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Fa <br />Minnesota Charitable Gambling Control Board <br />GAMBLING LICENSE APPLICATI <br />(Class A, B, or C) <br />GAMBLING SITE AUTHORIZATION <br />By my eignsturs belo., local Is. enforcement officers or agents of the Board are 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 prec Lire. <br />BANK RECORDS AUTHORIZATION <br />By my signature belo., the Board is hereby authorized to inspect the bank records of the <br />General Gambling Bank Account whenever necessary to fulfill require+ents of current gambl <br />rules and is,. <br />OATH <br />I hereby declare that <br />1. 1 trove read this application and all information Submitted to the Board; <br />2. All Information submitted is true, accurate, and complete; <br />), all other required znforastion nma aeon Tully disclosed; <br />A. 1 am the chief executive officer of the organization; <br />S. 1 assumr full responsibility for the fair and lawful nperetrun of all activities to be <br />conducted; <br />6. 1 .111 familiarize myself Lth the lams of the State of Minnesota respecting gamble* <br />and rules of the Board and agree, if licensed, to abide by those laws end rule., <br />including amendments thereto. <br />eOffluml. Legal tame of Organization <br />The Associatio for Alzheimer's & Related Disorders <br />Sloogure Xxt be U 4% Lhiaf E.ecutive Officer) <br />ACKNOWLEDGEMENT OF NOTICE By LOCAL GOVERNING BJOT <br />I hereby acknowledge receipt or a copy of this application. By acknowledging receipt, I <br />&dolt having been served with notice that this application will be reviewed by the <br />Charitable Gambling Control Board and if approved by the R.card, will become effective 30 <br />days from the data of receipt (noted below), unless a resolution of tnc kcal governiny <br />body is passed which speciflcelly disallows such activity and a copy of that resolution Is <br />received by the Charitable Gosbling Control Board within 30 days of the below noted dote. <br />Name of Local Govsrnl�q Body <br />"'�-uRGAKii ATIGh j <br />�blg <br />s is t from which the 10 day Nerve of Repreeentstin for Gaobling Licari Applicant <br />Spj�j Yf. g� (mervrng notice) <br />M-00001-01 (12/64) tattle - Bard <br />