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Page 2 of 2 <br /> Application for Exempt Permit - LG220 3/98 <br /> Organization Name Church of St. Genevieve <br /> Local Unit of Government Acknowledgment (Required by Statute) <br /> ie Xp"_ P1129 ' Fenill d =h '�.g�th <br /> 5 11 ­ . If fwl" <br /> ocate <br /> us <br /> _g <br /> V !T A <br /> On behalf of the city, I acknowledge this application On behalf of the county, I acknowledge this application <br /> and three options for the city: and three options for the county: <br /> 1. Approve the application: By taking no action, 1. Approve the application: By taking no action, the <br /> the city allows the Board to issue a permit after county allows the Board to issue a permit after30 days. <br /> 30 days (60 days for a first class city). 2. Waive the above-noted waiting period: The county <br /> allows the Board to issue a permit before 30 days. <br /> 2. Waive the above-noted waiting period: The Documentation attached. <br /> city allows the Board to issue a permit before 3. Deny the application by passing a resolution within <br /> 30 days (60 days for a first class city). Docu- 30 days. <br /> mentation attached. Print name of county: <br /> 3. Deny the application by passing a resolution <br /> within 30 days (60 days for a first.class city). (Signature of county personnel receiving application) <br /> Print name of city: Title <br /> Date I <br /> (Signature of city personnel receiving application) On behalf of the township, I acknowledge that the <br /> organization is applying for exempted gambling activity <br /> Title within the township limits. <br /> Date <br /> A township has no statutory authority to approve or deny <br /> an application (Minn. Stat. sec. 349.213, subd. 2). <br /> Print name of township: <br /> (Signature of township official acknowledging application) <br /> Title <br /> Date <br /> Chief Executive Officer's Signature <br /> The information provided in this application is complete and accurayto the best of my knowledge. <br /> Chief Executive Officer's signatureLZ. <br /> Name (please print) Richard J. Wolter Date 6 7 1 <br /> Mail Application and Attachment(s) <br /> At least 45 days prior to your scheduled activity date send: <br /> • the completed application; <br /> • a copy of your proof of nonprofit status, and <br /> • a $25 application fee (make check payable to "State of Minnesota")- Application fees are not prorated, <br /> refundable, or transferable. <br /> Send to: Gambling Control Board <br /> 1711 West County Road B, Suite 300 South <br /> Roseville, MN 55113 <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 />