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<br />2009-02-27 11:43 <br /> <br />NORTHWEST AIRLINES INC <br /> <br />6127263761 >> <br /> <br />6516530071 <br /> <br />P313 <br /> <br />LG220 Application for Exempt Permit <br />LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT <br /> <br />If Ihe gambling premises is within ~ily Iimilll. <br />a ~il)r offi~ial must ~heek IX) the action that Ihe <br />~ity ia taking on Ihis appli~tion and sign the <br />application. <br /> <br />_The application is acl<nowledged willl nowarting period. <br />_The application is acknowledged with a 30 day wailing <br />period, and allows. the Board to issue a permit after 30 <br />days (eo days for a 1st class city). <br />_The application is denied. <br /> <br />Print city name <br />On behalf of the ci1y, I acl<nowledge Ihis application. <br /> <br />Signature o' Clty official recei....ing application <br /> <br />Trtle <br /> <br />Oale_'_I_. <br /> <br />* CHIEF EXECUTIVE OFFICER'S SIGNATURE <br /> <br />Pl:tge2ot2 <br /> <br />Il108 <br /> <br />If the gambling premiaea ia located in a township, a <br />~ounty official must cheCk (Xl ""' action that the county <br />I, Iakltlg on this application and sign the application. A <br />township official must also Bign the appllcation. <br /> <br />_The applk;ation is acl<nCNIledge<l wilh no waiting period. <br />_The application is acl<nowledge<l wilh a 30 day wailing <br />period, and allows the Board to issue a permit after 30 <br />days. <br />_The application is denied. <br /> <br />Print county name <br />0/1 behalf of the county, I acknowledge this application. <br />Signalllls 01 county official receiving application <br /> <br />Title <br /> <br />Dale <br /> <br />1 <br /> <br />TOWNSHIP: On behalf 01 the 10wnShip, I ecllnowledge thet <br />the organization is appl~i"ll for e.empled gambling adivity <br />within ,ownship limits., rA township t1e5 no staMOfV authority to <br />approvo Of' deny an apPlication (Minnet;uta Statute 3"'9.213. 5ubd. 2)1 <br />Print 10wnship name <br /> <br />Signature of township official acl<nowledging application <br /> <br />T~1e <br /> <br />Dale <br /> <br />, <br /> <br />I <br /> <br /> <br />The infotmation proVided in /1Iis appIicafion is complete and BCCUIllI9 10 the /Jest of my know <br />nnanciat report will be completed and retu to the 8<fB'J1 wi . 30 day of fhe dale of our 9 <br /> <br />Chiel executive offi<:e~s signature \ 1 . Date <br /> <br />~: <br /> <br />Comp....lI .....l'lII8 aP!lllcatlon for each gambing adivity: <br />- one day of gambling activity, <br />. r.vo 01 more consecutive days of gambling aCliviry, <br />- eech da~ a rallle drawing IS held <br /> <br />Send application with: a copy of your proof of nonprofit status, <br />and $50 application lee lor each evanl. Make ched< payable to <br />"Sta" ot Minnesota." <br /> <br />To: Gambling Contto! Boonl <br />1711 west County Roan e, Suite 300 South <br />Rosev~le, MN 55113 <br /> <br />9Cl<nowledge that fhe <br />ng ac!ivi/y. <br />j-Z-O<j <br /> <br /> <br />Financial ",port and 19cordkeeping <br />requi19d <br />A financial reporllorm and instruclions win be <br />senl with ~our pem'ln. VlMhin 30 doys of the <br />activity dale, complete and return the financial <br />report form to the Gambling Control Board. <br /> <br />Qwsliona? <br />Call the Uoensing Section of the Gambling <br />Conttol Board aI651.639-4076. <br /> <br />PrInt Fonn <br /> <br />Reset Form <br /> <br />D... privBey. this rOrM wlU be made!! awllabie In the Board will be eble w pI'OQeS!A your <br />.1'_ ,......1 0... Wgt "',",c 8r....) u_ oppllcation. Your nome ond ond fOUl" <br />'.quesL The ....l'onnadon tequested on mls form org&l"Ilzadoo's neme end eddfess wi. be pubic <br />(and itrf attadlments) will be used by the InfDn'n8llon wtwln received by the Board, All <br />Gambling Connol Baird (8oMd) 10 detenTllne )'~, the oIher tntonn"ti.on 'tOLl pnMde will be priVllll.. <br />qu_ionsloboirwo!vtdillllwlul_bItng _ '"'iii "'" - - your pomlil. - <br />~inM_., V..........."9"'.. 1l101loanl_~ourponnl\.oIlollhe <br />ftfu$f ta supply the 1nf000rnatlon requested; ill'ormaoon prtNided m the ~ win beeo:"'l!I <br />however, If you r!!!fuse 10 supply this in'ormation, public. If thl 801fd does not lII'ue. pennlt, all <br />tM 80Ird may nM be able to cleterminl!!)'OUf infOrmation ~ remains private. wich -.e <br />qlYllfkidons and, U II con$tqucnce~ may rduSoe exception of yow ~ and your ~~'B <br />to iuut you. I)ftmft. If)'Ol.l JUOpIy ,he n~ ttnd "'1 ~ wit remeln pubf.:. <br />information ,eqUt:St~. PriY8le data al"9 BVlIJlablB lo: Board membel1l, <br /> <br />BoaRI""'W_wor1t requires....... to Ill. <br />in_lion: _.. D_.._oofPublic <br />Solely: """""'V _: Commission""'.' <br />Adminisullion. Fi~. Ind Rtyenue; <br />leglal8tlve Audlloc, nBllon8l and Intl!ll'nadonal <br />gol11bling f8lJMtoIY __ onyon.. ""_I <br />to court order, dIW i~ end 8gWldM <br />lhtI. ttn!I IPtCificely aulhorized by I!Itsts or <br />fedetallaw to NlWl ateeM to I.h6 Intorma~; <br />;ncIividuola _ __ "" W111C1l1ow...1egaI <br />otder autflOI'lZM a new use or tl\aring of <br />Infonntuon Ift6r this NMC8 WM gfven; end <br />anyone with yourmnsenl. <br />