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E-2 UTZ & I. Ila <br />flgwft L=fuli CwnbUngi <br />P Apip, lication go Part 3 <br />G SIte An <br />I hearby ConsoM that kx:W law enforcamerd offnam the board or agents of the board., orthe commissioner of revenue or <br />Pubra z-doty., or agenm of th* commiss' <br />MGM fnay, enter this premises to eftrI the law., <br />lt=or& L-jj3A-&jC23M <br />The board is aLithafted to insped the bwki racwds of 1he gambling a=Unt Whenever necessary to NEW <br />f"Wromern of czirrom, garnbiling ruIWs and law, <br />I dadare, that: <br />Signmure at diet exemIrm Offiaw Oat* <br />1. Thai cky, 61must sign N the gambling premises is Iccz ed within cfty lilmftm, <br />2. The cou,M "AND town3hip" must sign if tha gambling promises is, !a Wohin a tcwnsnip� <br />IIIIIIIN - - —1 0 <br />3. The k= � govemmiant (City or county) rust pa -a, resciution3pecam-mlly raving or denying the applica tin <br />. <br />4. A capy cf the rescMon appmving the ap <br />pli=lian must be anached to the, aWli=ion. <br />li=)Qns whic'n" are denied by t:ho b= soverning, bafy shcuid not be submitted to the Gambling Ccntmi Oivision. <br />Town,zh1p: By nawre beiow the, tow " nshi ' <br />p acknowledges that the organization is appiying for a promises rma wah" <br />PIG in <br />C#1yO ar County," Township" <br />Qyi nor C4unW Name Townsno Name <br />Peman ricamn <br />SignatUre ot pw=n n3mving appik=Mon <br />!; mm 1-7f,-7f <br />.01 <br />WP T F; W : I I I W-111 <br />IgAaw=on to $MWqoYemtng ooc7f Dome <br />V\ - <br />j- <br />'.3--- <br />'177 I'S MWInship: 0 OrrwizDd UnOManized C] Uninwipomted <br />Refer tlo the InstMcIons for the requIred attachments Mail tol* 040 meat of dming <br />Gamaling Cantrai 0i"Vislan <br />RO-sewood Paza SmAh, 3rd Fccr <br />