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r Mitrutesota Lawfi.tt Gantbiinp
<br /> !:• .' ' Premise Permit Application —Part 2 of 2
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<br /> • t nick Name' ;': !— ;`,. . �i • Bank Account Number
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<br /> Firys'tar Bank. of Miruieso;ta i• —_ZO514
<br /> 8iiiik hcTdress. r.• , —_. : - _— —• i•
<br /> . .city –`tate Zip-Code
<br /> •650',1) .Nico:Llet Ave. S. Richti.eid Mn. 55421_
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<br /> ,rrY► , W' ., _ Address _,Tl�tiia
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<br /> Leslie tlu:i-kko i Pt:. 6 Box 198 Buffalo, Mn. 55313 President
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<br /> •Roger El let son Rt.. 3,' Box 44 Map.]e Lake,' Mn . 55358 Cnnih.l .i ii Manager
<br /> John A. Lever • 2100 Roecrest Ct: . No. Mankato, Mn. 56003 C.E.O.
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<br /> 17;tiirt6ling SSttdi A ti$orliiitttoin ,t;;•I am the chief executive officer of the organization;
<br /> I hereby consent that local taw enforcement officers,the •I as+lane lull responsibility for the fair and lawful opera-
<br /> board or agents cif the board,lot the commissioner of . tion of all activities to be conducted;
<br /> revenue or public safety, or agents of the commissioners, - l will familiarize myself with the laws of Minnesota
<br /> may enter the prc.imises to entered the law. :'governing lawful gambling and rules of the board and
<br /> 13rt<nk Record i,Irifornrtatioit '•agree, If licensed, to abide by those laws and rules;
<br /> The board le aUliibrized to inspect the bank records of the : including rirriendmenis to them;
<br /> tiambiing accoUrtl,Whenever necessary to fulfill ..•any changes in application Information will be submitted
<br /> requirements of current gainbling rules and laws '.`to the board and local Unit of government within 10 days
<br /> bath .; ';;I. ::'. ; of the change;and
<br /> declare that: !',` . • ,.•,,i understand that failure to provide required information
<br /> . i I have read this fippilcatlort end ell information Submitted::: '..,l or providing jalse br Misleading information may result in
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<br /> b the board boo; accurate And complete; :'' the denial or,revocatlon bf the license,
<br /> ion other required,fnformatibr3 has been fully diticlosed; ,•i,.. •
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<br /> ;iigniatur flet ex cuts officer ' ' . • • Data
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<br /> If ,, - ' ' . lid:: A.cool�tLihe lociljlllt of aovetrut tGvs tiongp.:
<br /> I. The city einust sign this a fiplk:rition if the gambling prem- ; �(gtovJti tht;llip1211s�tlgn must t etle ted to ttlis pUstttutn.
<br /> lb ns Is ideated wiryq'Erlit';city HMOS, ','' .{ r;5 ' If this appHc tlbii it#dehI d by the local unit at gcrveriarnent,
<br /> t. •The county 3�At'1O tbwfi flip is must sign this npplicalion g.'''.151.
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<br /> it should not be Submitted to the Gambling Control Board.
<br /> the gambling prerhises Is located within a township-. i
<br /> ;11-1e tort bait g�Vernntent(city of cnrmtyj niust pass rf 'town9 rip, by signature below, tha township acknowlFdgns
<br /> resolution specifirially approving sir denying this application. !that the organization is ripptying for a premises permit within:
<br /> . .,township limits. •
<br /> '--, Townsii43""*
<br /> at ]. of Co�mty"* : --------------
<br /> (:ity or Co n Nanie • • ! township Name
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<br /> -_._ _ vie-, • ------- i _ ----- --__ -__ --- -- --------_____----
<br /> ;aignrit re of p:�� = vfng AFi canon ; Sign2ture of person receiving application
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<br /> lit' '' • 1FP' +. ' ;I.Date Flor.:eived ' 't•Title I? •• • I Date Received
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<br /> • osier to the instructions for required attachments. .
<br /> Mail to: Gambling Control board
<br /> Roser' od Pinta Sbr.rth,3rd Floor '
<br /> 1711 vi.County 1104d 13
<br /> Roseville,MN 5511:i 1.0214(11rirt 2)
<br /> (nnv 71^•vi 11
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