09-25-2000 Council Packet - Laserfiche WebLink

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Pf Premises Permit Application - LG214 Page 2 of 3 1/99 Bingo Occasions - for Class A or C Permits If applying for a clau A or C permit, enter days and beginning/ending hours of bingo occasions (indicate /V.M. or P.M.). No more than ten bingo occasions may be conducted per week. An occasion must be at least one and one-half hours no to exceed four hours. Day Beoinnino/EndinQ Hours ____ _________to_________ ______________to_________ Beqinninq/EndinQ Hours _________to_________ _________to_________ ___to_________ Pay Beginnino/EndinQ Hours ____ _________to_________ ______________to________ _______________to Gambling Bank Account Information Bank name Bank account number' Bank address City State/Zip code •New organizations: The account number may be obtained and submitted to the Gambling Control Board within ten dc.ys you receive your premises permit. Name, address, and title of members authorized to sign checks from the gambling account. The organization’s treasurer may not handle gambling funds. Name Address Title Acknowledgment 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 information The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill requirements of current gambling rules and law. 0.^.1^’ ration license authorization I hereby authorize the Gambling Control Board to modify the class of organization license to be consistent with the class of permit being applied for. Oath I declare that: 1.1 have read this application and all information submitted to the board is true, accurate, and complete; 2.all other required information has been fully disclosed; 3.1 am the chief executive officer of the organization; 4.I assume full responsibility for the fairand lawful operation of all activities to be conducted; 5.1 will familiarize myself with the laws of Mirviesota governing lawful gambling and rules of the board and agree, if licensed, to abide by those 'aws and rules, including amendments to them; 6.any changes ir application information will be submitted to the board and local unit of government within ten days of the change; and 7.1 understand that failure to provide required information or providing false or misleading information may result in the denial or revocation of Jhe license. iatuiy of cp^l executive officer (Designee may not sign)Date