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<br />ACKNOWLEDGMENT
<br />GAMBLXNG PREMXSES AUTHORXZATXON
<br />I IIIfBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS
<br />O~ BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS,
<br />TO ENTER THE PREMISES TO ENFORCE THE LAW,
<br />
<br />BANK RECORDS XNFORMATXON
<br />THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT
<br />'AEENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES,
<br />
<br />X DECLARE THAT:
<br />I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD;
<br />ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE;;
<br />ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED;
<br />I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION;
<br />I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING
<br />ACTIVITIES TO BE CONDUCTED;
<br />I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES
<br />OF THE GAMBLING CONTROL BOARD AND AGREE, IF ISSUED A PREMISES PERMIT, TO ABIDE THOSE LAWS
<br />AND RULES, INCLUDING AMENDMENTS TO THEM;
<br />ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND
<br />LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE;
<br />I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING
<br />INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT.
<br />
<br />SXGNATURE ,9F ~~X~FJlEXE DATE
<br />V\ V~ 1- / C - <r ~
<br />
<br />Lea GOVERNMENT ACKNOWLEDGMENT .,..,'
<br />l~E CITY' MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY
<br />LIMITS. . .'. ' .
<br />"
<br />2, THE COUNTY" AND TOWNSHIP" MUST SIGN THIS APPLICATION IF THE 'GAMBLING ,PREMISES IS ':,:'..,.
<br />LOCATED WITHIN A TOWNSHIP, '..', '., ' '--'.'h','.',' ""'" '~;y"
<br />3, FOR TOWNSHIPS THAT" ARE UNORGANIZED OR UNINCORPORATED, THE 'COUNTY** IS REQUIRED TO ATTACH
<br />. '''. , <, .: ..', "" . :-~ " ,',' ,. .._..; -'....:'.~."" J ._
<br />A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS.' .' "'\~'~:.~' , .
<br />4, THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PABS A RESOLUTION SPECIFICALLY '~"!'\
<br />, ,",' -- .. .. ".,,:..--,.', ,-j"",",-;{",
<br />APPROVING OR DENYING' THIS APPLICATION, ..', '., ...,. "\"~j~:"
<br />5. A COpy OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLIcATION MUST BE "'.
<br />ATTACHED TO THIS .APPLICATION::."'.' ",;~:?::" ,'. ,; "..;'- .';. ,...:...:'\>;q,'::".
<br />6. IF THIS APPLICATION IS DENIED BY THE LOCAr;,UNIT OF ,GOVERNMENT,' IT SHOULD NOT'BE'SUBMI.TTED
<br />TO THE GAMBLING CON'l'ROLBOARD :,:'," ~. '. " ..:" "iL>>,'~~~""
<br />TOWNSHXP: . .
<br />BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS' APP.LYING FOR A . "
<br />PREMISES PERMIT WITHIN TOWNSHIP LIMITS, .,
<br />
<br />CXTY' OR COUNTY" . ':'. TOWNSHXP** " :'..,
<br />:-:-'.. '. -, .. ".">
<br />
<br />CITY OR COUNTY NAME. I ,':,TOWNSHIP NAME . .'J
<br />(/i't OF AIU(jJihLJ..XI,~;'. '.- " .... '. .:i,\'
<br />-
<br />I SIGNATURE OF PERSON RECEIVING. APPLICATION .
<br />I':/~::
<br />
<br />"-,,;,,,'c.
<br />TW '.' ., ". .'..... ., . . ".>pATERE,~.~IVED ;:1 TITL~ 'H, ,;DATE RECEI,~E;
<br />H~ "")\lp"'?a, .[..,.. ...',.....
<br />'. ':f.;'.\. ". ]..., ",':,::,..:,!" ....... ';':. ';,:.' ." :'",':'T;:>
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