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1998-03-11 Packet
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1998-03-11 Packet
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Local Unit a Government Jurisdiction <br /> Is this gambling premises located within city limits ?0 Yes E:] No <br /> If Yes, write the name of the City: <br /> City Name Centerville <br /> If No, write the name of the County and the Township: <br /> County Name Township Name <br /> Check the appropriate status of the Township: organized unorganized unincorporated <br /> Local unit W Government Acknowlec gmen# <br /> 1. The city must sign this application if the gambling 3. DO NOT submit this application to the Gambling Control <br /> premises is within city limits. Board if it is denied by the local unit of government. <br /> 2. The county and township must sign this applica- 4. NOTE: A Township may not deny an application. <br /> tion if the gambling premises is not within city limits. <br /> Upon submission of this application to the Gambling Control Board, the exemption will be issued not <br /> more than 30 days (60 days for cities of the 1st class) from the date the local unit of government <br /> signed the application, provided the application is complete and all necessary information has been <br /> received, unless the local unit of government passes a resolution to specifically prohibit the activity. A <br /> copy of that resolution must be received by the Gambling Control Board within 30 days of the date <br /> filled in below. Cities of the first class have 60 days in which to disallow the activity. <br /> City or County Acknowledgment of Receipt of Township Acknowledgment of Awareness of <br /> Application Application <br /> Signature of person receiving application Signature of person acknowledging application <br /> Date Received: Date Signed: <br /> Title of person receiving application Title of person acknowledging application <br /> Oath of Chief Executive Officer <br /> 1 have read this application and ill information is true, accurate and complete. <br /> ` <br /> 2° / %. i Date: February 27, 1998 <br /> Submit the application at least 45 days prior to your scheduled date of activity. <br /> Be sure to attach the $25 application fee and a copy of your proof of nonprofit status. <br /> Mail the complete application and attachments to: <br /> Gambling Control Board <br /> 1711 W. County Rd B Suite 300S <br /> Roseville, MN 55113 <br /> This publication will be made available in alternative format (i.e. large print, braille) upon request. <br /> Questions on this form should -be directed to the Licensing Section of the - Gambling Control Board at <br /> (612)6394000. <br /> Hearing impaired individuals using a TDD may call the Minnesota Relay Service at 1- 800 - 627 -3529 in the <br /> Greater Minnesota Area or 297 -5353 in the Metro Area. <br /> The information requested on this form will be used by the Gambling Control Board (GCB) to determine your <br /> compliance with Minnesota Statues and rules governing lawful gambling activities. All of the information <br /> that you supply on this form will become public information when received by the GCB. <br />
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