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<br />Al?plication for Exempt Permit - LG220 <br /> <br />Organization Name St. John the Baptist Catholic Chu'rch. <br />Local Unit of Government Acknowledgment (RequIred by Statute) <br /> <br />Page 2 of2 <br />.10198 <br /> <br />, 1 <br /> <br />I <br />, ,. <br /> <br /> <br />On behalf of the city, I acknowledge this application <br />and three options for the city: <br /> <br />1. Approve the application: By taking no action, <br />the city allows the Board to Issue a permit after <br />30 days (60 days for a first class city). <br /> <br />2. Waive the above-noted waiting period: The <br />city allOws the Board to issue a permit before <br />30 days (60 days for a first class city). Docu- <br />mentation attached. <br /> <br />3, Deny the application by passing a resolution <br />within 30 days (60 days for a first class city). <br /> <br />Print na e of city: C n'f o~ JtoBtJ <br /> <br />(L. <br /> <br /> <br /> <br />(Signature of city personnel receiving application) <br /> <br /> <br />J.MjJL <br /> <br />Tide <br />Date 01-1 \D 1 <br /> <br />l <br /> <br />e <br /> <br />On behalf of the county, I acknowledge this application <br />and three options for the county: <br />1. Approve the application: By taking no action, the . <br />county alloWs the Board. to i~ue a permit after 30 days. <br />2. Waive the above-noted waiting period: The county <br />allows the Board to issue a pennit before 30 days. <br />Documentation attached. <br />3. Deny the application by passing a resolution within <br />30 days. . <br />Print name of county: <br /> <br />(Signature.of County personnel receIVing application) <br />Tnle <br /> <br />Date <br /> <br />I <br /> <br />I <br /> <br />On behalf of the township; I acknowledge that llie <br />organization is applying for exempted gambling activity <br />within the township limits. <br /> <br />A township has no statutory authority to approve or deny <br />an application (Minn. Stat. sec. 349.213, subd. 2). <br /> <br />e <br /> <br />Print name of township: <br /> <br />(Signature of township official acknowledging application) <br />Tille <br />Date J I <br /> <br />Chief Executive Officer's Signature <br />The information provided in this application is complete and accurate to the best of my knowledge. <br />'vt-:......... a.. _ 7YJ;.u. ~ <br /> <br />Chief Executive Offjce~s signature <br />Name (please print) ; \ \" \ a <br /> <br /> <br />DateOZ./~~ <br /> <br />Mail Application and Attachment(s) <br /> <br />At least 45 days prior to your scheduled activity date send: <br />the completed application; <br />a copy of your proof ofnonprofjt status, and <br />. a $25 application fee (make check payable to "State. of Minnesota'1- Application fees are not prorated, <br />refundable, or transferable. <br /> <br />Send to: Gambling Control Board <br />1711 WeSt CountyRQad B, Suite 300$0Iltb <br />Roseville, MN 55113 <br /> <br />If your application has not been acknowledged by the local unit of government, do not send the application to the <br />Gambling Control Board. <br /> <br />e <br />