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Minnesota Lawful, Gambling, <br />Gambling License Application - Part 3 <br />Oath <br />,-* T--- <br />Vi <br />93 - ILUBIZE= Edo <br />I hereby consent that local law enforcement officers,, the, board Wagents of the boiard, or the commissioner of revenue or <br />public safety, or agents of the commissioners, may enter the Ipremises to enforce the law. <br />in MI <br />x3ang <br />records Authorization <br />The board is authorized to insp6ct the bank records, of the gambling account whenever necessary to fulfill requirements of <br />current gambling rules, and law. <br />I declare that: <br />el have read this application and all information submhted to, the board-, <br />*Al1l infor M-ition is true, aiccuTate and c*mpilete; <br />*A11 other req u ired 'I nfo rmat io n has been fully d isclosed; <br />*1 am the chief executive officer of the organization-, <br />of assume full responsibility for the fair and llawful operation of all activities to be conducted; <br />al will familiarize myself with the laws of Minnesota governing lawfu,ill gambling and ruches of the board and agree , if licensed, to <br />abide by those liaws and rulles, iniclulding amendments, to them; <br />eA membership list of the organization will be available within seven days after it is requested by the board; <br />opAny changes in application 'Information will be s�u�bmftted to the board and local government within 10 days of the change; and <br />nA termination plan will be, submitted to the board within 15 day's when the, organization's license is terminated. <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Locial Govemme <br />VL "Acknowl, ent, <br />-� e!�gem <br />city 'mulst sign #'the gambfing premisesi is Jocated within any city limitsi. <br />7h,e countyi "AND townsh'" must s'n ifthe gambling premisies is located4fthin a township. <br />/P 19 <br />I have received a copy, ofthis application. This application will be, reviewed by the Gambling Control Division, and 'if approved <br />by the Director, and will become effective 60 days from the date ofteceipt by th�e city or county, unless the local government <br />,(city or cou�nty) passes a, resolution to specifically forbid the activity. A clolpiy of that reisol�uti�on must be received by the <br />i <br />Gambiling Control Division within 60 days of'thei date, filled in below. <br />cIfty or 0olUnty, <br />C'iry or county name <br />Signature, of person ir6 c <br />jz-0, LL)E: <br />iving application <br />Uate receivea <br />.P <br />1411 <br />71 Fit <br />,Name of person delivenng application to locaj govemment <br />.......... <br />Refer to the instructions for the required attachments. <br />Mail to: IC epartment of Gaming <br />Gambling Control Division <br />Mail Station 3315 <br />St. Paul, MN 146-3315 <br />Townsh 1'p** (corripiate in add lion to county signature) <br />Township came <br />gnature of person receiving application <br />ide I Date receiveo <br />Is township: 0 o�rg�anized El unorganized 13 unincorporated <br />