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ACKNOWLEDGMENT <br /> GAMBLING PREMISES AUTHORIZATION <br /> I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AG <br /> OF THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OF THE COMMISSIONERS, <br /> TO ENTER THE PREMISES TO ENFORCE THE LAW: <br /> BANK RECORDS INFORMATION <br /> THE GAMBLING CONTROL BOARD IS AUTHORIZED TO INSPECT THE BANK RECORDS OF THE GAMBLING ACCOUNT <br /> WHENEVER NECESSARY TO FULFILL REQUIREMENTS OF CURRENT GAMBLING RULES AND STATUTES. <br /> I DECLARE THAT: <br /> I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL 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 /> I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING <br /> ACTIVITIES TO BE CONDUCTED; <br /> • I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES <br /> OF THE GAMBLING CONTROL BOARD AND AGREE, IF ISSUED A PREMISES PERMIT, TO ABIDE THOSE LAWS <br /> AND RULES, INCLUDING AMENDMENTS TO THEM; <br /> • ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND <br /> LOCAL UNIT OF GOVERNMENT WITHIN TEN DAYS OF THE CHANGE; <br /> • I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING <br /> INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE PREMISES PERMIT. <br /> SIGNATURE OF CHIEF EXECUTIVE OFFICER DATE <br /> LOCAL GOVERNMENT ACKNOWLEDGMENT <br /> 1. THE CITY* MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS LOCATED WITHIN CITY <br /> LIMITS. <br /> 2. THE COUNTY** AND TOWNSHIP** MUST SIGN THIS APPLICATION IF THE GAMBLING PREMISES IS <br /> LOCATED WITHIN A TOWNSHIP. <br /> 3. FOR TOWNSHIPS THAT ARE UNORGANIZED OR UNINCORPORATED, THE COUNTY** IS REQUIRED TO ATTACH <br /> A LETTER TO THIS APPLICATION INDICATING THE TOWNSHIPS STATUS. <br /> 4. THE LOCAL UNIT OF GOVERNMENT (CITY OR COUNTY) MUST PASS A RESOLUTION SPECIFICALLY <br /> APPROVING OR DENYING THIS APPLICATION. <br /> S. A COPY OF THE LOCAL UNIT OF GOVERNMENT'S RESOLUTION APPROVING THIS APPLICATION MUST BE <br /> ATTACHED TO THIS APPLICATION. <br /> 6. IF THIS APPLICATION IS DENIED BY THE LOCAL UNIT OF GOVERNMENT, IT SHOULD NOT BE SUBMITTED <br /> TO THE GAMBLING CONTROL BOARD. <br /> TOWNSHIP: <br /> BY SIGNATURE BELOW, THE TOWNSHIP ACKNOWLEDGES THAT THE ORGANIZATION IS APPLYING FOR A <br /> PREMISES PERMIT WITHIN TOWNSHIP LIMITS. <br /> CITY* OR COUNTY** TOWNSHIP** <br /> CITY OR COUNTY NAME TOWNSHIP NAME <br /> City of St. Anthony <br /> SIGNA FP SON RECEIVING APPLICATION I SIGNATURE OF PERSON RECEIVING APPLICATION <br /> TITLE T DATE RECEIVED TITLE DATE RECEIVED <br /> Citv Manager <br /> REFER TO THE'CHECKLIST FOR REQUIRED ATTACHMENTS <br /> MAIL TOs GAMBLING CONTROL BOARD <br /> 1711 W COUNTY RD B — SUITE 300 S <br /> ROSEVILLE, MN 55113 <br />