CCP 07-28-1997 - Laserfiche WebLink

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-- ---- Lr'JtAiT ,J-\ ~, I .;.'! Ii ACKNOWLEDGMENT I ,~LING PREMISES AUTHORIZATION HEREBY GIVE CONSE~~ TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS~ ' THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE CO"~ISSIONERS, o ENTER THE PREMISES TO ENFORCE THE LAW, ANK RECORDS INFORMATION I HE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING 1KCOUNT HENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT Gfu~BLING RULES k'w STATUTES, DECLARE THAT: I I HAVE READ THIS APPLICATION AND ALL INFO~ATION SUBMITTED TO THE G,~BLING CONTROL BOARD; ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE;; ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; I I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES I OF THE GAMBLING CONTROL BOARD AND AGREE, IF ISSUED A PREMISES PERMIT, TO ABIDE THOSE L~WS AND RULES, INCLUDING AMENDMENTS TO THEM; ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND I LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT, I DATE / ~ ,OCAL GOVERNMENT ACKNOWLEDGMENT THE CITY* MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY LIMITS, I THE COUNTY** AND TOWNSHIP** MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN A TOWNSHIP. FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH I A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS, THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY APPROVING OR DENYING THIS APPLICATION, A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE I ATTACHED TO THIS APPLICATION, , IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED TO THE GAMBLING CONTROL BOARD, I .'OWNSHIP : 'Y SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A 'REMISES PERMIT WITHIN TOWNSHIP LIMITS, .'ITY* OR COUNTYu TOWNSHIP** I :ITY OR COUNTY NAME I TOWNSHIP NAME I on oF 4uJoJ' )-11 z..u) I G APPLICATION I SIGNATURE OF PERSON RECEIVING APPLICATION I I 'ITLE DATE RECEIVED I TITLE DATE RECEIVED .. CI'tf !if6t;W1cIL. -;~}(lf7 I REFER 0 T~E CHECKLIST FOR REQUIRED ATTACHMENTS MAIL TO: GAMBLING CONTROL BOARD I 1711 W COUNTY RD B - SUITE 300 S ROSEVILLE, MN 55113 ----------