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ACKNOWLEDGMENT <br />:GAMBLING PREMISES AUTHORIZATION <br />,'THEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS <br />.',OF THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, <br />irTO ENTER THE PREMISES TO ENFORCE THE LAW. <br />,_ BANK RECORDS INFORMATION <br />.xs THE GAMBLING CONTROL BOARD I5 AUTHORIZED TO-INSPECT-THE-BANK RECORDS OF THE GAMBLING ACCOUNT <br />???;WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES.' <br />-- 11 :1.• ;. e.... <br />Z ,;DECLARE THAT: • "'. .. . <br />.'y <br />$ I`HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; <br />ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE ;; pa , .�� <br />ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; <br />.I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; <br />i. <br />.1 ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALLp GAMBLING <br />ACTIVITIES TO BE CONDUCTED; ,., .� .. <br />'I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES <br />THE GAMBLING CONTROL BOARD AND AGREE, IF ISSUED A PREMISES PERMIT, TO ASIDE THOSE LAWS <br />AND RULES, INCLUDING AMENDMENTS TO THEM; " ' <br />ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO GAMBLING CONTROL BOARD AND <br />LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; r s -s '' <br />I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING <br />MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. ' <br />SIGN}�TURE 7 IEF ECUTIVE OFFICER DATE <br />LOCAL GOVERNMENT ACKNOWLEDGMENT <br />'1. :THE CITY* MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY <br />, LLIMITS. <br />THE COUNTY ** AND TOWNSHIP ** MUST SIGN THIS APPLICATION IF-THE GAMBLING PREMISES IS <br />LOCATED WITHIN A TOWNSHIP. <br />FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY ** IS REQUIRED TO ATTACH <br />A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS. <br />4. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY <br />APPROVING OR DENYING THIS APPLICATION. <br />5. A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE <br />ATTACHED TO THIS APPLICATION. <br />6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED <br />TO THE GAMBLING CONTROL BOARD. <br />- TOWNSHIP: <br />BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A <br />0-PREMISES PERMIT WITHIN TOWNSHIP LIMITS. <br />etc;;... .. -. .. .. .. <br />;CITY* OR COUNTY**- TOWNSHIP ** <br />i!iCI <br />Y j R COI NTY <br />Are <br />AME <br />TOWNSHIP NAME ' <br />SIGNAT 'E . PERSON RECEIVING APPLICATION I SIGNATURE OF PERSON RECEIVING APPLICATION <br />II .I <br />TIT C/ DATE RECEIVED TITLE DATE RECEIVED <br />/ c --7 -44/ <br />REFER TO THE CHECKLIST FOR REQUIRED ATTACHMENTS <br />MAIL TO: GAMBLING CONTROL BOARD <br />1711 W COUNTY RD B - SUITE 300 S <br />ROSEVILLE, MN 55113 <br />Page 6 <br />