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-2- <br />Minnesota Charitable Gambling Control Board GAMBLING LICEN) 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 />0-ficial(.,[egal Name f.0 an <br />(\;20) 111,30tpnn Won <br />Signature Must d by <br />Title <br />4 <br />wit . 1 � Q461-11, <br />Date <br />zatioe n <br />Chi i11t��� C.la l„Ar,,�j( <br />f Executive Officer) <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 />Nome of Local Governing Body <br />City of Little Canada <br />Sig ure of Pe on Receiving App 'ca <br />ate R eived (This is date from which the 30 day <br />approval begins) 8 /21 /85 <br />ORGANIZATION <br />Name of Representat've for Gambling License Applicant <br />(serving not , o <br />IG- 00001 -01 (12/84) <br />4Riite - Board Canary i board Pink - Applicant <br />(.inrn ....r _,.� <br />Goldenrod - Governing <br />