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<br /> .
<br /> ACKNOWLEDGMENT
<br /> G.NG PREMISES AUTHORIZATION ' .
<br /> I BY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS
<br /> OF E BOARD, OR THE 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 /> w~ENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES ~~TI 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 /> . GOVERNMENT ACKNOWLEDGMENT ;.' ','
<br /> ..
<br /> 1, THE CITY* MUST SIGN .THIS APPLICATION IF THE GAMBLING PREMISES .IS .LOCATED'WITHIN.CITY
<br /> . LIMITS, . ,..,. ,""" '?<:?k. .' <'..,:'." c.'
<br /> 2, .. THE COUNTY* *. AND TOWNSHIP* * ,MUST SIGN' THIS. APPLICATION 'IF ;THE):;AMBLING.'PREMISES :IS ,':',:..
<br /> 'LOCATED WITHIN' A' TOWNSHIP .; ,.....,:,., ..".:,,,\,,,,.i'f'\""F{i:g<:.;~':; ,.<t.:)}t~i~:;i',:;E' "i,:;;k(
<br /> 3 . .'FOR TOWNSHIPS THAT ',ARE UNORGANIZED OR UNINCORPORATED; THE 'COuNrY": ";' IS REQUIRED, TO ATTACH
<br /> A LETTER TO THIS APPLICATION INDICATING' THE' TOWNSHIPS : STATus . ;.y.'::.:.' "'" ~:::; ,.. ,: ':~' ..: )',.
<br /> 4, THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLuTION SPECIFICALLY,;:.,
<br /> APPROVING OR DENYING THIS APPLICATION,' .' '.;}:ti.,.,....:,:./~:.:;,\>(/.<.b.';Y.
<br /> 5 , A COpy OF THE LOCAL UNIT OF' GOVERNMENT'S 'RESOLUTION APPROVING THIS APPLICATION:MUST BE .:,
<br /> . ATTACHED TO THIS APPLICATION ; .' . . '!:";i:<::'.>~'. ' :', .:'SN;~1" '".:;;,.,<:.1tr;':;',:?':"';',:7'"
<br /> 6, IF THIS APPLICATION IS DENIED B"iTHE LOCAL .UNIT OF GOVERNMENT ,.;CU SHOULD,NO!';BE "SUBMITTED,
<br /> TOm;~~I~~E GAMBLING CONTROL BOARP:. . ' '.':' .' ",:r:~~':::{:7'~:2g'::,):;':?A'J,:;;':~~0';;,:':;:~:.;ij..
<br /> BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT1;HE ORGANIZATI6N:IS'P,PPLYING.FOR'A '.:0',:'
<br /> PREMISES PERMIT WITHIN TOWNSHIP LIMITS, . 'YO....'." ..<',:',',-
<br /> .;.. ";"c
<br /> CITY' OR,COUNTYu "'. TOWNSHIP...,,;~;~>... :.":,:( :;l:~;i'::..,'
<br /> CITY, OR COUNTY NAME., ',',. .' :.\ '. :}~WNSHIP: NAME ,t1~0Z;..;:,,~"';";?'~";l~;';:\ ,c.
<br /> (j riDFAMiJ.~;.I//l~J .
<br /> .( . . "_. .";', <-".,." ;,'<;~';-.';i. .,"'1"-: .;_';~>'. ., ';."
<br /> '" . .1. SIGNATURE' OF PERSON RECEIVING' APPLICATION
<br /> - :~,~:.-,' I ,. ~:_~:~~X~~~t~,"~.~:.;~ ~;~-/.':. ':. :,.;: ;-/:~t; :~~.j <:_:~.~ir":~~~1;~F::,;'~Pr~~);~~,::'--:.:.~ ,'. ,:',
<br /> 7~f~~~1~~~1$~i,]~~~<<~~~i.'
<br /> .
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