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<br />8-)\,~'1 A:. <br /> <br />z" <br />-./ <br />- t-:. <br /> <br />ACKNOWLEDGMENT <br /> <br />GAMBLING PREMISES AUTHORIZATION <br />I AEBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS <br />~F~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 /> <br />BANK RECORDS INFORMATION <br />THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT <br />WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. <br /> <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 /> <br />SIGNATURE OF CHIEF EXECUTIVE OFFICER <br /> <br />DATE <br /> <br />. GOVERNMENT ACKNOWLEDGMENT <br />L THE 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 />LOCATED WITHIN A TOWNSHIP. <br />. . FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH <br />A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS. <br />4. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY <br />APPROVING OR DENYING THIS APPLICATION. <br />S. A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE <br />ATTACHED TO THIS APPLICATION. <br />6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED <br />TO THE GAMBLING CONTROL BOARD. <br />TOWNSHIP, <br />BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A <br />PREMISES PERMIT WITHIN TOWNSHIP LIMITS. <br /> <br />CITY* OR COUNTY** <br /> <br />TOWNSHIP** <br /> <br />CITY OR COUNTY NAME <br /> <br />lJr 1t1lA!N H IL~ <br /> <br />TOWNSHIP NAME <br /> <br /> <br />F PERSON ;r:.EIV <br /> <br /> <br />SIGNATURE OF PERSON RECEIVING APPLICATION <br /> <br />lrr ~~W'D1- <br /> <br />TITLE <br /> <br />DATE RECEIVED <br /> <br />CHECKLIST FOR REQUIRED ATTACHMENTS <br />TO, GAMBLING CONTROL BOARD <br />W COUNTY RD B - SUITE 300 S <br />ROSEVILLE. MN 55113 <br />