02/08/1999 Council Packet - Laserfiche WebLink

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LG2406 Minnesota Lawful Gambling Application for Authorization to Conduct Excluded Bingo Part 2of2 Organization Name Centennial Middle School Parent/Association Chief Executive Officer's Signature The information provided in this application is complete and accurate to the best of my knowledge. Date 10/12/98 Chief Executive Officer's signature Name (please print) Barbara R. Regnier Local Unit of Government Acknowledgment and Approval • 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 govemment, 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). e of City OR Coun Name of Township Lino Lakes 3 ,■1-y .e- By signature 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. Signatur, ofpe�` approving applica n for local unit of gove ment. (Sign above) Signature of person acknowledging application for for township. (Sign above) 'rifle Date Received . ,. a -1k-°� Title Date Received Township is: Organized ❑ Unorganized ❑ Attach letter Unincorporated ❑� 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. Acknowledged by: Send the completed registration form with your organization's proof of nonprofit status to: Gambling Control Board white- original 1711 W. County Road B, Suite 300 South Yellow - Board Roseville, MN 55113 FOR BOARD USE ONLY This form will be made available in attemative format (Le. large print, braille) upon request. 1