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ACKNOWLEDGMENT "" LING P RXNX S E S AUTHORIZATION HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARDS OR AGENTS OF THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, TO ENTER THE PREMISES TO ENFORCE THE LAW. RANK RECORDS INFORKATION THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANS{ RECORDS OF THE GAMBLING ACCOUNT WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. I DECLARE THAT: • I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; • ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE; ; ALL OTHER RHQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; • I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACI`IVITIES TO BE CONDUCTED; • I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GADOLING AND RULES OF THE GAMBLING CONTROL BOARD AND AGREE, IF ISSUED A PREMISES PERMIT, TO ABIDE THOSE LAWS AND RULES, INCLUDING AMENDMENTS TO THEM; • ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMHLING CONTROL BOARD AND LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; • I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MIS LEADING INFORMATION MAY RESULT IN rrAE DENIAL OR REVOCATION OF THE PREMISES PERMIT. I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IWIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIWIIIIIIIVWlllllllllllllllllllllllllllllllllllllllllll .. .. ..,.. —.. .... ., .!!'ri1WNMl M1YfiRMRIWWYimMM'M'MIl�iiii111111111111111111111111111111111�8WN'MllllluxnrtOO lmllllllllllll,'NnlllIP1YIIII II�IIh,»,,»,,»,MO,..,�R,M. S17T RE MO C=H E CUTIVE OFFICER DATE 'AL GOVE ACKNOWLEDGLKENT 1. THE CITY* MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY LIMITS, 2. THE COUNTY** AND TOWNSHIP** MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIK A TOWNSHIP 3. FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY* IS REQUIRED TO ATTACH A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS 4. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY APPROVING OR DENYING THIS APPLICATION 5. A COPY OF THE LOCAL UNIT OF GOVERNMENT'_S RESOLU`ION APPROVING,.TIC I S APPLICATION MUST BE •ATTAC= _TO_ THIS_APPLI TION. 6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED TO THE GAMBLING CONTROL BOARD. TOWNSHIP: BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A PREMISES PERMIT WITHIN TOWNSHIP LIMITS. CITY* OR COUNTY** TOWNSHIP** CITY OR COUNTY NAME TOWNSHIP NAME CL-r� Or- TZP5r"k SIGN E OF PERSON RECEIVING APPLICATION SIGNATURE OF PERSON? RECEIVING APPLICATION �E DATE RECEIVED TITLE DATE RECEIVED q#jor*Kx, Urr hm%,lr- REFER TO THE CHECKLIST FOR REQUIRED ATTACHNENTS MAIL TO: GAMBLING CONTROL BOARD 1711 W COUNTY RD E - SUITE 300 S ROSEVILLE, MN 55113