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Application for Exempt Permit - LG220 <br />Organization Name <br />Local Unit of Government Acknowledgmtee t(Re <br />wlftYh 9a . �ling�i?� r�•��1�s{tW��in•c <br />p � ; mus. sr. n thisa licaHo • <br />this application <br />On behalf of the city, I acknowledge <br />and three options for the city: • <br />1.. Approve the application: By.takinl 59 action, <br />the city allows the Board to <br />class city). <br />permit after <br />30 days (60 day period: The <br />2. Waive the above -noted waiting pert eribefore <br />• <br />30 days (60 d ay yy allows s for to <br />fist class city). Docu- <br />mentation d <br />attached <br />3. Deny'the application by passing a resolution <br />within 30 days (60 Sys for a first ciass city). <br />print name .f city: <br />eat <br />(Signat e of cit /personnel receivin <br />Title <br />Date_ /j_k_/ <br />C•o <br />Chief Executive Officer's Signature <br />The information provided in this applicatio• <br />Chief Executive Officer's signature <br />Name (please print) <br />,t'c5cmf - <br />/C/14-1,-5 <br />quired by Statute) <br />f xhecgambltngiRafi isess, 9,C ted irt�aitownship; ibo lir <br />i u hcatton rrte`+ <br />thec•untyandtownship :musts %gntihi,.app .,. <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 p ersonnel receiving application) <br />„co C/ <br />Page 2 of 2 <br />10/98 <br />Title <br />Date <br />he <br />On behalf of the township, exempted acknowledge that thetivity <br />organization is applying <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 />cy plete and accurate to the best of my knowledge. <br />G <br />Date/ /7 / <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 <br />roof of nonprofit statu to "State of Minnesota"). Application fees are not prorated, <br />a $25 application fee (make check payable <br />refundable, or transferable. <br />Send to: Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 application to the <br />If your application has not been acknowledged by the local unit of government, do not send the app' <br />Gambling Control Board. <br />Page 169 <br />