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LG220 Application for Exempt Permit Page 2 of 2 ............... ............... LOCAL UNIT OFIGOVERNMENT ACKNOWLEDGMENT aff�- � If thel gambling premises Is wilthin c4 film-lits, - .. ......... . ............................................................................................ If the gambling premises is, locatedin a township', a a city offir-Aal m�ust check the action, tha�t the, city is county afficial m�ust check the action that the county is taking taking o application and sign the applicabon. on this application and siign the application. A township ofricial is n�ot, mquired to sign the application. >�.The application Is, acknowledged With no waiting period- ___:r'he application is acknowledged with no waiting perliod. The application is, acknowledged with a 30 day waiting The application is acknovAedged with a 30 day waiting period, and allows the Boa�rd to issue a permit after 30 da 60 days tbr a I st class city). period,, and allows the Board to issue a permit after 30 The applicabon Is denied. d�ays. 7be application is denied. Print city name Ut.,6 Print county name On behaff of the, ci�y, 1 acknowledge this, application. I On belhaff of'the couft, I acknowledge thisi application. Signature of county official receiving application Signature of city official ceiving application III Title Date /I Title Date I (Optional) TOWNSHIP: On behalf of the townshipl I acknovdedge that the organization is applying for exernpted� gambling activfty vAthin township Hill [A township has no statutory authority tR approve or deny an application [Minnesota Statute 349.166)] Print township name Signature of township officital acknowledging application Title Date CHIEF EXECUTIVE OFFICEWS SIGNATURE R' lirW wow, low ............... IS