10/23/1995 Council Packet - Laserfiche WebLink

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LG240B Minnesota Lawful Gambling Application for Authorization to Conduct Excluded Bingo Part 2 of 2 Organization Name Chief :Executive Officer's Signature The information provided in this application is complete and accurate to the best of my knowledge. Chief Executive Officer's signature Name (please print) J%l ,/ 4) /1. T -- fl 1' al Unit of'Government Acknowledgment clnd Approval Date • 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 Township is: Organized ❑ Unorganized 0 \ Attach letter Unincorporated 0 / Acknowledgment of Registration (For Board Use Only) Your request to conduct excluded bingo has been received and is acknowleged by the Executive Director of the Gambling Control Board. Send the completed registration form with your organization's proof of nonprofit status to: Gambling Control Board 1711 W. County Road B, Suite 300 South yellow -Board Roseville, MN 55113 This form will be made available in alternative format (i.e. large print, braille) upon request. FOR BOARD USE ONLY By signatul-e below, the local unit of government hereby approves this application for excluded bingo activity at the premises located within their jurisdiction. By signature below, the township acknowledges that the organization is applying for excluded bingo activity within the township limits. /1 1 Signature of pefson approving application for local unit of government. (Sign above) Signature of person acknowledging application for for township. (Sign above) Title Date Rece ed (` (L 'k - - 1 e i i t _,- /C /c/f Title Date Received Township is: Organized ❑ Unorganized 0 \ Attach letter Unincorporated 0 / Acknowledgment of Registration (For Board Use Only) Your request to conduct excluded bingo has been received and is acknowleged by the Executive Director of the Gambling Control Board. Send the completed registration form with your organization's proof of nonprofit status to: Gambling Control Board 1711 W. County Road B, Suite 300 South yellow -Board Roseville, MN 55113 This form will be made available in alternative format (i.e. large print, braille) upon request. FOR BOARD USE ONLY