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<br />Application for Exempt Permit - LG220 <br /> <br />Page 2 of2 <br />10/98 <br /> <br />Organization Name <br />Local Unit of Government Acknowledgment (Required by Statute) <br /> <br /> <br />If the gambling premises Is within city limits, the <br />city must sign this application. <br /> <br />On behalf of the city I I acknowledge this application <br />and three options for the city: <br /> <br />1. Approve the application: By taking no action. <br />the city allows the Board to i.ssue a permit after <br />30 days (60 days for a first class city). <br /> <br />2. Waive the above-noted waiting period: The <br />city allows the Board to issue a permit before <br />30 days (60 days for a first class city). Docu- <br />men:tation attached. <br /> <br />3. Deny the application by passing a resolution <br />within 30 days (60 days for a first class city). <br /> <br />Print name of city: <br /> <br />(Signature of city personnel receiving application) <br /> <br />Title <br />Date <br /> <br />I <br /> <br />I. <br /> <br />Chief Executive Officer's Sig.nature <br />The information provided in this apPlicati~ is comrt1e a <br /> <br />Chief Executive Officer's signature ~ ~J\ <br /> <br />Name (please print) <br /> <br />l,D mQ.~ <br /> <br /> <br />If the gambling premises is located In a township, both <br />the county and township must sign this application. <br /> <br />On behalf of the county, I acknowledge this application <br />and three options for the county: <br /> <br />1. Approve the application: By taking no action, the <br />county allows the Board to issue a permit after 30 days. <br /> <br />2. Waive the above-noted waiting period: The county <br />allows the Board to issue a permit before 30 days. <br />Documentation attached. <br /> <br />3. Deny' the application by passing a resolution within <br />30 days. <br /> <br />Print name of county: <br /> <br />(Signature of county personnel receiving application) <br />Title <br /> <br />Date <br /> <br />I <br /> <br />I <br /> <br />On behalf of the township, I acknowledge that the. <br />organization is applying for exempted gambling activity <br />within the township limits. <br /> <br />A township has no statutory authority to approve or deny <br />an application (Minn. Stat. sec. 349.213, subd. 2). <br /> <br />Print name of township: <br /> <br />(Signature of township official acknowledging application) <br />Title <br /> <br />Date <br /> <br />I <br /> <br />I <br /> <br />Date S I 11 I oft, . <br /> <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 $2~ application fee (make check p:lyable to "State of Minnesotalll- ~lication fees are not prorated, <br />refundable. or transferable. - - - -- ~ --- <br /> <br />Send to: Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 <br /> <br />If your application has not been acknowledged by the local unit of government, do not send the application to the <br />..Gamblin-g Control Board.. -_. " . . <br /> <br />r'" <br /> <br />;.~ <br /> <br />1tJ <br />