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f-13a <br />CG, 230(81891) Minnesota Lawful Gambling <br />Application for ane -Day <br />Off -Site Lawful Gambling <br />V- V- W-- <br />I have received a, copy of this application. This, application will be r,evileiwed by, the Gambling Control Board and will become effective 60 <br />days, from the date of receipt by the city or county, uniless the local government passes a resolution to specifically forbid the activity. A copy <br />of that resolution mnust be received by the, Garnbling Control Board within 60 days of the date filled in Wow. <br />City or County (tio, be filledin for alI applicants ) <br />City or county narne <br />d( 77- Y 0 <br />sig9ture of Person <br />itle <br />EM921=- <br />g z <br />o M4 <br />Township <br />Township name <br />e <br />Attach a copy of the lease for the off-site location <br />Mail this application and a cioply of the lease to: <br />IDepart,ment of Gaming, - Gambling Control Division <br />A." Mail Station 33, 15 <br />St. Paul, IVIN 146-3315 <br />M OTTF =-.: <br />