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r"Minnesota Lawful Gambling <br />Premise Permit Application - Part 2 of 2 <br />^n^Hng Bank Account Information <br />Bank Nam# <br />I ^ <br />Bank Addrita <br />Bank Account Numoar <br />City Sun ' Zip Coca <br />VV\vn.crf vnr\ <br />bfparMO* au*ar»arf » s^n ehacks andmak* daposis and wtWraiaaJi <br />;■ traafuTw ma/ fiot ftaodra eambSno fundt ______ <br />Nam#Aoorass iiua <br />Kingsley Murphy 2344 N:. allit Avenue, Suite 280 Board of Directors <br />Richard Law 2344 Nicollet Avenue, Suite 280 Board of Directors <br />!• <br />?!P?-' <br />Eleanor Novak 2344 Nicollet Avenue, Suite 280 Controller <br />\Biimg Site iU^iorUatlo a <br />I hara^ eonMnt that ioeal law enfoicamant officers, the <br />board or agents of the beard, or the commissioner of <br />revenue or pubiie safety, or agents of the commissioners, <br />may errter the premises to enforce the law. <br />Bank Records Infonnation <br />The board is authorized to inspect the bank records of the <br />gambling aoeou.nt whenever necessary to fulfill <br />requirements of current gambling rules and law. <br />Oath <br />I declare that; <br />•I have read this application and all information submined <br />Id the board is true, accurate and complete; <br />•al ether required Mormatien has been fully disclosed; <br />•I am the chief executive officer of the organization; <br />•I assume full responsibility for the fair and lawful opera­ <br />tion of all aaivities to be conducted; <br />•I will familiarize myself with the laws of Minnesota <br />governing lawful gambling and rules of the board and <br />agree, if licensed, to abide by those laws and rules, <br />including amendments to them; <br />*any changes in application information will be submitted <br />to the board and local unit of government within 10 days <br />of the change; and <br />•I understand that failure to provide required information <br />or providing false or misleading information may result in <br />the denial or revocation of the license. <br />Signature of chief eim^ive officer Date <br />mmwpmfnff <br />r <br />s' <br />I <br />¥ <br />1. The dly *must this applieatbn if the gambfing prom­ <br />ises is locked wdthin dty limits. <br />2. The county “AND township** must sign this appncation if <br />the gambling promisee is located within a township. <br />3. The local unK government (dty or county) must pass a <br />resohition apecHically approving or denying this application. <br />4. A eoav of tha leieal unit of otwemment's reeQlution ao- <br />ofovtnQ thia aopfieetion must be attached to this anofication. <br />5. If this application is denied by the local unit of government, <br />it should net be submitted to the Gambling Control £oard. <br />Township: By signature bebw, the township acknowledges <br />that the organization is applying for a premises permit within <br />township limits. <br />cmr or coumv^ <br />Cly er County libme <br />A'A. (^rat70 <br />1 WWII9lll|il <br />Townihip Hwmm <br />Sgnawe^ parson receiving appficetien Signature of person reoeiving application <br />Hie <br />b^/kcU d/erK <br />Oaii Received rise Date Reoaivad <br />•V' <br />i <br />f,' <br />I <br />i:m-1. <br />Be ee weed Bleae Sewdi, 3rd Floer <br />1711 W. Ceunty deed ■ <br />Beeevme, MM »1i3 LCZUfPart 2) <br />(AwTOWai)