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-2- <br />Minnesota Charitable Gambling Control Board GAMBLING LICENSE APPLICATION <br />(Cl&is A, B, or C) <br />GAMBLING SITE AUTHOBIZATIG <br />By my signature below, local Is. ehforcvmunt office,: or n-.ante or the Board are hereby <br />authorized to art., upon the site, at any time gambling 1, being conducted, to observe <br />the gambling and to enforce the low for any unautha,,zed game or practice. <br />BANK RECORDS AU(HURi2AT10N <br />By my signature below, the Board 1, hereby authorir'.a rn inspect the bank records of the <br />l:eneral uahbling Bank Account whenever necessary t• fulfil) requirements of current Somali, <br />rules and law. <br />OATH <br />I hereby declare that <br />I have read this spot icat ion and all information submitted to the Board; <br />All information submitted ie true, accurate, and camp l ate; <br />all other required information has been fully disclosed; <br />1 am the chief executive officer of the organization; <br />I assume full responsibility for the fair and lawful operation of all activities to be <br />conducted; <br />1 will familiarize myself with the law. of the State of Minnesota respecting gambling <br />and rules of the Board and agree, if licensed, to abide by those law. and rules, <br />including amendments thereto. <br />Urat, legal News -o•'f Organization <br />a--- ^`------ <br />uc <br />Officer) <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BUOY <br />I hereby acknowledge receipt of a copy of this application. By acknowledging racelot, I <br />admit having been served with notice that this application will b� revl awed by the <br />Charitable Gambling Control Board and if approved by the Board, will beeome effective 30 <br />days from the date of receipt (noted below), unless a resolutinn or the local governing <br />body le passed which specifically disallows such activity and a copy of that resolution Is <br />received by the Charitable Gambling Control Board within 30 days of the below noted date. <br />approval b n 1! <br />CC-ODOOI-01 (12/54) mite - Board <br />Canary - Board <br />(data entry) <br />ORGANIZATION <br />Home of Represantativ r Gambling <br />(ae rving notice) /,- <br />pink - Applicant <br />Applicant <br />Governing <br />Body <br />