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1998-12-07 Packet
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1998-12-07 Packet
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Minnesota Lawful Gambling <br /> Premise Permit Application - Part 2 of 2 <br /> Gambtirlg Bank Account ir�fornirztion <br /> Bank Name Bank Account Number <br /> Bank Address Ulry State Zip Cow <br /> X=Em <br /> Name Tess e <br /> . . .... ....... <br /> Gambling Site Authorization -1 am the chief executive officer of the organization; <br /> I hereby consent that local law enforcement officers, the •1 assume full responsibility for the fair and lawful opera - <br /> board or agents of the board, or the commissioner of tion of all activities to be conducted; <br /> revenue or public safety, or agents of the commissioners, -1 will familiarize myself with the laws of Minnesota <br /> may enter the promises to enforce the law. governing lawful gambling and rules of the board and <br /> Bank Records Information agree, if licensed, to abide by those laws and rules, <br /> Tne board is authorized to inspect the bank records of the including amendments to them; <br /> gambling account whenever necessary to fulfill -any changes in application information will be submitted <br /> requirements of current gambling rules and law. to the board and local unit of government within 10 days <br /> Oath of the change; and <br /> I d eclare that: -1 understand that failure to provide required information <br /> -1 have read this application and all information submitted or providing false or misleading information may result in <br /> to the board is true, accurate and complete; the denial or revocation of the license. <br /> -all other required information has been fully disclosed; <br /> I nCa I a of c" xacu" <br /> al Govemme Acknoultedgement <br /> 4. A copy of the local unit of government's resolution ap- <br /> 1. The city 'must sign this application if the gambling pram- provino this aoolication must be attached to this application, <br /> ises is located within city limits. 5. If this application is denied by the local unit of goverrimani, <br /> 2. The county **AND township•• must sign this application 0 it should not be submitted to the Gambling Control Board. <br /> the cam blind prem ises is located within a township. <br /> 3. The local unit government (city or county) must pass a Township: By signature below, the township acknowledges <br /> resolution specifically approving or denying this application. that the organization is applying for a premises perimit within <br /> township limits. <br /> City* or County** Township*' <br /> City or County Name Township Name <br /> Signature of person receiving application Signature of person receiving application <br /> Tide I Date Received Tide I Date Received <br /> Refer to the instructions for required attachments. <br /> Mail to Gambling Control Board <br /> Rosewood Plaza South, 3rd Floor <br /> 1711 W. County Road 8 <br /> Roseville, MN 55113 LG214(Part 2) <br /> (R.7,�I) <br />
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