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<br />.. <br /> <br />i <br /> <br />ACKNOWLEDGMENT <br /> <br />GAMBLING PREMISES AUTHORIZATION <br />I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS. THE GAMBLING CONTROL BOARD, OR AGENTS <br />OF THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS. <br />TO ENTER THE PREMISES TO ENFORCE THE LAW. <br /> <br />BANK RECORDS INFORMATION <br />THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT <br />WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. <br /> <br />I DECLARE THAT: <br />I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARDj <br />ALL INFORMATION IS TRUE, ACCURATE AND COMPLETEj j <br />ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSEDj <br />I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATIONj <br />I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING <br />ACTIVITIES TO BE CONDUCTEDj <br />I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES <br />OF THE GAMBLING CONTROL BOARD AND AGREE. IF ISSUED A PREMISES PERMIT. TO ABIDE THOSE LAWS <br />AND RULES. INCLUDING AMENDMENTS TO THEMj <br />ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND <br />LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGEj <br />I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING <br />INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. <br /> <br /> <br />OFFICER <br />d~ <br /> <br />DATE .J. '_ <br />'7 /- 9Y <br /> <br />LOCAL GOVERNMENT AC 0 EDGMENT <br />1. THE CITY* MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY <br />LIMITS. <br />2. THE COUNTY** AND TOWNSHIP** MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS <br />LOCATED WITHIN A TOWNSHIP. <br />3. FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH <br />A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS. <br />4. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY <br />APPROVING OR DENYING THIS APPLICATION. <br />5. A COpy OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE <br />ATTACHED TO THIS APPLICATION. <br />6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED <br />TO THE GAMBLING CONTROL BOARD. <br />TOWNSHIP: <br />BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A <br />PREMISES PERMIT WITHIN TOWNSHIP LIMITS. <br /> <br />CITY. OR COUNTY.* <br /> <br />TOWNSHIP * * <br /> <br />CITY OR COUNTY NAME <br /> <br />II '(, (.J 13 r ( ,1 /~ h <br /> <br />TOWNSHIP NAME <br /> <br />rrf( <br /> <br />SIGNA~CEIVING APPLICATION <br /> <br /> <br />TITLE /JI /,j,.y DATE RECEIVED <br />{t{l4 ~ c(--(,-~! <br /> <br />SIGNATURE OF PERSON RECEIVING APPLICATION <br /> <br />TITLE <br /> <br />DATE RECEIVED <br /> <br />REFER TO THE CHECKLIST FOR REQOIRED ATTACHMENTS <br />MAIL TO: GAMBLING CONTROL BOARD <br />1711 W COUNTY RD B - SUITE 300 S <br />ROSBVILLE, MN 55113 <br />