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- 2 - <br />Minnesota Charitable Gambling Control Board <br />GAMBLING LICENSE APPLICATION <br />(Class A, B, or C) <br />GAMBLING SITE AUTHORIZATION <br />By my signature below, local law enforcement officers or agents of the Board are hereby <br />authorized to enter upon the site, at any time gambling is being conducted, to observe <br />the gambling and to enforce the law for any unauthorized game or practice. <br />BANK RECORDS AUTHORIZATION <br />By my signature below, the Board is hereby authorized to inspect the bank records of the <br />General Gambling Bank Account whenever necessary to fulfill requirements of current gambling <br />rules and law. <br />OATH <br />I hereby declare that <br />1. I have read this application and all information submitted to the Board; <br />2. All information submitted is true, accurate, and complete; <br />3. all other required information has been fully disclosed; <br />4. I am the chief executive officer of the organization; <br />5. I assume full responsibility for the fair and lawful operation of all activities to be <br />conducted; <br />6. I will familiarize myself with the laws of the State of Minnesota respecting gambling <br />and rules of the Board and agree, if licensed, to abide by those laws and rules, <br />including amendments thereto. <br />Official, Legal Name of Organization <br />vc t-it.s of 1"1ary -V11 C_ <br />Signet (Must be e ry Chief Executi,{e Officer) <br />Title <br />'l C c - Pr c94 % ce a? <br />Date <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br />I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I <br />admit having been served with notice that this application will be reviewed by the <br />Charitable Gambling Control Board and if approved by the Board, will become effective 30 <br />days from the date of receipt (noted below), unless a resolution of the local governing <br />body is passed which specifically disallows such activity and a copy of that resolution is <br />received by the Charitable Gambling Control Board within 30 days of the below noted date. <br />LOCAL GOVERNING BODY <br />Ntiity oTa iietvge anaecfx <br />eV (Th s s dot from which the 30 day <br />approval begins) March -26 -85 <br />ORGANIZATION <br />Signet re of Pers n Receiving Ap ic ion <br />����. <br />D e Rec <br />Name of Representative for Gambling License Applicant <br />(serving notice) <br />CC- 00001 -01 (12/84) White - Board Canary - Board Pink - Applicant Goldenrod - Governing <br />(data entry) <br />007 <br />Body <br />