08-27-2003 Council Agenda - Laserfiche WebLink

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LG220 Application for Exempt Permit Organization Name Local Unit of Government Acknowledgment If the gambling premises Is within city limits, the city must sign thls application. On behalf of th a city, I acknowledge this application. Check the action that the city is taking on this application. D L!The city approves the application with no waiting period. n The city approves the application with a 30 day 1—i waiting period, and allows the Board to Issue a permit after 30 days (60 days for e first class city). ■ The city denies the application. Print name of city (Signature of city pereonnel receiving application) Mlle Date / / Page 2 of 2 06/03 If tha gambling premises is located In a township, both the county and township must sign this application. On behalf of the county, 1 acknowledge this application Check the action that the county Is taking on this appltcatton. The. county approves the application with .no wailing period. O The county approves the application with a 30 day waling period, and allows the Board to Issue a permit after 30 days. O The county denies the application. Print nama of county Chief Executive Officer's Signature The information provided in thia2ppli -lion is complete { Chief executive officers signature Name (please print) (Signature of county personnel receiving application) l ite Data J TOWNStiIPI On behalf of the township,1 acknowledge that the organization is applying for exempted gambling activity wlthinthe township limits. (Atownahip has no statutory authority to approve or deny an application (Minn. Stat, sec. 349.213, *Wed. 2).1 Print name of township (Slgnatum of township official acknowledging application) Title Date J / cc ate the best of my knowledge, ,.t 0 3E T 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 to "State of Minnesota ". Application fees are not prorated, refundable, or transferable. Send to: Gambling Control Board 1711 West County Road 2, Suite 300 South Roseville, MN 55113 oat. / )3 03 If your application has not been acknowledged by the local unit of government or has bean denied, do not send the application to the Gambling Control Board.