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<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 ~HE,COMMISSIONER OF REVENUE .OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS,
<br /> TO ENTER THE PREMISES TO ENFORCE .THE LAW, . '..,
<br /> BANK RECORDS INFORMATION
<br /> THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT
<br /> WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES,
<br /> I 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 /> SIGNATURE OF CHIEF EXECUTIVE OFFICER DATE
<br /> "
<br /> LOCAL GOVERNMENT ACKNOWLEDGMENT .--' e
<br /> 4_ . ,c.,_,.:,_'
<br /> 1, THE CITY' MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS,LOCATED WITHIN CITY':~:'
<br /> LIMITS, " ,..."...,.t"-'k-:~'a,.:': 2, THE COUNTY" AND,}O,vn<SHIP~~l1US-r:,.SIGN THIS, ,!<pPLICATION,~:;!!I~9~LI!;IG,p,REr:lJ:,~,~s,~;~e;~;,~t*f~:..
<br /> .' LOCATE!;) WITHIN_ A -'.T~~SHIP~<::"" . .. "- ,_?"'-'"' -~";~, ~''''<:''';''~~:' ',' <-_ .- ~-._~.-,:.;-:;-, "~~~:~~~:.:~:::>~'~~:-:\<9:-;(:~'
<br /> 3 , FOR TOWNSHIPS THAT :ARE UNORGANIZED OR UNINCORPORATED, THE' COUNTY** IS' REQUIRED..: TO. AT,TA9l
<br /> .: ,_ .' . : . .' _, _, .",." _ _,. ,'_ , ....,'". .., .. -, ';>.~: -., "._,' " -_.'" ',;',' .:~_t'..-. ,'_-
<br /> A LETTER TO THIS .APPLICATION INDICATING THE "TOWNSHIPS STATUS. ". . ,':,:ii>:CC!c....';t,:;..tfJ/
<br /> .' .' .'.' .' .' ".., '-,. ........" --, ,-~ ".,- .'
<br /> 4, THE LOCAL UNIT OF GOVERNMENT. (CITY OR COUNTY) MUST PASS.A RESOLUTION SPECIFIcALLY.,,::', 'i"'::
<br /> ,_ .. ,_' .' .' _,_ '.L .' .. .' : ',';' -' -,,_ ,..C-,'..:''' ...),.~.~.... .
<br /> APPROVING OR DENYING THIS ,APPLICATION. ,"'. ." ."", ." "':"\'>:',:>:"',':'~';c',
<br /> . . -, , . .... . ' , . . '.' . ;: "'.. -;... . ''"'.....~.-....- ':
<br /> 5, A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION' MuST BE ';;':,
<br /> ATTACHED TO THIS.APP'LICATION::" '''. ,~. "':.: "". :.:: '_:"F,'~':~ <--,:-~:'.- ..,:,i;'..~':"::f:":/?::}.~~~~~~~~l~~J~<.
<br /> 6. IF THIS APPLICATION IS DENIED BY THE LOCAL uNIT OF GOVERNMENT, IT SHOULD NOT~BE;SUBMITTED'
<br /> TO THE GAMBLING "CONTROL BOARD '. :"'.,,'" , "~.,."';.",^,"'~~~'.,'"
<br /> TOWNSHJ:P: . ./,::. .:, . ..~~'~'-_": -.'........ ~. ~-' ~S:-?~~?;_:~~.;~~2t~~.:-.
<br /> BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING"FOii:A':'1t,r,'.':<'
<br /> PREMISES PERMIT WITHIN TOWNSHIP LIMITS, -.,....:. .~':>..:-.:,.::.~~':~:>.:.~,j~?:t:~~:.~~ -
<br /> ,.' ':-:.-~-~',:~-->.:.'-:':X.'t -
<br /> CITY' OR COUNTY" TOWNSHIP** - xk~:" :~'.':i:~~:' :jii%~;%>""
<br /> .. .,-,
<br /> CITY OR COUNTY NAME I TOWNSHIP NAME ,::'i.~:. ;---'J~2:;:~'>,;'~1~;~t~:~....
<br /> ..' -
<br /> c tNoF:A!di:ij'~H ,i~~) I ~'" ,".- . :.-~:...:~-::f:::;li..~:~-~';~~' ~.-. X~~s~t-:~.
<br /> < :.~ -
<br /> ._..:'"_',",,,;cl.:'/: _:'!a;" .~1"-:-,_:
<br /> PERSON '. APPLICATION I"',SIGNATUREOF"PERSON RECEIVING 'APPLICATION':,
<br /> k.) ".... :~:._~ '.:. ,.-- 'I;E~r:?:~ : ~/; '~'. . .:.~:_; . ' . -:'.( ~.~;;~.. '~;';:(...5.'~~~.~{~{ij;',
<br /> :-'.~ -:'.. . ' " -'" :_:".' . , , : .' - ..~.
<br /> TITLE ".... .'."';DATE RECEI DDATERECElimD'c.
<br />
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