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Minnesota Lawful Gambling Gambling License Application - Part 3 • Oath ::.:.:::::.. . Gambling Site Authorization I hereby consent that local law enforcement officers,the board or agents of the board,or the commissioner of revenue or public safety,or agents of the commissioners,may enter the premises to enforce the law. Bank Records Authorization The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill requirements of current gambling rules and law. I declare that: •1 have read this application and all information submitted to the board; •AIL information is true,accurate and complete; •AIL other required information has been fully disclosed; •1 am the chief executive officer of the organization; •1 assume full responsibility for the fair and lawful operation of all activities to be conducted; •1 will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the board and agree,H licensed,to abide by those laws and rules, including amendments to them; •A membership list of the organization will be available within seven days after it is requested by the board; -Any changes in application information will be submitted to the board and local government within 10 days of the change;and •A termination plan will be submitted to the board within 15 days when the organization's license is terminated. Signatur t chiei.e or r Date L_ ocal Government Ackno g ed ement The city 'must sign if the gambling premises is located within any city limits. • The county "AND township"must sign if the gambling premises is located within a township. 1 have received a copy of this application. This application will be reviewed by the Gambling Control Division,and if approved by the Director, and will become effective 60 days from the date of receipt by the city or county, unless the local government (city or county)passes a resolution to specifically forbid the activity. A copy of that resolution must be received by the Gambling Control Division within 60 days of the date filled in below. City or County" Township"(ccrrptata In addmon to county aura) City or county name Township name Signature of person receiving application Signature of person receiving application isle I Date received Title F Date received Name of person delivering application to local government Is township: ❑ organized ❑ unorganized ❑ unincorporated Refer to the Instructions for the required attachments. Mail to: Department of Gaming Gambling Control Division Mail Station 3315 St. Paul,MN 55146-3315