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- - - -- FEB 009 ' 00 15: 05 JOb I tnti HK <br />07r 05/2030 10:36 612132210300 <br />Premises Permit Applle3tiOn - LG214 <br />Bing Occasions - for Class A or C Permits No <br />If applying to • - a A or C permit, enter days and beginning /ending hours of bingo o.castons (indicate A. <br />more than ten bingo a .ns may be conducted per week. An Occasion must beet least on - ' - ,atf hcuur . not to <br />exceed four hours. <br />PaY { <br />MN USA WRESTLING <br />. 1- <br />Ppge 2 of 3 <br />1199 <br />Gambling Bank AccoUnt Information <br />Bank name <br />Bank address <br />Bank account number" • <br />(-7 o;,a. so?. 02 3 3 0 r <br />—"" City State/Zip co • I • I • 5541 <br />M. <br />to <br />". New orgerezations: The account number may be obtain = ► and submitted to the Gambling Control 6o <br />• ten days'after you receive your premises permit "' "H a r : <br />u•..;fr: <br />GErns>aiflaagmen <br />r+diaim 0[tt site authorization <br />thereby consent that local law enforcement officers, the <br />board or agents of the board, or the cornrnissicner of <br />revenue or public safety or age's of the commissioners. <br />may enter the premises to enter= the taw <br />Sank records inearmgtton <br />The board is authorised to inspect the bank records of the <br />gambling account whenever necessary to fulfil <br />requirements of current gambling rules and taw. <br />Orgartleettan license authorisation <br />t hereby authorize the Gambling Control Board to modify <br />trite class$ of organization lcense to be consistent with the <br />class of permit being applied for. ' <br />-1 FMS ICJ, mit f. S 'atlg j . 5s- 37 <br />tone <br />440 <br />• <br />Oath „y: <br />declare tat: ' '.. , • ° , <br />1. i have read this applicat ion and aliirrioiratiors rimed <br />to the board is true, accurate, and cOrnplete; <br />2. all other required inforiration has been fatly d closcdi <br />3. i am the chief executive officer of the orgatli tion; <br />lawful <br />4. 1 assume full responsibility for the fair <br />operation of all activities to be conducted; <br />6. 1 wi11 familiarize myself with the taws of nnesota <br />governing lawful gambling and rules or the b rd and <br />agree, if licensed, to abide by those laws rules, <br />including amendments to them: <br />6. arty changes Inappficetioninforrnationwiltbe bmitted <br />to the board and local unit of government ''thin test' <br />days of the change, and <br />7. I understand that failure to provide required i rmation <br />or providing false or misleading information ay result <br />in the dental or revocation of the license. <br />lef *seals* officer fPesignes ay not sign) - ' , . • "s' Date <br />