01-12-1987 Council Packet - Laserfiche WebLink

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Gambling License Application Typo of Application: I ]Class A Class 0 I (Class C I ]Class D Ves❑No 23. Is gambling premises located within city limits? Page 2 Yan(1No 24. Are all gombling ectivitioa conductod at Iho promises listed in at9 of iM- .yplicetioN If not, complete a separate applicst[gn for each premises lexcept raffles) as a separate license .,squired for each premises. I lyesNo 25. Does organization own the gambling premises? If no, au- _.,copy of the lease with terms of at least one year. I :Yes�flo 26. Does the organization lease the entire premises"!, to, attach a sketch of 27. Amount of Month[ Rent the premises indicating what portion is Is' g leased. A lease and sketch Is not required for Class D applicati- -s. ❑yesyNo 28. Du you plan on conducti.•� umgo with this license? If yes, give days and times of bingo occasions: u.y. nit,.. a0. Insurance 32, became f4 GAMBLING SITE AUTHORIZATION By my signature below, local law enforcement officers or agents of the Board are hereby authorized to enter upon the site, at any time, gambling is being conducted, to observe the gambling and to enforce the law for any unauthorized game or practice. BANK RECORDS AUTHORIZATION By my signature below, the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to fulfill requirements of current gambling rules and law. OA^I I hereby declare that: 1. I have read this application and all information submitted to the Board; 2. All informatior, submitted is true. accurate and complete; 3. All other required information has been tally disclosed 4. 1 am the chief executive officer of the organization; 5. 1.ssume full responsibility for the fair and lawful operation of all activities to be conducted; 6. 1 will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, if licensed to abide by those laws and rules, inclus in amendments th:,r of 40. Official, Lgqgal Name of Organization 41. Signaturle arbeigned by.Chief Executive Officer) IxI.a ILTA /.)a a5 Ti. iJlcq (/1)11S x / 1•L�i'l�/X.(/( _ v ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, will become effective 30 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30 days of the below noted date. 4 Name of City or C my (Local Goye n 1 Bndyl II site is located within I township, Item 43 must he completed. in r idd,ton to the county s gnarute Smna url eof oersoli rcce vmn and r. nGon �� 33 Nm Jl was p � �—--- Yple - /r Data ocv .d l_i0 ty r d Snnitlum nl prnon xv .l anpllcalu"n 1,,I,,nj 1,ort,llt d re) 44 col Pe sul�,t ye Vlau� rnv I 0r. ,,,, .Ig .Iv t l' [CAUpIIV it Hi" All,. r'i.l,, It 1 1 .m RHtu.AGn 'gently