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aw 2 <br />Minnesota Charitable Gambling Control Biolard GAMBLING LICENSE APPLICATION <br />(Class A, B, or C) <br />GAMBLING SITE AUTHORIZATION <br />Bly my, signature below, 11DC81 law enforcement officerS or agents of the Board are hereby <br />authorized to enter, upon the site, at any time gambling is being conducted, to observe <br />the gambil,i,nig and to enforce the law for any unauthorized game or practice-6 <br />BAN) ORDS AUTHORIZATION <br />By, my s,ignat,ure be�lowl, the Board Is hereby authorized to inspect. the bank records of the <br />General GainblAiLng Bank Account, whenever necessary to fulfill requirements of current gamblinc <br />rulies and low." <br />OATH <br />I hereby, declare that <br />1 0 # I ha'vo read this application and all information, submitted to the Board; <br />2 . All information submitted is true, accurate, and complete; <br />30, all other required information has been fully disclosed; <br />4a I am the chi,3*Le,f executive officer of the organization; <br />5. 1 assume full riesponsibillity for the fair and lawful operation of all activities to be <br />c o ni diu c it e d ; <br />6 1 will familiarize my'self with the laws of th�e State of Minnesota respecting gambling <br />and rules of the Board and agree, 'If licensed, to abide by those laws and rules, <br />includinig amendments thereto. <br />Official, Liegal Name of Organization <br />Rosetown Memorial Post No 542 <br />ignatur (Must be signed b <br />y Ch"ef kecutive Officer) <br />Wa 9J-04 <br />Title <br />Connander, <br />Date <br />ACKNOWLEDGEMENT OF NOTICE BY' LOCAL, GOVERNING BODY <br />I he�reby acknolwledg�e recelipit of' a copy of this application. By acknowledging receipt, I <br />admil't having been served with noitice that this applicati]'.oin will be reviewed by the <br />Charitable Gambling Control Board and "If' approved by the Board,, Will become effective 30 <br />1 days, from the date of receipt noted bell,ow), unless, a resolution of the <br />local governing <br />is passied which specif"cally disallows such sictivity and a, copy of that resolution is <br />bi a d y <br />I received by, thiie Charitable Gambling Conit,ral Board within 30 days of the below noted date. <br />LOCAL GGIVERNING BODY <br />JI Niame of Local Governing Body <br />UtY Ros <br />of ievine <br />*1 - I <br />re &L-Perso <br />SA ing App ation <br />or <br />Date Received (TKls is date from Wichi'the 311) day <br />approval begins) <br />ORGANIZATION <br />Name of Representative for Gambling License Applicant <br />(serving notice) <br />M-00001-01 (12/84) 'White - Boarid Canary - Board Pink,, - Applicant Goldenrod - Governing <br />(data entry Body <br />