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LG214 Minnesota Lawful Gambling Premise Permit Application - Part 3 .c�na� %3'�eme Gambling Site Authorization - 1 hearty 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. Hank Records Information The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill raquirements of current gambling rules and law. 1 declare that: I have read this application and all information submitted to the board; AU 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 list 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 evernment Acknowledgement. Data 1. The city *must sign if the gambling premises is located within city limits. 2. The county"AND township" must sign 11 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 cf the resolution approving the application must be attached to the application. 5. Applications which are denied by the local goveming body should not be submitted to the Gambling Control Division. Townahlp: By signature below, the township acknowledges that the organization is applying for a premises permit within township limits. City* or County Townshlp" Cary or County Name City of Little Canada Signature of person receiving application Township Name Signature of person receiving application Title Dare Received Title Date Received Person cowering appecaeon tu local governing boy Date JoAnn M. Sherman 11/28/91 Is township: ❑ Organized ❑Unorganized Refer to th. Instructions for the required attachments Mail to: Department of Gaming Gambling Control Division Rosewood Plaza South, 3rd Hoar 1711 W. County Road P,osevilki. MN 55113 ❑ Unincorporated Page.10