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loll' <br />Mot "0'01011r, W <br />__'_L11LWA1i1111W 1 14 1P I <br />O#j ft�M_ <br />kW_.W.P9W "To <br />A1101116 <br />-71 <br />II <br />Al V1 <br />Mi <br />el_-, _V It <br />JL i <br />4, Poo, <br />Of 40 AP 'A <br />A 10 <br />10 <br />� • " IMeM <br />H-M g isizeAnwonzauan, <br />ol am the chief executive offilcor of the organization; <br />w is A here consent" that local law entomement, offlicers, the <br />11Y <br />oil assume full responsibil" for the fair and lawful opera- <br />ity <br />board or agents of the board., air the commissioner of <br />tioin of all adlovhies to be conducted; V, <br />fevenuie or public safety,,, or agents of the, commissioners, <br />all will familiarize myself with the laws of Minnesota <br />;-may enter the, prelmis�es to enforce, the law., <br />gaverning lawful gambling and rules of the board and <br />13 Records Tnformmatlon <br />agree, N liconsed., to abide by those laws and rules, <br />The board is authorized to inspied the bank records of the <br />Including amendments to theme <br />giambling unt whenever necessary, to fulfill <br />eany changes in application information will be submitted <br />mquirements of c�urTe�n't gambling rules and law. <br />to the board and local unit of government within 10 days <br />Oath <br />of the change; and <br />11 declare that: <br />oil undersillandthat failure to provide required information' <br />4 have read this application and all information submitted <br />or providing false or misleading information may result In <br />W tber� b6itrd is true_," accurate, , and c *.'m% p''Ietlei; <br />the denial or revocation of the license. <br />*aH other required Information has been fully disclosed; <br />Signature i'ief executive officer . ,I <br />.,,P �IAe * ®; �. ' x Date <br />9 <br />1. The to yl emlu�st sign this applicad ion if the ga,mbiling prom-, <br />es "I's located within city limits. <br />2. This Icolunty "AND township** must sign this, application I <br />th) gambling promises is I tedl Iwlithin a township. <br />31, The local unit golvernmeinit (city or county) must pass a <br />resolution, specificlall, approving or denlying this application., <br />y <br />atIr or Countr Townshlo** <br />C-4 or County (Name, <br />V" <br />Signaturle of person receiving application <br />ride <br />'#T_ "77 :747=717,0111111111111 <br />-91 <br />Refer, to ft insviuctions for required aftachments., <br />MaWl to: Gambling Contriol Board <br />Rosewood Plazz Southl, 3,rd Floor <br />1711 W lent IRoald 8 <br />Roseville, iW ICI 55,113, <br />C <br />so <br />Towship Name <br />f Signature, of persion receiving application <br />01 <br />1141 'Part 2) <br />