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Minneso to Lawful Gambling <br />Bingo Hall License Application (LG300) - Part 2 <br />I declare that this application is correct and complete to the best of my knowledge and belief. twill familiarize myself with the <br />laws of the state of Minnesota and rules of the Board regarding gambling and agree, if licensed, to abide by those laws and <br />rules, including amendments to them. Changes in the information submitted in this application will be submitted to the Board <br />• and local government unit within ten days after the change occurs. <br />9. Si <br />tur of chief executive officer of the lessor <br />10. Name of Berson comple <br />Martin J. Krogman <br />Date <br />95' <br />Name (please print) Title <br />Martin J. Krogman President <br />Title <br />President <br /><,�.s$sx.F.:j««,s.<m ss < F.« n s s,�:`.L >x >- , <�.' <t` s'^cwiF s sssn5ss�;,o;s�. <br />7 acat, .ver; en A tc'n °o leclr r rrzen a: <br />1. The city' must sign if the bingo hall is located within city limits. <br />2. The county •• AND township" must sign if the bingo hall is located within a township. <br />3. The local government (city or county) must pass a resolution specifically approving or denying the application. <br />4. A copy of the resolution approving the application must be attached to the application. <br />5. An application which is denied by the local governing body should not be submitted to the Gambling Control Division. <br />Phone <br />(612 ) 661 -8345 <br />Rnsczssa' ,'.F.<scnu�.�FEi.<s;: <br />Earigi, Ana <br />01Y`?i <br />ar,o,:,n .e41. <br />• Form LG300, Bingo Hall License Application, Parts 1 and 2 <br />,Form LG302, Bingo Hall Occasion List <br />• Form LG315, Bingo Hall Personnel Information (for each person listed in item 4 and 5 on form LG300) <br />• Form LG316, Bingo Hall Affidavit, (for each person listed in item 4 and 5 on form LG300) <br />• Check for license fee of $2,500, made payable to "State of Minnesota" <br />Department of Gaming <br />Gambling Control Board <br />Rosewood Plaza South, 3rd Floor <br />1711 W. County Road B <br />Roseville, MN 55113 <br />Page 100 <br />Township By signature below, the township <br />acknowledges that the organization is applying for <br />a bingo hall license within township limits. <br />City' or County`* <br />Township" <br />11. City or ounty namee�/ / <br />/%, /C a ir/ <br />12. Township name <br />Signature of erson receiving applica' <br />Olt !--lee- vtom. -2 -/� <br />Signature of person receiving application <br />Title <br />L-4_, ice. <br />Date received <br />-�o? -7/ <br />Title - Township official Date received <br />Name of person delivering application to local government <br />Is township? organized unorganized unincorporated <br />I <br />Earigi, Ana <br />01Y`?i <br />ar,o,:,n .e41. <br />• Form LG300, Bingo Hall License Application, Parts 1 and 2 <br />,Form LG302, Bingo Hall Occasion List <br />• Form LG315, Bingo Hall Personnel Information (for each person listed in item 4 and 5 on form LG300) <br />• Form LG316, Bingo Hall Affidavit, (for each person listed in item 4 and 5 on form LG300) <br />• Check for license fee of $2,500, made payable to "State of Minnesota" <br />Department of Gaming <br />Gambling Control Board <br />Rosewood Plaza South, 3rd Floor <br />1711 W. County Road B <br />Roseville, MN 55113 <br />Page 100 <br />