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Minnesota Lawful. Gambling <br />Bingo Hall License Application (LG300) - Part 2 <br />v - aye) . <3jW .x.:v.. .:.:T.:,. N� 3ii'• -. T ea:2y;" ... zz <br />& a, rNf /yi....?<�..,,,. a tLa >`; \mN <br />I declare that this application is correct and complete to the best of my knowledge and belief. I will 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 govemment unit within ten days after the change occurs. <br />9. Sigh of. cif pfcu) officer the Date <br />10. Name of person completing this form <br />- <br />/f 06P✓ *,risen -V /� <br /><v�t t a;fa rcp f 3'¢„ t < Sf yf Q, y q TSAR t fr <f<ff i;£iC<(Yj <br />,, ,acaFT oiler rr�enEW.art} ecigerfiet <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 />Name (please print) Title <br />,pp,L, P✓ %t 4-2,A,,sts/a AnArply <br />Phone <br />Q6 /aL 9 " / /for <br />The <br />www <br />��33C .�.�.fi4n �.. s�.• <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 Rem 4 and 5 on form LG300) <br />• Check for license fee of $2,500, made payable to "State of Minnesota" <br />g #1? i rI t <br />ii371. +, <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 37 <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 • - •untyi ame <br />12. Township name <br />/dr' <br />Signs re of erson rp.cemng applirati <br />•t2,. 1Ti* <br />Signature of person receiving application <br />Title <br />go <br />ed <br />Date ecewed <br />c/ —/8 —/ns <br />Title - Township official Date received <br />Name of person delivering application to local govemment <br />Is township? organized unorganized unincorporated <br />I-1 <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 Rem 4 and 5 on form LG300) <br />• Check for license fee of $2,500, made payable to "State of Minnesota" <br />g #1? i rI t <br />ii371. +, <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 37 <br />