTBE Su;:'~I,,~~t~D .'. ,
<br />
<br />TOWN~~I~~E, GAMBLING CO;j;;:ROt;~j~!'flJ:'F;'. ..:,>::.;:j?':~:,!k: ~>~)';;,;' - "':;";;i\';,, '::.ii;\,t ',:.\:":''':'',i2''0f~~~ ,~'
<br />
<br />BY SIGNATURE BELOW, ,THE TOilllS}!IJ?ACI?'O~LJ;;I??:~i,i~:r;;;ri:E;<?~)'~~~~U?If,:-:!',l"P~LYIN;>,~?~..'), >;(i'~)2Jto/; 'J
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />'.: .',.' , "DATERECEIVE6;;:':'
<br />
<br />
<br />., .REFER TO THE, H~ciL:i:!iT'~ORREQUIREDATTACHMENTS >': ';ft~{t,tJj
<br />
<br />..MAIL:r:Oj'I<;AM,BI,oINC;C<>N,TROLB()ARD 'j i~
<br />'17,l1'W,:CO~YRD;B'.:SUITE3 0 0 S "I'
<br />,ROSEVILLE,' MN'55113, ,",
<br />,~~ ...A~
<br />1
<br />
|