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ARM% <br />tiC.AACD <br />under oath state thato <br />(type/pn"nt, narne) <br />in addit"I'mi I understand, agree and hereby irrevocably consent that sults and actions reliating� to the subject <br />matter of Ittie attached gambling n-anager licensel ori acts, or omissions arlsing from suilch application, may <br />be commenceTagainst my, organization and I will accept the, service of process for my organization in any <br />court of competent Jurisdiction 'gin Minnesota by service on the Minnesota Secretary of State of any summons, <br />process or pleading authorized bly the iaws of Minnesota. <br />i I nz 1� <br />By, signatu�re of this document, the unders"grield autho 01 els, the, Department of Public Safety to conduct a <br />criminal background check or review and to share the resufts with the Lawful Gambling Control Board. <br />Fallure to provide requ�ire,d' 'Information or Providing false or mii�sileadl�ing informfilon may resuft in the denial- <br />or revocation of the licensel., <br />My, commission expirles <br />Ak '& AL k 0%0%04" 04 04 Ah A&L 01 04 A 0 A a A <br />THOMAS R. BEIG,ILI.E <br />IG <br />]LE <br />.01 No Ivy pu= <br />40UrTV <br />) <br />RU43EY COU <br />19047 <br />A? , <br />(Narne, of o,rigianization) <br />31 `3 <br />License nu fte,r <br />