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FEB, -04` QO (FRI ) 12:46 FREFERED 017E TEL,612 0" 82801 F 035 Area mledgment Page 2 of 2 Gambling Site Auth or r'"non Oath 6. any changes in application intorM to an 111creby cOM011 that local law etlfarCQMQnt i decir:,re NE: will be submimd to tha board and 104 o Mears,the board or agents of the board,or 1. 1 Iiavz rcpA tl;u&°:n'=etim and W l unit of govemmcnt within tm days of the carnlniaianar of revenuc or information=r-,,;:red to TMe board is mie6 C change; and public safety ar ogenti of the 4cumatz, and oc. 7. 1 understand that fWjure m provj4a commissioners,may mintier the premises to ?. 411 ath�rrqu=re:=_M �rrftat.:an has been required i nformaion or providing false or en force the I aw. � dully disc lase; Bank iiccatds Information - �, � � � misleading information may ri�rii� in the 3. t am the chi r. c v�:Jv i. o=1err o,the The bourd is authorized to inspect ncc hank argariaation: d��or rcvucauon of ft lircnse. r=nrds of the gambling iwcQunt whenavcr 4. t assume fui' for the t::ir and . access any to fUiri i�arctl«Is�menrs ofcurrenr iawf'bi aperall-0n 3f F-It ace:Vr IF_s to t.e Am gombling rules and law. oonducxW- rgonization Luanne Anthorlation S. i evil I fWniIiw'zc m self with the laws of Si9 mpture of the ch s=oantiMti I hereby Qutharin the Gikmbi ing Control 'firmasom a we,i'=,I aw 41 prnbl=,ng end u'""r(Dwip=may not sign) Award to modlt-Y the 043s of org4nization rules of the tLan,;ar.d agr,�,d.If iIcemed,is licen-w to be c;Onsialan;with tho class of abide by thole i ,wb and riles,inctuding amps WN permit being applied for. irn endm ants o�� riit of aver l ed-t- cat Approval On bcu c the city,[hereby 3c k�o wi ed ge this application i .._... A% O-C for lawful gambling activity at 110 premises 10rWcd widlin of tie cry's juri sdicdon,and theta resolution Spe6 ftcelly , 44U dcdg&M upprovutg or denying tho app licadon will be forwarded to ::� � r�13f cagy po-sonncl rccei Mg spplic*don die applying or anizanon. ., AA a � / 00 - ir=w t3atc IN !L r, ' jmjtllIw On hc-.ha I l o l�the township, 1 acknow le��g�= Bill(die organization is applying to conduct lawfui garbling activity within the township limits. A mwrWtip JIM no statutory authority to appmvc or deny all =gnaluuc of tOvWmn 31P OM401=lVina nppkadon application (Minn.StM_Bar.349.213, Wbd.2). - Q ti=: Dac Ear Ihe gqMM On behalf of the cowty.i havby uc:knowl edge Vs application for lawful garnbl ing acd v iry at - ;;;n of ool h-y rho premises lacaW Within rho county's jurisdiction, Md that a rrwju�on SpftifiCnlly approving or denying the application will�forwarded to the applying organization. �`�g`'a�C o�coun�personnel rooGivnmg applioatiuri ri t~:: Date 1bc information raqucated on this form (and Your narne and a ldrcA a will be public Board whole work osaignmene require9 that any attachments)will bo ujCd by the information What tc-4iw0d by the Board. All they have fle=w to IN information;W Gambll'ng Control Soul(Board)to tha od-icr info tha iYou provide will Minnesota DBPARMOM of Public 90c;y-1 dctcrrn ine your qualifications to be invalvod be private da a aL�u=you tmtil the Board the Minnesota Attorney General;the in lawful gambling activities in Minreso'.s :ssu=your 11:ur:5. VVhCn the BOArd iSSUM Minnciou1 Commissioners Of and La moist the Board in condugdn&a your I±canse,ail &f Uhe in€C)rMUion V161t you Administration. Rnancer snd venua; the background investigation of you. You have heive prcvi&4 xc* 1.308rd in the process of Minnesom LAgislative Auditor. national l ie right W refuse 1117 supply gild information applying for ;o►:Y lice.tft will becor a and intamUional gambling regulBtary requestcd;however,if yatt rcfude TO supply publ ic. If t7e$o,�rd does nor issue you a agencies'.anyone!pursua-M to eating Order; this informmione ft Board may AOt be able limn-u:Bit the Ire.*rM.atiOn you have other individuals and e0a as drat at'C to dawrmine your quWifietions ad,es a provided in Lr.p;-acesa of 4 lying for a sp=ffically uuftr1ZW by MID or fedeml W I�sagt1WCej My refuse to iasUe you a 1icr�n�;em�ns�:rl��:e,with�a c�c�tptivn law to havc acrggs w the inform Kion; l=C�nse. If you supply ft information of your ,jams-Ml,-addre.%which wiR remain Individuals and agencies for which lbw or req ticit►ed,the Board will be Ub 1a to Pr00034 public. W&W order aLL horlaas a new use or shann g your€tpplicn;lon, of!nlb matian iif r ftj no ke WU givcn; pr1V8W data.,:oo- c y=-u are.1veilabl a only to and 10yore with :(avc writren eoneOnt. ft following.: V,jars fnem bay,marl of the