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<br /> ACKNOWLEDGMENT
<br />GAMBLING PREMISES AUTHORIZATION
<br />I~BY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CO~~ROL BOARD, OR AGENTS
<br />o BOARD, OR THE COMMISSIONER DF 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 />,mENEVER 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 EXE=I~ W J:iLw cz;t- DATE
<br /> j-/S-C} 't
<br />L. GOVERNMENT ACKNOWLEDGMENT '
<br />1, HE CITY* MUST SIGN THIS 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 '~ "~-':---
<br /> , '
<br /> LOCATED WITHIN A TOWNSHIP, ' .. ~'. \ ',',< :..-'
<br />3. FOR TOWNSHIPS THAT ~E UNORGANIZED OR. UNINCORPORATED, THE,COUNTY** IS REQUIRED TO ATTACH
<br /> A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS'STATUS.
<br />. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY
<br />.. .
<br /> APPROVING OR DENYING THIS APPLICATION. -,
<br /> '--..'"
<br />5, A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE
<br /> ATTACHED TO THIS APPLICATION,
<br />5. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, ',IT SHOULD NOT BE SUBMITTED
<br /> , TO THE GAMBLING CONTROL 'BOARD: 'h '-"-';';-'
<br /> .. ,
<br />TOWNSHIP, ..
<br /> . ,
<br />BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A
<br />PREMISES PERMIT WITHIN TOWNSHIP LIMITS.
<br />CITY* OR COUNTY** TOWNSHIp.. .
<br />CITY OR COUNTY I "TOWNSHIP' NAME
<br /> I j:. :;'" 'H~'~
<br /> I SIGNATURE~OF ,PERSON RECEIVING APPLICATION
<br /> '" I
<br /> ..
<br /> '.
<br /> I TITLE DATE RECEIVED
<br /> I
<br /> " ...: c.,.. '.' ~.
<br /> , REFER. 'l'? THE CHECKLIST, FOR ,REQU;R~DA'l'TAClIMEN'l'S ,
<br /> ",MAIL :TO: GAMBLING, CONTltOL:.BOARD:> ....
<br /> ," ,..,' "', . ",-,..', ,..,.,...-'-....,.:d, ~,~.... . >. - ,.' _" -. """; _, '.. .
<br /> "'1711 W COUNTYRDBC';SUIU'300':S :':-
<br /> ROSEVILLE. "')IN 55113' "',0...:<
<br />
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