CONFOPMD — FOR TRANSMISSION
<br />OF LEA AMENDMENT AND OTHER 5a
<br />INFORMATION For Board Use Only
<br />Paid Arm
<br />Check No.
<br />Date:
<br />GAMBLING LICENSE RENEWAL APPLICATION
<br />Vr1UB2j'1JP,y I JL I FM SATURDAY I — 5, P,m SUNDAY 3 — 5 PM
<br />FRIDAY 7 11 PM I S U'NDAY 1— 3 P�M ISUNDAY 7 — 10 PM
<br />19. Has license ever been® Ll Revoked (Date. 13 Susipenided Date: MAyx 19 8 Denied Date:
<br />20. Have, internal controls been submitted previously? 7KI Yes 0 No (if *No ,n attach copy)
<br />-2.11:. Has current lease been filed with the board? 0 Yes 2; No (If "No," attach copy) /V/04
<br />"i Has current sketch bieen filed with the boarld? 113 Yes No (IfoNo." attach copy) ~/K4
<br />GAMBLING SITE AUTHORIZXTION
<br />Ry Imy signatulrie below, local law enforce-ment officers , or agents of the Board are hereby authorized to enter upon the site, at any time. gambling is
<br />being conducted. to observe the gambling and to en,force the law for any unauthorized game or practice.
<br />BANK RECORDS AUTHORIZATION
<br />By my signature below,, the Board is hereby a,u�thorized to inspect th e- bank records of the General Gambling Bank Account whenever necessary to
<br />fulfill requirements-of currenit gam,blling rules and law.
<br />OATH
<br />I hereby declare that:
<br />'I. I have read this application and all linform atilon submitted to the Board,
<br />2. All information, submiltied is true. accurate and complete;
<br />3. Allll other required information has been ifully discilosed;
<br />4. 1 am the chief executive, officer of the organization;
<br />5. 1 assume, full responsibility for the fair and lawful operation of all activities to be c�onducted,,
<br />6. 1I will famrliarize myself with the laws of the State of Minnesota respecting gambling and rules ofthei board and agree, it licensed, to abide by those
<br />laws and rules, including amendments thereto.
<br />23,. Official Legal Name of Organization Siqnature (Chief Execultivie Officer)
<br />Ir
<br />ACKNOWLE&EMENT 0060TICE BY LOCAL, GOVERNING BODY
<br />I hereby acknowledge receipt oil a copy of this application. By acknowledging receipt,, I admilt having been served with notice that this application will
<br />be reviewed by the Charitable Gairribiling Control Board and it approved by the Board, will become, effective 60 days from the date of receipt (noted
<br />below). unless a resolution of the local governing body is passed which specifically disallows, such activity qnd a copy of that resolution is received by
<br />the Charitable Gamblinig Control Board within 610 days of the below noted date.,
<br />24. City / County Name (Local Governing Body) Township: If site is located within a township, please complete items 24
<br />ri T ?P'V in, M1, V n CW'T?-r T 'T 'IM I and 25,
<br />Signature of Persoin Receiving Application-
<br />ile Date Received (this date bleg 60 day period)
<br />_-FINANCE 'DEPT.-- APRTL 3 0" - 19i90
<br />Naime lot Person Dielivering Application to Loica! Governiing, 60ay."
<br />,ROBERT KRITTA
<br />Cio'"010022-01 (4/89)
<br />25. Signature of Person Receiving Application
<br />Township iNamrie
<br />While Coloy—Board Canariiiiiii — Appilticant Pink -- Local Governing Body
<br />Department of R,evien,uie - Gaming Division
<br />Ok '94
<br />Mail Statioh 3315
<br />•ter ZZ.
<br />S' It Paul, M1N 55111416-33151
<br />(612) 2971-5300
<br />*6'
<br />CONFOPMD — FOR TRANSMISSION
<br />OF LEA AMENDMENT AND OTHER 5a
<br />INFORMATION For Board Use Only
<br />Paid Arm
<br />Check No.
<br />Date:
<br />GAMBLING LICENSE RENEWAL APPLICATION
<br />Vr1UB2j'1JP,y I JL I FM SATURDAY I — 5, P,m SUNDAY 3 — 5 PM
<br />FRIDAY 7 11 PM I S U'NDAY 1— 3 P�M ISUNDAY 7 — 10 PM
<br />19. Has license ever been® Ll Revoked (Date. 13 Susipenided Date: MAyx 19 8 Denied Date:
<br />20. Have, internal controls been submitted previously? 7KI Yes 0 No (if *No ,n attach copy)
<br />-2.11:. Has current lease been filed with the board? 0 Yes 2; No (If "No," attach copy) /V/04
<br />"i Has current sketch bieen filed with the boarld? 113 Yes No (IfoNo." attach copy) ~/K4
<br />GAMBLING SITE AUTHORIZXTION
<br />Ry Imy signatulrie below, local law enforce-ment officers , or agents of the Board are hereby authorized to enter upon the site, at any time. gambling is
<br />being conducted. to observe the gambling and to en,force the law for any unauthorized game or practice.
<br />BANK RECORDS AUTHORIZATION
<br />By my signature below,, the Board is hereby a,u�thorized to inspect th e- bank records of the General Gambling Bank Account whenever necessary to
<br />fulfill requirements-of currenit gam,blling rules and law.
<br />OATH
<br />I hereby declare that:
<br />'I. I have read this application and all linform atilon submitted to the Board,
<br />2. All information, submiltied is true. accurate and complete;
<br />3. Allll other required information has been ifully discilosed;
<br />4. 1 am the chief executive, officer of the organization;
<br />5. 1 assume, full responsibility for the fair and lawful operation of all activities to be c�onducted,,
<br />6. 1I will famrliarize myself with the laws of the State of Minnesota respecting gambling and rules ofthei board and agree, it licensed, to abide by those
<br />laws and rules, including amendments thereto.
<br />23,. Official Legal Name of Organization Siqnature (Chief Execultivie Officer)
<br />Ir
<br />ACKNOWLE&EMENT 0060TICE BY LOCAL, GOVERNING BODY
<br />I hereby acknowledge receipt oil a copy of this application. By acknowledging receipt,, I admilt having been served with notice that this application will
<br />be reviewed by the Charitable Gairribiling Control Board and it approved by the Board, will become, effective 60 days from the date of receipt (noted
<br />below). unless a resolution of the local governing body is passed which specifically disallows, such activity qnd a copy of that resolution is received by
<br />the Charitable Gamblinig Control Board within 610 days of the below noted date.,
<br />24. City / County Name (Local Governing Body) Township: If site is located within a township, please complete items 24
<br />ri T ?P'V in, M1, V n CW'T?-r T 'T 'IM I and 25,
<br />Signature of Persoin Receiving Application-
<br />ile Date Received (this date bleg 60 day period)
<br />_-FINANCE 'DEPT.-- APRTL 3 0" - 19i90
<br />Naime lot Person Dielivering Application to Loica! Governiing, 60ay."
<br />,ROBERT KRITTA
<br />Cio'"010022-01 (4/89)
<br />25. Signature of Person Receiving Application
<br />Township iNamrie
<br />While Coloy—Board Canariiiiiii — Appilticant Pink -- Local Governing Body
<br />
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