08-24-2005 Council Agenda - Laserfiche WebLink

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. /lO. :,-,C), L0220 Application for Exempt Permit Organization Name Local unit of Government Acknowledgment Page 2 or2 lithe gambling premises is within city limits, the city must sign this application, On behalf of the city, I acknowledge this application. Check the action that the city la taking on this application. 7 The uty approves the application with no 1— waiting period. The city approves the application with a 30 day wailing period, and allows the Board to Issue a permit after 30 days (60 days fora first class city). . The city denies the application. Print neme of city (Signature of city personnel raceiving application) Title Date / / Chief Executive Officer's Signature The information provided in this applicatio ��s . e et+ a d actuate to th t of my knowledge. r Name (please print) " it • i.SO:\11 @.Y' 06/03 If the gambling premises Is located In a township, both the county and township must sign this application. On behalf of the county, I acknowledge this application. Check the action that the county Is taking on this application. Thei county approves the application with no wailing period. ElThe county approves the application with a 30 day waling period, and allows the Board to Issue a permit after 30 days. The county denies the application. Print nama of county (Signature of county personnel receiving application) Title Data TOWNSHIP, On behalf of the township, I acknowledge that the organization is applying for exempted gambling activity within the township limits. (Atownship has no statutory authority to approve or deny an application (Minn, Stat. sec. 349.213, subd. 2),I Print name of township (Signature of township official acknowledging application) Title Date I / Chief executive officer's signature Date 9 (91 / of Mail Application and Attachments At least 45 days prior to your scheduled activity data send: • the completed application, • a copy of your proof of nonprofit status, and • a check for $50. Make check payable lo "State of Minnesota ". Application fees ars not prorated, refundable, or transferable. Send to Gambling Control Board 1711 West County Road 8, Suite 300 South Roseville, MN 55113 If your application has not been acknowledged by the local unit of government or has teen denied, do not send the application to the Gambling Control Board.