04/08/2002 Council Packet - Laserfiche WebLink

Home Search

LG214 - Premises Permit Application Page2of3 Bingo Occasions for Class A or C Permits If applying for a class A or C permit, enter day and beginning /ending hours of bingo occasions (indicate A.M. or P.M.). No more than ten bingo occasions may be conducted per week. An occasion must be at least one and one -half hours, not to exceed four hours. Day Beginning/Ending Hours Qy Beginning/Ending Hours y Beginning/Ending lrlours to to to to to to to to to to Noon Hour Bingo Only Day Beginning/Ending Hours Day Beginning/Ending Hours Qy Beginning/Ending Hours to to to to — to �..,_— to . to Gambling Bank Account Information Bank name Bank account number* co, Bank street addres I 65 S City State /Zip code e v Q res ,r„� 55 0 Z. 5 * New organizations: The account number may be obtained and submitted to the Gambling Control Board within ten days after you receive your premises permit. Name, address, and title of members authorized to sign checks from the gambling account. The organization's treasurer may not handle gambling funds. :• .. Name Street Address City Zip Code Title ` !C `.. 3 sl SS -S\- f1rnh Tr SS04 z. Q ccs l dsIw Vic PN.c.5 - e\ —\off t;03. \t ,S Av. \ c co LNk� r w. S50 7 m 21.•(--Y... S mar, 0,r- \ �■o So rvz eve " ' rtSi- Le MY-. GS0 'ZS Gar.. mar'ao ' 0 rn - Sc-V•a ha%.,S.Q,.. 1 b t5 L( - ZUoi'^ 61c w\ Scam►'• `Mv. 65 b `13 tO ar1 'c.c.., Acknowledgment Oath Gambling site authorization • I declare that: I hereby consent that local law enforcement officers, 1. I have read this application and all information submitted the board or agents of the board, or the commissioner to the board is true, accurate, and complete; of revenue or public safety or agents of the 2. all other required information has been fully disclosed; commissioners may enter the premises to enforce the 3. I am the chief executive officer of the organization; law. 4. I assume full responsibility for the fair and lawful Bank records information , :',. _: operation of all activities to be conducted; The board is authorized to inspect the bank records of 5. I will familiarize myself with the laws of Minnesota the gambling account whenever necessary to fulfill " governing lawful gambling and rules of the board and requirements of current gambling rules and law: `` . agree, if licensed, to abide by those laws and rules, • including amendments to them; Organization license authorization 6. any changes in application information will be submitted I hereby authorize the Gambling Control Board to. to the board and local unit of government within ten days modify the class of organization license to be of the change; and consistent with the class of premises permit being applied for. 7. I understand that failure to provide required information or providing false or misleading information may result in the denial or revocation of the license. Signature of chief executive officer (Designee may not sign) Date