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Resolution 23-047
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Resolution 23-047
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Last modified
5/23/2023 8:46:42 AM
Creation date
5/23/2023 8:46:39 AM
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City Council
Council Document Type
Resolutions
Meeting Date
05/22/2023
Council Meeting Type
Regular
Resolution #
23-47
Resolution Title
Local Approval of Lawful Gambling Premises Permit for Forest Lake Area Athletic Association
Resolution Summary
gambling permit approval for FLAAA at Fiesta Mexican Grill
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LG214 Premises Permit Application 6/15 Page 2 of 2 <br /> ACKNOWLEDGMENT BY LOCAL UNIT OF GOVERNMENT: APPROVAL BY RESOLUTION <br /> CITY APPROVAL COUNTY APPROVAL <br /> for a gambling premises for a gambling premises <br /> located within city limits located in a township <br /> City Name: Lino Lakes County Name: <br /> Date Approved by City Council: MA-Al Zy, 2 Date Approved by County Board: <br /> Resolution Number: 13,— 4:1 Resolution Number: <br /> (If none, attach meeting minutes.) (If none, attach meeting minutes.) <br /> Signature of City Personnel: Signature of County Personnel: <br /> Title: G C'14"-VIO"'" Date Signed: '127-12✓ Title: Date Signed: <br /> TOWNSHIP NAME: <br /> Complete below only if required by the county. <br /> Local unit of government On behalf of the township, I acknowledge that the organization is <br /> must sign. applying to conduct gambling activity within the township limits. <br /> (A township has no statutory authority to approve or deny an <br /> application, per Minnesota Statutes 349.213, Subd. 2.) <br /> Print Township Name: <br /> Signature of Township Officer: <br /> Title: Date Signed: <br /> ACKNOWLEDGMENT AND OATH <br /> 1. I hereby consent that local law enforcement officers, 6. I assume full responsibility for the fair and lawful operation of <br /> the Board or its agents, and the commissioners of all activities to be conducted. <br /> revenue or public safety and their agents may enter <br /> and inspect the premises. 7. I will familiarize myself with the laws of Minnesota governing <br /> lawful gambling and rules of the Board and agree, if licensed, <br /> 2. The Board and its agents, and the commissioners of to abide by those laws and rules, including amendments to <br /> revenue and public safety and their agents, are them. <br /> authorized to inspect the bank records of the gambling <br /> account whenever necessary to fulfill requirements of 8. Any changes in application information will be submitted to the <br /> current gambling rules and law. Board no later than ten days after the change has taken <br /> effect. <br /> 3. I have read this application and all information <br /> submitted to the Board is true, accurate, and complete. 9. I understand that failure to provide required information or <br /> providing false or misleading information may result in the <br /> 4. All required information has been fully disclosed. denial or revocation of the license. <br /> 5. I am the chief executive officer of the ganization. 10. I understand the fee is non-refundable regardless of license <br /> approval/denial. <br /> 06.'04-A <br /> Signature of Chief Executive Officer(designee may not sign) Date <br /> Data privacy notice:The information requested on this information when received by the Board. Minnesota's Department of Public Safety, <br /> form (and any attachments)will be used by the All other information provided will be Attorney General,Commissioners of <br /> Gambling Control Board (Board)to determine your private data about your organization until Administration, Minnesota Management& <br /> organization's qualifications to be involved in lawful the Board issues the permit. When the Budget,and Revenue; Legislative Auditor, <br /> gambling activities in Minnesota.Your organization has Board issues the permit,all information national and international gambling <br /> the right to refuse to supply the information; however, provided will become public. If the Board regulatory agencies; anyone pursuant to <br /> if your organization refuses to supply this information, does not issue a permit,all information court order; other individuals and agencies <br /> the Board may not be able to determine your provided remains private, with the specifically authorized by state or federal law <br /> organization's qualifications and,as a consequence, exception of your organization's name and to have access to the information; individuals <br /> may refuse to issue a permit. If your organization address which will remain public. Private and agencies for which law or legal order <br /> supplies the information requested,the Board will be data about your organization are available authorizes a new use or sharing of <br /> able to process your organization's application. Your to: Board members, Board staff whose information after this notice was given; and <br /> organization's name and address will be public work requires access to the information; anyone with your written consent. <br /> This form will be made available in alternative format, i.e. large print, braille, upon request. <br /> An equal opportunity employer <br />
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