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A 41 <br />nn&wta, L=ful Ganiblbv <br />LG230 <br />Application for' One-mDay <br />OffmSi,t,e Lawful Gambling <br />117V <br />N-72 Z <br />4. WWfz&&W� conducted bff-slte 1jambi ing ft mikndu YOW7 LJ Y"I M <br />YW' <br />J,affinn that ft above Informadon is true and comect <br />For Board use o <br />fez, wnw w= ww %mup oi um wvwit <br />i�.. The city must siign this apprmbon it the gambling premiseS IIS 1=190 in 01Y arnim. <br />2. 'Jrhe gg1jaUl AND townshl"g. must sign this application if the 19ambling pivilmises, i's located Wfthin a tcwnship. <br />13. The local unit of govemmen�t (chy or county) must pass a resolution specificWty approv*mg or denying this appfication <br />4. A, cogy thg I 1� Unit of gWrn apts rgsolution V this ag,E),licato MUAt be attadMd aiopjicaflon- <br />2= <br />16. If fts, apphimton is, &%nied by ft . local unit of govemmient, it should root be subeftd to the Gambling Control Board. <br />I <br />TownshIp <br />Township name <br />0 0 <br />ftimium of person wamng application <br />Tide Data received <br />