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ACKNOWLEDGMENT <br />OANBLXNO PREMISES AUTEORISATZON <br />I HEREBY GIVE CONSENT TO LOCAL LAW ENFORCEMENT OFFICERS, THE GAMBLING CONTROL BOARD, OR AGENTS <br />OF THE BOARD, OR THE COMMISSIONER OF REVENUE OR PUBLIC SAFETY, OR AGENTS OP 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 />DECLARE THATI <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 />Z 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 A.UD 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 T21AT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING <br />ZNFORMAKON/ilAY RESULT IN THE DENIAL OH REVOCATION OF THE PREMISES PERMIT. <br />ZBP/EZBCUTZVB OFFICER <br />■ <br />IT A< <br />DATE <br />• MUST SIGrmrrS-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 DENYINC THIS APPLICATION. <br />5. 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 />TOWNSBIPt <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 />SICNi^TORE OF PE^^N REQEIVIN^ APPLICATION SIGNATURE OF PERSON RECEIVING APPLICATION <br />DATE RECEIVED TITLE <br />DATE RECEIVED <br />REFER TO THE CHECKLIST FOR REQUIRED ATTAG <br />MAIL TOt OANBLINO CONTROL BOARD <br />1711 W COUNTY RO B - SUITB 300 S <br />ROSEVILLE, MM 9S113 <br />. • . I . <br />I