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ALCKNOWLE OMOL P15E8 AUTRI ZATION I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCE NT OFFICERS, THE GAMBLING CONTROL BOARDf OR AGENTS OF THE BOARDp OR THE COMMISSIONER OF REVEL OR PUBLIC SAFETYo, OR AGENTS OF THE HMISSIONERS, TO E'ETER THE PREMISES TO ENFORCE THE LAW O � BA'l11C REDS 11M ION THE GAMBLING CONTROL Bcum IS AuTHORIEED TO INSPECT THE BANE RECORDS OF THE GAMBLING ACCOUNT NEVER NECESSARY TO FULFILL REQUIRE NTS OF CURRENT GAMBLING RMAS AND STATUTES. 'r I DECLARE TENT t I HAVE READ TRIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; * ALL INFORMATION IS TRUE] ACC MTE AND 00KPLZTZvel AM OTHER REQUIRED INPORMATION HAS BEEN FULLY DISCLOSED; I AN THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; I WILL FMILIARI ZE MYSELF WITH THE LASTS OF KINNBSOTA GOVERNING LAWFUL GAMBLING AND RULES OF THE GAMBLING CONTROL HOARD AND AGREEr IF ISSUED A PREMISES FERNITj TO ABIDE THOSE LAWS AND RCS# INCLUDING AMENDMENTS TO THEM; ANY AGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND Z. LOCAI+ UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING- FALSE OR•ICISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMITS .r .. Sf GNA CRISIS EZE o"lczR DATE • r LOCAL GOVERNMENT 1.a TEiE CITY* MUST SIGN THIS APPLICATION Ilr THE GAMBLING PREMISES IS L chTED WITHIN CITY x LIMITS. a THE COUNTY** AND TOWNSHIP** MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN A TOWNSHIP 3a FOR TOWNSHIPat THAT ARE UNORGANIZED OR UNINCORPORATEDp THE COUNTY** IS REQUIRED TO ATTACH A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS, S. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY APPP"%FING OR DENYING THIS APPLICATION. so A COPY OF THE twat. UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION DUST BE A ACHE'S TO THIS APPLI CATION-# $# IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SCSI TTED TO THE GAMBLING CONTROL BOARD& C BY SIGNATURE BELOW TOWNSHIP RCENOWUDGZS THAT TSE ORGANIZATION IS APPLYING FOR A ®; PREMISES PERMIT WITHIN TOWNSHIP LIMITS . s r CITY* OR ** SHIP** r CITY OR t NAME T-NSHI P N r SIG BIOTURE OF PERSON RECEIVING APPLICATION TITLE DATE RECEDED TITLE DATE REC:EI D o 0% --]UiXL Toy 1711 W COUNT2 RD M — OU TE SOD S . . W $3113