CCP 10-09-2001 - Laserfiche WebLink

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t . . . : Page 2 012 3/01 LG220 - Application for Exempt Permit Organization Name THE CATHOLIC AID ASSOCIATION Local Unit of Government ACknowledgment If the gambling premises is within city limits, the city must sign this application. On behalf of the city, I acknowledge this application. Check the action that the city is taking on this application. 'XI The city approves the application with no L::::I waiting period. O The city approves the application with a 30 day waiting period, and allows the Board to issue a permit after 30 days (60 days for a first class city). o The city denies the application. (Signature of city personnel receiving application) ./," Ji.L(y u./LtIZ Date~l-'--_!:L-'~ THle If the gambling premises is located in a township. both the county and township must sign this application. On behalf of the county, I acknowledge this application. Check the action that the county is taking on this application. O The county approves the application with no waiting period. o The county approves the application with a 30 day waiting period, and allows the Board to issue a permit after 30 days. o The county denies the application. Print name of county (Signature 01 county personnel receiving application) THIe Date----'----'_ TOWNSHIP: On behaff of the township, I acknowledge that the organization is applying lor exempted gambling activity within the township lim~s. [A township has no statutory authority to approve or deny an application (Minn. Stat. sec. 349.213, subd. 2).] Print name 01 township (Signature 01 township official acknowledging application) Title Date----'----'_ Chief Executive Officer's Signature The information provided in this application is complete and accurate to the best of my knowledge. Chiefexecutiveofficerssignature ~~ V 1fiI1"4.9...... - Name (please print) MICHAEL F. MCGOVERN Date C; 1~_J.sJ.L Mail Application and Attachments At least 45 days prior to your scheduled activity date send: the completed application, . a copy of your proof of nonprofit status, and . a $25 application fee (make check payable to "State of Minnesota"). Application fees are not prorated, refundable, or transferable. Send to: Gambling Control Board 1711 West County Road B, Suite 300 South Rosevilie, MN 55113 If your application has not been acknowledged by the local unit of government or has been denied, do not send the application to the Gambling Control Board.