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ACKNOWLEDGMENT
<br />6AXBLZNG'PREMISES AUTHORIZATION
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<br />*HEREBY" GIVE CONSENT TO LOCAL LAW ENFORCEMENT` OFFICERS: TAE. GAMBLING` "CONTROL, BOARD „ -• OR AGENTS. -..
<br />0 '. TEE 'BOARD „' OR 'TEE COMMISSIONS& OF REVENUE OR. PUBLIC'SAFETY,; OR(; AGENTS;' OE";�TEr.COMMISSIONERS;:;!
<br />•• ENTER. THE PREMISES., TO ENFORCL.THE' LAW'„. ∎A di >::'4�''. ... ..r t «�• +.a... Y7 «.•.a •.:: ..,....:u..�..w�........_--.. -. ,...-_-.-..:.....
<br />•
<br />BANIC�` RECORDS INFORMATION' .. „
<br />•' S”' ve:;•..•:..: c�.•; o, rt,:::;. 7;• :..,."is:; ?;,.;p Y;:.. a7,:: _'iSU„"Q,i..; •'
<br />TSE,;GAMBLING CONTROL BOARD. IS AUTHORIZED TO INSPECT"trieBANIC';RECORDS) OE"'THE: GAMBLIN .`ACCOUNT
<br />^. ^. R NECESSARY TO FULFILL. RE UIR r• 4Ii D.,
<br />Q EMENT3. OP_CURREN'.L' GAMBT:t'NG;; RULE .T r
<br />' x- -.r. .f�• • . Sr.�AND: 3.TATUTES' ik;.',. ..
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<br />•
<br />DECLARE: TBATt '•'• •
<br />HAVE READ THIS APPLICAT ION' AND..' ALL. INFORMATION,,SUBMITTEM ra .GAMBLINGt.
<br />ALL• INFORMATION' IS TRUE',: ACCURATE: AND' COMPLETE'i � .�;.;,,•t;;`y::' , ^r',i "jJ, `' ` + "'; • ' E`. 'e ,k 2':�;
<br />„ r
<br />ALL OTHER REQUIRED INFORMATION' HAS BEEN FULLY DISCLOSED K4,.;
<br />I:S,''AM' THE CHIEF' EXECUTIVE OFFICER. OF THE. ORGANIZATIONS; " • :• ; %'
<br />4ASSUME FULL. RESPONSIBILITY FOR THE, FAIR, AND LAWFUL ,OPERATSON'�OE"ALL'..GAMBL
<br />ACTIVITIES T0: BE' CONDUCTED, :';;'d^ ,._.e', „,•• „� ;. :G
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<br />T;li,WILL, FAMILIARIZE MYSELF WITH THE. LAWS OFD MINNESOTA GOVERNINC(;,LA GAMBLINCx'p� A'ND"RULES �`;
<br />On"; THE. GAMBLING.. CONTROL BOARD AND AGREE;7'''It ISSFIMISBI;I"PREMISES' PERMIT;;; ;;;TQv ABIDE- THOSE:. LAWS'
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<br />". Vie., •5 'r'r� >:R�i::. ':iiL.�:g ,f4 r,�''S, ad/; 4,41,44$,C .. .,.
<br />EXfl C• • OL BOARdANn
<br />•Y a',J {
<br />MISLEADIN
<br />AND;, BALES „.INCLUDTNG.AMENDMENTS_.TO?• THEM; ;+.;r +:. i•:,.•' ;r
<br />,.AH$'•_ ' CHANGES' I. N' - APPLICATIONS INFORMATIONF„ SUBMI.TTEDT
<br />LOCALF;UNIT OF GOVERNMENC' WITS TEN .DAYS\ OEt°,THE,£.CHANG n q
<br />UNDERSTAND', THAT; FAILURE- TO PROVIDE: REQUIRED:f• INFORMATIONw O PIiOINe-
<br />INFORMATION MAY:, RESULT' IN THE DENTALMM REVOCATION OF: THE:' PREMISEggEERM.
<br />TURK. OF CHIEMy.,�-XECDTIVE OFFICER;:'
<br />GOVERNMENT,'. ACKNOWLEDGMENT „;a. .. .;,,....!.,.::;;,i
<br />'rtin:.CITY* MUST' SIGN THIS APPLICATION"IF,° THE GAMBLING” PREMISE
<br />•'LIMITS.
<br />g'1RE, cowry**. AND TOWNSHIP**', MUST' SIGN".THIS;S.APPLICATION Ir'TBE. GAMBLING' PREMISES ..IS
<br />LOCATED WITHIN A TOWNSHIP:.'.. ... ;�• ,St, ..;ea:,i. «'a ;•Mr`•:r L•6:z d. °st'j >• .^'.r:i'- :.:.:;C r,�,.....
<br />FOR TOWNSHIPS TEAT ARE UNORGANIZED OR UNINCORPORATED .,.THE.COUNTY **%'IS REQUIRED' TO' ATTACH”
<br />A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS.
<br />THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION 'SPECIFICALLY
<br />APPROVING OR DENYING THIS APPLICATION. . -
<br />A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BFk
<br />ATTACHED TO THIS APPLICATION.
<br />.. 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 />;CITY* OR COUNTY **
<br />TOWNSHIP **
<br />,CITY OR COUNTY N E
<br />TOWNSHIP NAME
<br />ING APPLICATION SIGNATURE OF PERSON RECEIVING APPLICATION
<br />'E RECEIVED ... � TITLE - .' .. DATE RECEIVED.
<br />/ —/l —
<br />REFER TO THE CHECRLIST-FOR REQUIRED ATTACHMENTS
<br />MAIL TO: GAMBLING CONTROL' BOARD
<br />1713. W COUNTY RD B - SUITE 300 S
<br />ROSEVILLE, MN 55113
<br />Page 54
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