Laserfiche WebLink
<br />LG220 Application for Exempt Permit <br />Organization Name <br />Local Unit of Government Acknowledgment <br />If the gambling premises Is within city limits, the <br />city must sign this application. <br />On behalf of the city, I acknowledge this application. <br /> <br />Page 2 of 2 <br />11/04 <br /> <br />Check the action that <br />the city Is taking on this application. <br /> <br />O The city approves the application with no <br />waiting period. <br /> <br />O The city approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days (60 days for a first class <br />city). <br /> <br />o The city denies the application. <br /> <br />Print name of city <br /> <br />Signature of city personnel receiving application <br /> <br />Title <br /> <br />Date-1-1_ <br /> <br />" <br /> <br />Chief Executive Officer's Signature <br />The infonnation provided in this application is complete and aecura <br />:=~I report will be comPlet~~~ to the Gamb~i <br /> <br />Chief executive officer's signrre-= <- <br /> <br />Name (please print) ~ <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 /> <br />Check the action that <br />the county Is taking on this application. <br /> <br />O The county approves the application with no <br />waiting period. <br /> <br />o The county approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days. <br /> <br />o The county denies the application. <br /> <br />Print name of county <br /> <br />Signature of county personnel receiving application <br />Title <br />Date-1-1_ <br /> <br />TOWNSHIP: On behalf of the township, I acknowledge that <br />the organization Is applying for exempted gambling activity <br />within the township limits. [A township has no statutory <br />authority to approve or deny an application <br />(Minnesota Statute 349.213, subd. 2).] <br /> <br />Print name of township <br /> <br />Signature of township official acknowledging application <br />Title <br />Date--1--1_ <br /> <br />to the best of my knowledge. I acknowledge that tha <br />ntrol Board within 30 days of the date of our gambling <br /> <br /> <br />Mall application and attachments <br /> <br />Complete an application for each <br />gambling activity: <br />. one day of gambling activity <br />. two or more consecutive days of <br />gambling activity <br />· each day a raffle drawing is held <br /> <br />Date~...1!....J~ <br /> <br />Send: <br />· the completed application, <br />. a copy of your proof of nonprofit status (see Instructions), and <br />. a $50 application fee. Make check payable to nSate of Minnesotan. <br /> <br />To: Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Rosevllle, MN 66113 <br /> <br />~ <br />