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-2- <br />Minnesota Charitable Gambling Control Board <br />GAMBLING LICENSE APPLICATION <br />/Pleas a a ,. rf <br />GAMBLING SITE AUTHORIZATION <br />By my signature below, local low enforcement officers or agents of the Board ere hereby <br />authorized to enter upon the site, at any time gambling is being conducted, to observe <br />the gambling and to enforce the law for any unauthorized game or practice. <br />BANK RECORDS AUTHORIZATION <br />By my signature below, the Board is hereby authorized to inspect the bank records of the <br />General Gambling Bank Account whenever necessary to fulfill requirements of current gambl <br />rules and law. <br />OATH <br />I hereby declare that <br />1. I have reed this application and all information submitted to the Board; <br />2. All information submitted is true, accurate, and complete; <br />3. all other required information has been fully disclosed; <br />4. I am the chief executive officer of the organization; <br />S. I assume full responsibility for the fair and lawful operation of all activities to be <br />conducted; <br />6. I will familiarize myself with the laws of the State of Minnesota respecting gambling <br />and rules of the Board and agree, it licensed, to abide by those lame and rules, <br />including amendments thereto. Ad <br />of Organization <br />be signed by Chief Executive Officer <br />ACKNOYLEDGERENT Of NOTICE BY LOCAL GOVERNING BODY <br />I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I <br />admit having been served with notice that this application will be reviewed by the <br />Charitable Gambling Control Board end if approved by the Board, will become effective 30 <br />days from the date of receipt (noted below), unless s resolution of the local governing <br />body is passed which specifically disallows such activity and s copy of that resolution is <br />received by the Charitable Gambling Control Board within 30 days of the below noted date. <br />of <br />approval begins) <br />ORGANIZATION <br />Nome of Reprnsentative for Gambling License Applicant <br />(serving notice) <br />CC-ODDOI-01 (12/04) Wits - Bard Conary - Board Pink - Applicant Goldenrod - Governing <br />(date entry) Body <br />