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10/10/2005 Council Packet
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10/10/2005 Council Packet
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City Council
Council Document Type
Council Packet
Meeting Date
10/10/2005
Council Meeting Type
Regular
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LG220 Application for Exempt Permit <br />Organization Name <br />Local Unit of Government Acknowledgment <br />Page 2 of 2 <br />11/04 <br />If the gambling premises is within city limits, the <br />city must sign this application. <br />On behalf of the city, I acknowledge this application. <br />Check the action that <br />the city is taking on this application. <br />The city approves the application with no <br />waiting period. <br />The city approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days (60 days for a first class <br />city). <br />The city denies the application. <br />Print name of city <br />Signature of city personnel receiving application <br />Title <br />Date / / <br />If the gambling premises is located in a township, both <br />the county and township must sign this application. <br />On behalf of the county, I acknowledge this application. <br />Check the action that <br />the county is taking on this application. <br />nThe county approves the application with no <br />waiting period. <br />❑ The county approves the application with a 30 day <br />waiting period, and allows the Board to issue a <br />permit after 30 days. <br />❑ The county denies the application. <br />Print name of county <br />Signature of county personnel receiving application <br />Title <br />Date <br />TOWNSHIP: On behalf of the township, I acknowledge that <br />the organization is applying for exempted gambling activity <br />within the township limits. [Atownship has no statutory <br />authority to approve or deny an application <br />(Minnesota Statute 349.213, subd. 2).] <br />Print name of township <br />Signature of township official acknowledging application <br />Title <br />Date <br />Chief Executive Officer's Signature <br />The information provided in this application is complete and accurate to the best of my knowledge. I acknowledge that the <br />financial report will be completed and returne oche Gambling Control Board within 30 days of the date of our gambling <br />activity. <br />Chief executive officer's signature 2 Ye <br />Name (please print) j w, o T jL! <br />Date 7 /13 /�` <br />Mail application and attachments <br />Complete an application for each <br />gambling activity: <br />• one day of gambling activity <br />• two or more consecutive days of <br />gambling activity <br />• each day a raffle drawing is held <br />Send: <br />• the completed application, <br />• a copy of your proof of nonprofit status (see instructions), and <br />• a $50 application fee. Make check payable to "State of Minnesota ". <br />To: Gambling Control Board <br />1711 West County Road B, Suite 300 South <br />Roseville, MN 55113 <br />- 2 7 - <br />
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