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LG214 <br />Minnesota Lawful Gambling <br />Premise Permit Application - Part 3 <br />feknorzteclgement <. <br />Gambling Site Authorization <br />I hearby consent that local law enforcement officers, the board or agents of the board, or the commissioner of revenue or <br />public safety, or agents of the commissioners, may enter the premises to enforce the law. <br />Bank Records Information <br />The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill <br />requirements of current gambling rules and law. <br />I declare that: <br />have read this application and all information submitted to the board; <br />All information is true, accurate and complete; <br />All other required information has been fully disclosed; <br />I am the chief executive officer of the organization; <br />assume full responsibility for the fair and lawful gambling and rules of the board and agree, if licensed, <br />to abide by those laws and rules, Including amendments to them; <br />A membership list of the organization will be available within seven days after it Is requested by the board; <br />Any changes in application Information will be submitted to the board and local government within 10 <br />days of the change; and <br />A termination plan will be submitted to the board within 15 days of the termination of all premise permits. <br />Failure to provide required information or providing false information may result in the denial or revocation of the <br />license. <br />1. The city *must sign If the gambling premises is located within city limits. <br />2. The county "AND township" must sign if the gambling premises Is located within a township. <br />3. The local government (city or county) must pass a resolution specifically approving or denying the application. <br />4. A copy of the resolution approving the application must be attached to the application. <br />S. Applications which are denied by the local governing body should not be submitted to the Gambling Control Division. <br />Township: By signature below, the township acknowledges that the organization Is applying for a premises permit within <br />township limits. <br />City" or County" Township" <br />person <br />Refer to the <br />application <br />2—zs <br />for the required attachments <br />of person receiving <br />Is township: 0 Organized ❑ Unorganized <br />Mail to: Department of Gaming <br />Gambling Control Division <br />Rosewood Plaza South, 3rd Floor <br />1711 W. County Road B <br />Roseville, MN 55113 <br />❑ Unincorporated <br />