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Application for Exempt Permit - LG220 <br />Page 2 of 2 <br />10/98 <br />Organization Name <br />Local Unit of Government Acknowledgment (R <br />Ifthegamblmg titiMises Wivithith <br />city mustVgn this appiieat onli ; <br />On behalf of the city, I acknowledge this application <br />and three options for the city: <br />1. Approve the application: By taking no action, <br />the city allows the Board to issue a permit after <br />30 days (60 days for a first class city). <br />2. Waive the above -noted waiting period: The <br />city allows the Board to issue a permit before <br />30 days (60 days for a first class city). Docu- <br />mentation attached. <br />3. Deny the application by passing a resolution <br />within 30 days (60 days for a first class city). <br />: / _44//C1/24 <br />(Signature //of�� city 'jsonnel receiving fri eiving ap cation) <br />Title 1./e Pu Ty d <br />Date-1--/ 46_92_ <br />Print name ofcity <br />/ /kA' <br />Chief Executive Officer's Signature <br />Ji thergambiing) premisesais ,locatedriniaftownshrpboth <br />tllercountyt liditownshiprmustisfgnthis appilcafon' <br />On behalf of the county, I acknowledge this application <br />and three options for the county: <br />1. Approve the application: By taking no action, the <br />county allows the Board to issue a permit after 30 days. <br />2. Waive the above -noted waiting period: The county <br />allows the Board to issue a permit before 30 days. <br />Documentation attached. <br />3. Deny the application by passing a resolution within <br />30 days. <br />Print name of county: <br />(Signature of county personnel receiving application) <br />Title <br />Date / / <br />On behalf of the township, I acknowledge that the <br />organization is applying for exempted gambling activity <br />within the township limits. <br />A township has no statutory authority to approve or deny <br />an application (Minn. Stat. sec. 349.213, subd. 2). <br />Print name of township: <br />(Signature of township official acknowledging application) <br />Title <br />Date / / <br />The information provided in I s app <br />Chief Executive Officer's si(_c ature <br />Name (please print) <br />on is complete <br />:n• acc• <br />sisis� ta. oifirtinsis/� <br />ate t <br />the best of my knowledge. <br />Robert J. Fitzpatri <br />Date 8 / 73 / 99 <br />Mail Application and Attachment(s) <br />At least 45 days prior to your scheduled activity date send: <br />• the completed application; <br />• a copy of your proof of nonprofit status, and <br />• a $25 application fee (make check payable to "State of Minnesota "). Application fees are not prorated, <br />refundable, or transferable. <br />Send to: Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 <br />If your application has not been acknowledged by the local unit of govemment, do not send the application to the <br />Gambling Control Board. <br />Page 20 <br />