CCP 02-23-1998 - Laserfiche WebLink

Home Browse Search

.., Local Unit of Government Jurisdiction Is this gambling premises located within city lim~ Yes o No If yes. write the name of the city: e City Name NiJJT:?J )../ IL'--) If no, write the name of the county and the township: County Name Township Name Check the appropriate status of the township: o organized Dunorganized D unincorporated Local Unit Of Government Acknowledgment I. The city must sign this application if the gambling 4. A copy of the local unit ofgovemment's resolution premises is within city limits. approving this application must be attached to this 2. The county and township must sign this applica- application. tion if the gambling premises is not within city limits. 5. DO NOT submit this application to the Gambling 3. The local unit of government (city or county) that Control Board if it is denied by the local unit of govern- signs this premises permit application must pass a ment. resolution specifically approving or denying this 6. NOTE; A township has no authority to deny an appli- application. cation City or County Acknowledgment of Receipt of Township Acknowledgment of Awareness of APp~tion r--.. Application Sign re of person receiving application Signature of person acknowledging application :;j Date Received Date Signed e Title of person rec Title of person acknowledging application (try t1le1fju~ Oath of Chief Executive Officer I have read this application and all information is true. accurate and complete.- Signatun~.9~ef Ex;cutive Officer: Date: ./~ , , PJ;' T Submit the application at least 30 days prior to your scheduled date of activity and attach the resolution of approval from the local unit of government. For gambling activity other than raffles, attach a copy of the lease agreement. Mail the complete application and attachments to: Gambling Control Board 1711 W. County Rd B Suite 300S Roseville, MN 55113 This publication will be made available in alternative format (Le. large print. braille) upon request. Questions on this form should be directed to the Licensing Section of the Gambling Control Board at (612)639-4000. Hearing impaired individuals using a TDD may call the Minnesota Relay Service at 1-800-627-3529 in the Greater Minnesota Area or 297-5353 in the Metro Area. The information requested on this form will be used by the Gambling Control Board (GCB) to determine your - compliance with Minnesota Statues and rules governing lawful gambling activities. All of the information that you supply on this form will become public information when received by the GCB.