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71G 230(2/2mo)) Minnesota Lawful Gambling <br />Application jor On: <br />r <br />Of'f=S:ite L:awiful Gambling, <br />Send in this aWfimtion at least 60 days before your gambling acdvity. <br />n or Met execulive orlicer (p4ease pringi I Signature of chief executivel offer 1Date Phone Number' <br />Alff-SlIte Inforn tion <br />Locial Government Acknowledgement <br />ll have received a copy of this appli,cadon. This application will be reViewed Iby, the Gambling Control Board and will become effective 60 <br />days from the date of receipt', by the city or county, unless the locW golvernment, passes a resolution to specifically forbid the activity. A copy <br />Olt that resolution rmust be received by the, ' Gambling Control Board within 60 days, of the date filled in below. <br />Laty or county to be, filliedl in- r, all applican <br />City or county name R,o s e vj'- 11e <br />IllownshIp <br />Township name <br />Signature of person receiving, application Tie: 7 Signature of person receiving application <br />FF <br />Attach a copy of the lease, for, the, off-site location <br />Malil this application and a" copy of the lease to <br />Department of Gaming - Gambling Control DiWision <br />Mail Station 33115 <br />St. Paul, IVIN 114,6-3315 <br />