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0 <br />Local Government Acknowledgement <br />%.0 <br />I hnivo received a copy of 1his applilca6lon. This application will be reviewod by, tool Gambling Control Board and will boc*mo Offoctivio 60 <br />dl Isl from the dait,o, of receipt by the c4i ty lor colunity, unless the local govornmont paisses a resolution to spocifically forbid tho activity. A copy(, <br />of that resolution must be, raceffivied by the Gambling Control Board wilthin 6,10 days of the data filled in below. <br />I or ou ppl <br />ty --- C -nly (to be filled in for a a Fcants <br />City or county namie <br />Signature of Person rioco'lliving application <br />Titio <br />12 <br />Da to recilolved ju—n-, 14M <br />Townsihl <br />Township norno <br />Signaturo of person r000lving application <br />A 11 Elm= <br />Mail thl's application and a copy, of the, I'leaso, to: <br />Dieipa,rtmeint olf Gaming - Gambling Control Divislon <br />Mail Station 3�315 <br />St. Paulp MN 55146-M15 <br />