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LCai4 <br />Minnesota Lawjul Cambling <br />Premise Permit Application - Part 3 <br />fhwbjoln offic«r». th« board or agants of tha board, or thacommissionar of ravanua or <br />public or aganis of tha oommiasionara. may antar tha pramisas to anforoa tha law. <br />BbBk'RccoftfslnformatloB <br />^ • ’"Tha board is authorizad to inst^ tha bank racords of tha gamolmg account whanavar nacassary to fulfill ........ - ---------- <br />raquiramants of currarrt gambling rulas and law. <br />I dadara that: <br />I hava raad this application and all information submittad to tha board; <br />All infomtation is tnia, aocurata and complata; <br />An othar raquirad information has baan fully disdosad; <br />I am tha chiafaiacuthraofficar of tha organization: . ^ ^ i <br />I assuma fun rasponsibility for tha fair and lawful gambling and rulas of tha board and agraa. if Icansad. <br />to abida by thosa laws and rulas. induding amandmants to tham; ^ <br />A mambarship nst of tha organization will ba availabla within savan days altar it is raquastad by tha toard. <br />Any changas in application information will ba submitted to the board and local government within 10 <br />A*«T^nlTtot^*iiI^ submittad to tha board within 15 days of tha tarminaton of all prarnisa <br />Faiiura to provida raquirad information or providing falsa information may rasult in tha danial or ravocaton of tha <br />lioansa. <br />1. Tha city •must sign if tha gambling pramisas is locatad within city limits. <br />Township: By signatura balow, tha townsh^ acknowladgas that tha organization is applying for a promises permit within <br />CNy* or County**Township**- <br />Cky or County Nima Township Nama <br />■ V -• <br />~ ^-Signaaifa of parson roooiving appScatnn <br />■ -r-— ,, - <br />Signaiurs of parson .'^vinoapplieaiion <br />:TMa - ' V : ^ - .i: <br />Oats RaoaivaO <br />Parson dslivarirv^ appiealQn lo tooai goiwiw^i Oaia . - , ■ <br />1 ff 'tG' ^0 <br />'• '? 1.' • ^ St* ‘ ' <br />is township: □ Orgwszad” □ Unorgaoizad <br />- • J *1 <br />1 □ Uninoorjmladvcflat.. <br />^ W County Road B <br />V Rosavilla. MN55113 <br />.... <br />-vV-: