06-26-1991 Council Agenda - Laserfiche WebLink

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Minnesota Lawf21 Gambling Premise Permit Application - Part 3 ue v a' vna z.v. AcTcrfouxtedgement: Gambling Site Authorization I hearby consent that local law enforcement officers, the board or agents of the board, or the commissioner of revenue or public safety, or agents of the commissioners, may enter the premises to enforce the law. Bank Records Information The board Is authorized to inspect the bank records of the gambling account whenever necessary to fulfill requirements of current gambling rules and law. 1 declare that: I have read this application and all information submitted to the board; All information is true, accurate and complete; All other required information has been fully disclosed; I am the chief executive officer of the organization; I assume full responsibility for the fair and lawful gambling and rules of the board and agree, if licensed, to abide by those laws and rules, including amendments to them; A membership Iist of the organization will be available within seven days after it is requested by the board; Any changes in application information will be submitted to the board and local government within 10 days of the change; and, A termination plan will be submitted to the board within 15 days of the termination of all premise permits. Failure to provide required information or providing false information may result in the denial or revocation of the license. Signature of chief executive officer Gat GouerRment Ac nowIedgement Date 4/25/91 1. The city 'must sign if the gambling premises is located within city limits. 2. The county "AND township' must sign if the gambling premises is located within a township. 3. The local government (city or county) must pass a resolution specifically approving or denying the application. 4. A copy of the resolution approving the application must be attached to the application. 5. Applications which are denied by the local governing body should not be submitted to the Gambling Control Division. Township: By signature below, the township acknowledges that the organization is applying for a premises permit within township limits. City' or County" Township•' City or County Name Little Canada re of person recei Township Name g applicatio Signature of person receiving application ty Administrator Person delivering application to local governing body Date Richard E. Boss, III 14/25/91 Date Received 4/25/91 Tide Date Received Is township: ❑ Organized ❑ Unorganized ❑Unincorporated Refer to the Instructions for the required attachments Mail to: Page 18 Department of Gaming Gambling Control Division Rosewood Plaza South, 3rd Floor 1711 W. County Road B Roseville, MN 55113