02/26/1996 Council Packet - Laserfiche WebLink

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LG2406 (Rev. (1/21/93} Minnesota Lawful Gambling Application for Authorization to Conduct Excluded Bingo Part 2of2 Organization Name Z /Ale 44 "41,3 ..ce'S`>:::<: The information provided in this application is complete and accurate to the best of my knowledge. Chief Exet gtive Officer's signature Name (please print) Date 54°€?CRv/ J: • The city must sign this application if the gambling premises is located within city limits. • The county AND township must sign this application if the gambling premises is located within a township. • If this application is denied by the local unit of government, it should not be submitted to the Gambling Control Board. Township: A township has no statutory authority to approve or deny an application (Minn. Stat. 349.213, Subd. 2). Name of City OR County Name of Township C/4-4) 40-42-12-4--J $ sI natter • z, • w, the local unit of government herebyBysignature Y 990 approves this application for excluded bingo activity at the premises located within their jurisdiction. below, the townshipacknowledges 9 9 that the organization is applying for excluded bingo activity within the township limits. _ii % epi .. e At L. -- --Si Signature nature f person approving application for local unit of government. (Sign above) Signatura of person acknowledging application for for township. (Sign above) 'ritI Date ,R, ived -- \A -ex -.a-4--0-4-4— GAY / /2/916 Title Date Received Township is: Organized 0 Unorganized 0 Unincorporated 0 Attach letter Acknowledgment Send the completed registration form with your organization's proof of nonprofit status to: Gambling Control Board White- Original 1711 W. County Road B, Suite 300 South Yellow _ Board Roseville, MN 55113 This form will be made available in altemative format (i.e. large print, braille) upon request.