|
LG220 Application forExempt Permit I,i III V?
<br /> 2 2
<br /> to
<br /> scare within city limits located in a townsh 1 1 11 p
<br /> the application is -acknowledged Path no waiting period, heapplication is ac-'knowledged with no wenting period,
<br /> 'tie acph ation is acknowledged with a 30-day waiting he application is ackr h
<br /> nowdedge(i wit a 30 day yealtI
<br /> period, and allows the Board to 'issue a peron't after 2g0 Cava period, and shows the Board to issue a permit after
<br /> (60 days for a Ist class city), 30 flays,
<br /> it I
<br /> lige application i denied. he application is derded,
<br /> D "I .
<br /> ...... Pay
<br /> re submitting applicaU n to
<br /> .............
<br /> UNTY -------------------------
<br /> gambling premotee
<br /> p
<br /> Print C
<br /> - -Ey
<br /> Print County Borne;
<br /> . ........................ ......................
<br /> ...............
<br /> Signatur a of City Personnel= Sionature of County flersorvreik
<br /> ............................. ...................... .......................... ............................. ............................ . ........................... ................................. .............................. ....................................
<br /> it
<br /> ........................... ......................... ........................... ...Date°..... . .............. 'title:......................... .................................. Date
<br /> TOWNSHIP (if required by the county)
<br /> On behalf of the township, I ackilociledge that the organization
<br /> is applying for eXernOted garart illng acildvil wirril
<br /> i i t
<br /> the township
<br /> The city or county must sign before lirnift, (A township 65 no statutory authority to approve or
<br /> submitting application to the deny an application, per pfinn, Statutes,section 3491213,1,
<br /> Gambling Control Board. Print7ownship ftarnea ......... . ......... .............. ..................................... ......................
<br /> Signature of Township Officer. .... ...................
<br /> 1"i d e s ........................... ....................................—, _Dice:
<br /> .............................
<br /> ..............111.17............ ................................ ...............—..........
<br /> CHIEF EXECUTIVE OFFICER'S SIGNATURE (required) ...................................
<br /> .................. ....................................
<br /> .............................
<br /> ........................................
<br /> Th ............................................
<br /> e ir formabor Provided in this applicat m charade to the best of my knowfedge, acknowledge that the financial
<br /> don is cor--plete and a
<br /> report,will be conIpleraid and returned to the hoard stit-hin 30 days of the eventlate,
<br /> 0
<br /> Chief Executive officer-Is Signature, otDate, of
<br /> tT.�� .;................... ............... ...........
<br /> (S
<br /> on,
<br /> is lm; .a
<br /> C R a a Pay net son"I
<br /> I 5aC r--D
<br /> ior
<br /> PrName� Fr, r
<br /> I v G e
<br /> in
<br /> ..... ......................
<br /> .................. .................................................................. ............................
<br /> ...................... ................................... ............................ .............................
<br /> .......................
<br /> ............... .....
<br /> AREQI ........... ............................
<br /> EQUIREMENTS M�ilAPPLICATION AND ATTACHMENTS
<br /> ............ ........................
<br /> ........................
<br /> CCa ............... ........................................
<br /> c P plate a separate application for, F��
<br /> 'i i Mail application witho
<br /> • all gambling conducted on two or more r r P secutive days; or,
<br /> req
<br /> gambng ndsee d , ............. copy Of your proof Of nonprofit st tust a-rid
<br /> • all licoucted on ay
<br /> application fee i`ncP-refijncbdde�). if file application 'Bi
<br /> Only one application --is required if,one or more raffle. drawings are ;)earmarked or received 30 days or more before the event,
<br /> conducted on thesarne day,
<br /> the application fee is $100; otherwise the fee is 5150,
<br /> Financial report to be completed within 30 days after the Make check Payable to State of Minnesota.
<br /> gambling activity is done-,
<br /> To, Minneap Ir Garritfling Control Board
<br /> A financial report form mill axe mailed with your permit,, Complete 17'1'.1 West County Road B, Suite 300 SOUffi
<br /> and ratt=an the financial report forryi to me Gambling- Control
<br /> Rosevll�le, MN 55113
<br /> Boand,
<br /> or organa
<br /> oo"mz� Questions?
<br /> Yet a
<br /> your organ,�_zatfoh mustlyeep ail exempt and reports for Call the Licensing Section of the Garnbling Control Board at
<br /> Sr
<br /> 3 L1/2years(ninn, tart.i.ites, section 349,166, si bel, 2(f)), 651-539-:1900,
<br /> U
<br /> ....................................... ............................... ............................ ..............................
<br /> -red tr Fr I K, r
<br /> .)orb owncy not.cw The imorroation rogues appficatorl, Your organizat,on's name and n lent of'.utille,Safety;Attomey :are rale
<br /> on tho form and isly attachments)will beweld winners will be public information wher,received COrnmossorers of Administration,Minnesota
<br /> by the Gambling Cannot Boars (Board)to by the Board, A"other information prowdediniN uta race* &Bndpwt,and RevenuL; legislativdetnrte
<br /> on qnFlincathins to be private data abs I t your oroamoadon Untli the Aud:tor national or d international garobling
<br /> be in,,,,,)' J o
<br /> .ved in lawful gambling in Board issms,the pan iK, When the Board issues regulatory agenclair anyone pursuant to coort,
<br /> 1 41 o
<br /> miIineivirat Your orvoas inizatior hthe riah�to the perTilite all inforr latror provided will bacon older,, enter and agencies at arc
<br /> l
<br /> moles to supply the informe.1.0n; hossiver, public, If the Board goes not issue a Para It,all anthmand by state or federal law to have access
<br /> your orgarlizaflon to supply this
<br /> arms individuals arid agencies for
<br /> hionroticip provided totheinf. .ition F
<br /> the Board may list as able to exception 06 Your rare aI witkano name andwhich law or legal Order is.ithorow's a new use o
<br /> mirr
<br /> C '
<br /> detera tour organizationya poillfiratforis address which Will r Mairl PUNk, Private data shar d no of infoi matior after this n ou OR was
<br /> as a rilay rouse no issue a Permit, about your organizanon are avalable tri,Board given, and a~yore your wmk-to,',consent,
<br /> if torr organization supplies th a ru r members, d
<br /> over staff whosetorp returas s
<br /> requested,the fioard vdfl be able to process file access to the information;Phrineeol&s Dehart-
<br /> riri< rearm oai11 ba needs acailahle r a err'rati?ca tui.eat:ilea iarna to art#bre ail*�_ udon roguastr
<br /> A=r equal optivsevey.
<br /> erysinypr
<br /> 84
<br />
|