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mi'nnesota Chari,tabile Gambling Control Board <br />GAMBLING LICENSE APPL'ICAfION <br />(Class A, B, or C) <br />GAMBLING SITE AUTHURIZATION' <br />BY my signature below, local law enforcement officers or agents of the Board are hereby <br />%P <br />aut,hori,zed to enter upen the site $, at any time gambling is being conducted, to observe <br />the gamblinig and to enforce the law, for any unauthorized game or practice* <br />BANK RECORDS AUTHORIZATION <br />By my signature belowg the Board i,s hereby auithorized to inspect the bank records of the <br />General Gambling Bank Accoun�t, whenever necessiary, to fulfill requirements of current gamblinc <br />rules and law. <br />OATH <br />I hereby declare that <br />le I have read this application and, all, information submitted to the Board; <br />211, All information submitted is true, accurate, and co,mpletel; <br />30 all other required information has been fully disclosed, <br />40 I am the chief executive officer of the organization; <br />5. I assulme, full responsibility f'or the fair and lawful opleiration of all activities to be <br />condu�cted; <br />6* 1 will familiarize myself with the laws of the State of Minnesota respecting gambling <br />and rules of the Board and agree, if' licensed, to abide by those laws and rules, <br />including amenidmen�ts theretof <br />Official, Legal Name of Organization <br />rh,e Church of'. .i Rose Of Lima,2 Rosetown_, V <br />Signqtq;.e ( liar b ,,signed by Chief/,Executive Officer) <br />Tit,le- # /` <br />Vice�,Rres.dent <br />Date <br />8 <br />lot -18 51 <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br />LOCAL GOVERNING BODY <br />Name of IL ocal Governing Bc)dlu--- <br />C— OF " <br />ORGANIZATION <br />Name of Representative for Gambling License Applicant <br />(serving notice) <br />Pink - Applicant Goldenrod - Governing <br />Body <br />