90-2191 ' ' Council File �� ���
O
R�G I N' `� Green Sheet # 12238
RESOLUTION
����� CITY SAINT PAUL, MINNESOTA
� �
� r ���
Presented By / I ;� `��
. � ___
Referred To Committee: Date
RESOLVED: That application (ID ��45662) for renewal of a State Class B
Gambling Premise Permit by Como Area Youth Hockey Association
at Ted's Rec, 1084 W. Larpenteur Avenue, be and the same is
hereby approved/L�rEni pd.
Yeas Navs Absent Requested by Department of:
irr►on �
oswi z �- License & Permit Division
on
acca ee �
e man �
une �
z son � BY�
�
Adopted by Council: Date �E C � � �990 Form Approved by City Attorney
Adoption er$ified by Council Secretary gy; I/-3v- �'fv
B1'� Approved by Mayor for Submission to
Approved by Mayor: Date ��� � � ��90 Council
gy; ,�'J^'q�i��/ By° .
�����:IiU �'�•-'� � n �990
. . . 9a a� ���Q�
DEPARTMENT/OFFICE/COUNCIL DATE INITIATED { `�'
Finance/Lic nse GREEN SHEET N° _ 12238
CONTACT PER30N&PHONE INITIAUDATE INITIAUDATE
�DEPARTMENT DIRECTOH a CITY COUNCIL
Christine R zek 298-5056 A��GN �CITYATTORNEY �CITYCIERK
NUMBER FOR
MUST BE ON COUNCIL AOENDA BY(DA ) C1 y Clerk ROUTING �BUDGET DIRECTOR �FIN.&MCiT.SERVICES DIR.
2- -9O ORDER �MAYOR(OR ASSISTANT) �
�= R
TOTAL#OF SIGNATURE PA ES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUE3TED:
Approval of an a plication for renewal of a State Class B Gambling Premise Permit.
Notificatio / Hearing/ 12-13-90
RECOMMENDATIONS:Approve(A)or R ect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTION3:
_ PLANNINa COMMISSION CIVIL S RVICE COMMISSION 1• Has this person/firm ever worked under a contract for this department?
_CIB COMMITTEE YES NO
2. Has this person/firm ever been a city employeeT
_3TAFF YES NO
_DISTRICT COURT 3. Does this personlfirm possess a skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OB,IECTI E? YES NO
Explain all yes answers on ssparate sheet and attach to graen sheet
INITIATIN�PROBLEM,ISSUE,OPPO UNITY( ho,What,When,Where,Why):
Merle Aart un o behalf of Como Area Youth Hockey Association requests Council
� approval o the r application for renewal of a State Class B Gambling Premise
Permit at ed's Rec, 1084 W. Larpenteur Avenue. Proceeds from the pulltab sales
are used f r yo th hockey.
ADVANTA(iE3 IF APPROVED:
If Council appr val is given, Como Area Youth Hockey Association will continue
to operat a pu ltab booth at Ted�s Rec, 1084 W. Larpenteur Avenue.
DISADVANTAOES IF APPROVED: r
��C��V G�
p�C471990
(~�TY G�.ERK
DI3ADVANTAOES IF NOTAPPROVE :
�__...�.,, . .�� , _. _.�� '.,%���...� . ..
UL.v _ �� ,
TOTAL AMOUNT OF TRANSA TION S COST/REVENUE BUDGETED(CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXP IN)
NOT�: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO.298-4225).
ROUTING ORDER:
Below are correct routings for the five most frequent rypes of documents:
CONTRACTS(assumes authorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept. Grants)
1. Outside Agency 1. Department Director
2. Department Director 2. Ciry Attorney
3. City Attorney 3. Budget Director
4. Mayor(for contracts over$15,000) 4. MayodAssistant
5. Human Rights(for contracts over$50,000) 5. Ciry Council
6. Finance and Management Services Director 6. Chief Accountant, Finance and Management Services
7. Finance Accounting
ADMINISTRATIVE.ORDERS(Budget Revision) COUNCIL RESOLUTION (all others, and Ordinances) -
1. Activity Manager 1. Department Director
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor Assistant
4. Budget Director 4. City Council
5. City Clerk
6. Chief Accountant, Finance and Management Services
ADMINISTRATIVE OFiDERS(all others)
1. Department Director
2. Ciry Attorney
3. Finance and Management Services Director
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and paperclip or flag
each of these pages. �
ACTION RE(�UESTED
Describe what the projecUrequest seeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the issue in question has been presented before any body,public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objective(s)your projecUrequest supports by listing
the key word(s) (HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET,SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
PERSONAL SERVICE CONTRACTS: �
This information will be used to determine the city's liabiliry for workers compensation claims,taxes and proper civil service hiring rules.
INITIATINCi PROBLEM, ISSUE, OPPORTUNITY '
Explain the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is simply an annual budget procedure required by Iaw/
charter or whether there are specific ways in which the City of Saint Paul
and its citizens will benefit from this project/action.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past processes might
this projecUrequest produce if it is passed(e.g.,traffic delays, noise,
tax increases or assessments)?To Whom?When?For how long?
DISADVANTAGES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved? Inability to deliver service?Continued high traffic, noise,
accident rate? Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addressing, in general you must answer two questions: How much is it
going to cost?Who is going to pay?
, ; �o- ���'i
DIVISION OF LICENSE A�JD PERMIT ADMINISTRATION DATE �� (� Q(�/ �� ��{ '�JO
INTERDEPARTMENTAL REV�EW CHECKLIST Appn Pr e ssed/Received by
' Lic Enf Aud
' r _ M i Gh � q
Applicant � � ItiQQ. ht�C-�e Home Address /c�,(�(o �)ae s q�� �
�� r
Business Name Q,� F �QdS ��C� Home Phone g 3`J —��5�
Business Address f Q�g y (,�, (��,�Q,r}�(�y- Type of License(s) ���.5 S �j �1Gt M b��n�
�'
p� /
Business Phone '��(,QYy'►�SZ �Q�m �`�' I�-P�'LQ fn,�-�
�
Public Hearing Date �v�- 1� License I.D. � ��(p(po2.
at 9:00 a.m. in the ounci Chambers,
3rd floor City Hall �nd Courthouse State Tax I.D. �� p2 �'1�7a�j0
Date Notice Sent; ' Dealer � ��/g''
to Applicant
Federal Firearms 4i N�-
Public Hearing
DATE INSPECTION
REVIEW i VERFIED (COMPUTER) COrIlKENTS
A roved Not A roved
Bldg I & D ' I
1�.7 �,q-
Health Divn. ; I
�1�} (
Fire Dept. �
� 14 I
Police Dept. I e� 1l��Fi�
" I �'
License Div�. f
, l�'3�C�� � O�-
City Attorn�ey I �
! � �� ����� ��
Date Received:
' �� I�� �O
Site Plan , 1��3 � �v
, To Council Research
Lease or Letter � Date
f rom Landlord i �� '�D J �j(�
i
I
� ,a� . . 9� -a�9r
.r �
;._: � ' • • FOR BOARD USE ONLY
..- , .
;� r C'HECK
i'F:. ' II+RI7AIS
,;;;:
�:.: LGZ14 Mirtnesota Lau�ful Gart�bliny DATE
�� `9�5��� Premise Permit Application - Part 1
..-.
,:..
�.;..
,
..<. .:;:.::..>:.>:..>:.>:::...::>,.:..:::::>:.»._..K..>.:.,>:.,:.>,.�.,.,.:.:>�.�.,�»»:.:�K,:,:.».
_.,.. .;: , :...::.:.N;.:::< ...... . . .:..........:.::.,.>..:»:},�.x,,.::>w:::»:»:N>,,:.»:f,:>:.>::.::.:.;;.::::.:.:..::
. �.. :�....:.. �. . ..>,�:;::..;<.>,;:.>.r»Y.. �.,,.>,<.:::.::.:>.::.,:.::::.:
�;: .,....::a;..,:�.:::.::::�:::::::;<:'r,•:;:•::`•::::;<:>;;.;..;;;::,•:,;:;>;.............,.........:::::::. ��.:;.,::;•::�i;.�, �{
:� �r_8,I1�ZS� .: } ..-,::::::• ,::::::. r;..> a > ..:,..:.:..:....................:....... ;:..�...r..
.,:
_. OIIi:�Oi #�OII::.....f...::.:,:;,::.,>:•;>;:::.::.,.;.: ::.:.
.... :..::.. ......... .......
...
:...:..:..:.:::.:.:::::::....... ,.:,:.,_.:.:.:<..:_.....
^� g �>.,.::::.;:-:;.;::.;:.;:::::<�.::::...:.:.:..::::..:.::..::::.::::.::.:::::.:.:..:::::
.._ _
,::,. :<:, .. ;.>;;>::;;�::::::.::;:>;>;:;;.:.n,�.:::...:.:::.::.:.:<.;>�:.:::.:..::::.::::::..::::::::...:::�.
, . � .;<:.;;:.;::...
..::.....:...
...................... ;.;::;::::;;::::.
. .,;
-,�,,�: 69m na���v V�\Jf�7fllta
r� e �� � �f�. ��E� �
Business Address ot C�ganizatia�-Street or P.O Box(Do not use of gamblinfl manager)
—/3 S �7 C�^,,� a �,,� .
,,� Zip Code nry Buainess phone number
c���f � a�. � 1�11� �� S� l U� � (.1,� E�/y:53 6 � .
Nams of chief execurive offioee(cannot be 9ambGn9 m�aGer) Tide Business phone number
��r� � ��a r� �i � � ��c�e��" c � i� ��(y-�3C �/
Addre(s�of�Cch�f ex�ve offimer-S�or P.O. Box
� � r'ri U� l� �.
C�ty Stale Zip Code Counry
� ���- I �11�l.. (CZ �, '� YVIu�.
.:.....................................�:.:.::::.;.:::.�::' .
�:�:;:>.�>::•:,:::::�>:>:�>.::;s::;�•;:•::.:;;.;..;:.. ....,,.. ..
......,.::. .. ,,..;:..;u::•,.•:,:.:<,:.v;.;;.:�:r.....: ,,.::•::::. ...,•:..,..�::::,.:::::::::
•�........::..... ,.... ..: .................. . . ... .....
..:::.:.:.,:.;;.:::::::.:...::.�>:..:;......... ..... ::...:.>::......:.... ,................,...... ,,:::,,.::.,-.�::::::::::.
,... ..,::.:.;:,.sz-�:::::::::::•:::::::::..::. .:..:.;:.>:.;;::•;;;:.;:.;:.;::.;:..,.:.;;:.: ......... -.;,;:•:...,... ......V,....,
� ........�w::::.::::::i:.�:Y..:::^:,-�.iiii:_'.i:L.'.. ...............v:.............................................. qC.J...
............... . �..... .............:::::.......n..................:'�i:�::::5:::�w:.�::::
.:;�.:��:�i'�:�::.:�:::.. n: '::;..::: ......... ...... ......:.,..-.................................n.::::::�� .n�..... .t
..... v...:':::: ........r.v.......:::::i.::::::v;::r.....n�.�.�:::::vi.�:.�:.�?'.3'.4i�i:::{n...:::::::::::�.�:::::::::.::•::'f4:i�..�:::::•:iii:.;::::...........n.......v:x::�v.vv::.::r..:x::::::::::.�:m::yv.::.::�::
::.L:r::::::vu{•::::::v�.:::::::::.�.v
. .'.- '(�::. . . ...................... v....... r....... r....v..h......
. .� ................y:::...�..:::::� .. .. ...v:::�:: v.r:::::n.t:t•:::::�:::.:�r:::•::,�}v•
................ .::.�::::.•:v.�::i..
�j . ...... ....
.n.�xn�:.:...............:}_-iiiii::hiiiiiii?:i::iiiiiiii:•:::.?i:'iltiJiiii:r:::::.':':?iii:i::::::�i?ii::•:.�.::�ii.�.�::-.vv:w::::::.:..:_:. _ ................:•.
;!�i�.� •.:�c....,:.c>,....-.�.::�.;�::::a:::::<;.::., ...t;....:�- ::»,._. .�.�.r..::•:,::.�,.
. .YCS . ......._............
c
' . ... ':::.�..?�.,•::r.�:�nv. .XnlJiii::n::i�?Yiiiii4�WV+i::�::::v::::::::::i:i:::Yi?i4::•iiiiii:'W:\/.:!:::•:.:. .. •... }.v:�K�...n.
': ... ..::�::...:n�:::::.:�:..�-... ...... .. ..:...............e...........................n............n..:..:.::.y...v,-.�... �
�F� � � .... .....::.::..:. ..:::.::::..:...... ....:::.............:.:. .. .3. ..,�::::..::::;:�..::.�.>....:::.-
.....
. ..:;::;;;<::::
,,.. : .........:..: ...:. ....:::.�::.:... .:.::..:.:.�...:.:.. . .,�>
Class of Premise Peslm�it
❑ Class A— Bingo.Raf�ks.Paddlewhaels.Tipboards.Pu�tabs „_ _ . _.. ,
� Class B— Ralfles,P�ddlawheals,Tipboards,PuN-tabs T1fe C/HSS ot p�9/hlSB plR1flt
❑ Class C— Bingo onlyr muSt b@�@fIBCtBd by ClaSS of
❑ Class 0— Rafflas only the orpanlzatlon Ilcer�
Bia�o Occasians
� If class A or C. 8{tl ia day�s and be�lnnia� aad endin�honrs of bingo occasians:
�; No more thaa sen►ea bingo occasions may be condacted by an or�anization per weel�c.
.=•=, Day gegi�uiing/Ending Hours Day B�g/Ending Hours Day Be�nnin8�FadinB Houra
�f�'�:;s�-
. J�T
���•�.
•y7" � •_
:Yy'�:.. w �
�,. � w ' W
�
:::�.. ....n•.�::.::...........:.v.....;...e.v:{.�::::.i'.�:::nxv.v:.•v.. ��v •.w::..v:x .. ..........
::n........::::...::.::.:.:.:::.::n�.�:.::::::.:::•::::::::x.�:A`�t{•i}'viy?ti^:+aC.i.M......t.. %•:.ii:nvr::::::�::::vr's�..��n.........::::.::.�:::.;................ . ............................ .. ........
�,.�..�� .::v:..�:..:�:.:�.�:.��.�:.::•.:�:.:
n...._ . n .n..._. ....v ..,-.n..
....:::........e.............!�C..�.....:•.::::•:::::::}:�::::::::::::::::�::........:..:::vn�x::::.x...y:::::...::::::n_:-:.::.... . _ ..
:.:v::::............................:::n�:::::::..............::n.
...... .......:.............................................:.�-v...v...�i:::�.:v:r::-v:�:w.v-:�:::.::...............J.... ....... .::.:::::::..............:::.:......:. ...:{{tl...M.\n,-:...,-Kdry...�:^'n✓....::i�:Y4:.iiii::�
I..................:.:.v .......:.:::::.. t.r... ........:::........... ..r.......:::::::...........:.:..::.:;.;;..:..........:�::::::::::::i::,.�::::..•::::.,_...�...:....•.•
............
v T�..... .�...t.
.............................. ...... ...,.:.:.. . ..x........ ..............................:..:..: .....,..............................................�...:ri::::�::;:r�:�:::::::��.
.:,-....::........................................... .t....... s...<......,..c+,f?.... ,...•::.�:.�..a..............................................,......,...............,...................,.... ........t..:........,......:.:._.......
- �... .... ...::..::>:�;:::.:,::::-.... .. ....... ....:....:... .,......
.:.;,... ...:::::::,::.::. ................)
.. : .... :::......: :::: .,-.. .. .:..:..... .::.:.:.:...,. . ........... ..:.:..�:::-•.•.�..:.....::.::::-
. ...:::::::::::::.�:::�.:..?:..::t::..........:... .
. ;. ..�:,: :......."":.. � ......... :. ...... ... .:..�:�:::.:::::.::�:.:_::::::.:'v"�::;::;;::;:::::;:i::[:%::::':i:5
y �e ��,�f. ,.. .. ..:.:�:._x_:: "....::::::�..::
. ::LL� Q'. ,' . .. ..• ...::� �. �.-..l..—Y. :.::u..i:i:T>.:.>:::.i v;:;::�;:•::•
- -�W� .' .:.............. .... :...
_. �t. :..........r.... .......:..:::::.:.::a:::::;:::.>:';': '"".....::::.,-........ . ...
_.. . �. ' ' . .. "". ::::::::::::: .. ........:.�:ru.>::::.:;:.::t'<;:;::$;:;:;''_`i:;::c�-�'.�i:>:;:+>:n:'::::;:::r:.::
.... ��p�Li�
. � . . ��-�.i�i��
. : . . � j .. . ,��i
, : : € :.;;:.{.. . :. ...
.. _ . . ....... ......... ::.. ::..•.., � � ;:;;i<.;r::;:,;i;:?i
.. ;.:.
. .. . � .-_ . . . ' _
......... 2 •.:.. ......... ......... ......... ... ...... .........: �......... ......... ......... . ........n .:: �..�.......... .........
.G::.` .
- Statns of Premise Rermit - check onc �
- ❑ New premise—Fil in�,gg organization promise permit numbar
� Renewal of axisting premisa permR—Flt in�g�pramise parmit numbar L�-CC_7- //�-c`.G��
❑ Previously expired p�emiso permR—FII in�jg�promise permit number �
. , ;. ��- ��9�
,�� . ; .
�.�,,
� . LGZ 14
�'..•
;;,:.;
`;,a.°. MinnesotaLa:vfu[ Gamblin�
'�:' Premise Permit Application - Part 2
�i t;�.,
t.�
.J.�..
� ,
,^=L'. ::?!�.�:.:,..M1..,;.,�.;o-.+:!�;:t:vay:st•:»:;^.,.,Y••.'•a.v...:i::'•:ifi:^" ;:•:om.;..:.:.a..:::,.::,...;.:-n
....... "::.n::;•:::•;:....;.:.w::...::., .....,;., .a:u:.:...yp;cr:? ++M^t.y,+: ..;.;M...y«
...... . ._.......::'..�::::........ „ ::...:. .::.:::.v,-...... n}..: S^ti}:xy:. .
:... .:::. ..:......:Y.�i'^%':'::::::'::•�.i:ii:v:�......:,•�,n,�.,.::::::}iY.:?v.v.._ v:.....'-4.. :IY.Gi: n S. •`Yi?:ipiii:"W..O::.
. .:��...... . . .:...:. ....:.. ... ........... ;C...::^nYJCJ v.,r,.3r.vx .i;��,.}:;x..��.v:;x{�ii,'�,/.�.�,+{:i�:r:�i..........,-:{;.�.:::.
. -.•.^ ......,-........,........,.....;.ti ., ...
...�-:tiy
- � .:.:...... ...::........:.�:.,.:.:...
- :::'t�53:.::x:::`:>::::::.:;. x. ...�f.;'::%r':'::��:`:..........
.,,. . ... :::::..::::.:; .
�amb .:���.;<::.�.:�M:::.;;:;:«<;.<.:.:<.,,.,...::;;.;:::::...:::::.::::::.:.<:.;::.;;:<.;:;.k:;«::.<:.;»>:<::>.::.
lfn�':�rermise Inforsa�ttioa:>�::::::::::>::»:<::.;�:.:..::::>:::::.;»:::::::..:.:::t.::.s:,......�.
,,.<:..::::::.:.::::.:>:.::<.::.:.;.:>;�:.;:.;;:>;::;:;:.;:.:;.;.::::..;:<:.�<::::::«:..;:.;>:.;:.;::::::>:�:::�:::::
� �
� Name of estaWis where 9dmbGny wiil be conducoed ... Street Address do not use a post otfice box rwmber)
� � — C IO�'� Lv�r e:.,�eu,- �G . 9'• ��..�..� '��,w•w S�"Il3
Is the premiaes Ioca�ed wi1Mn diy 6mitsl [�yea ❑no
' Ciry and Counry where flamblin�premises is locaoed OR Township and Cou�r where pambriny premi�es is Iocated it outside ot ary 6mits
qw�s� 5� ��a�..� 6Y1 ,w� SslC
Name and Address of OWrner of Premises City �� Zp�
�t`�:l � ��4�M 7C: � I��0� ��. �f'CCD I� '�f�G..l 1 �T`'�v('TC'Y 1� I�I.i:iJ � 5���
- Does the oryan¢ation ovm the�ny where the gambling will he conducoed?�YES �Ip �—
�
, NOTE:Organizations may t pay themselves rent iF they own the building or havo a holding company. A letter must be sub-
mitted showing reM payme�as=ero from gambling funds d the organ+zatio�'s holding company owns the pramises. Tha
�-, letter must be signed by the�chief executive officer.)
�-'. If NO, attact�theifolbwing:
' a cop�of the Iease with tem�s b�one year.
' a cop of a sketch of the floor plan with dimer�sions,showin�what portion is being leased.
.1'.` A lease and ske�ch are not required for Class D applicanbons.
�,
�--
:i.;::-.:
``° Rent:
��'� Fo�gambling wi{h bingo $ Total square footage leased
!�r[�:�
�
�-, For gambling wi�hout bingo $ Total square footage leased
.��
_:- Addrass of sio Q ambl� ui maM
.�:-` "�9 SP�°�9 ^9�9 P
Addross
C'
n Stato
1�1(0 ��.� � 7' �...` � � Z�P code
,.,,,_.
_�
.
� S
- -� _ .......... .:::. :..�:: .;:,;.�.>..;,:...,;,;,...: ......................,.:::::.:::::::.:.:............................................._ ............. ..... .
,�. .,:,..:::: ..... .... ............. ,.,.,.,.::....
.; ......................,,�::::::.:. .�...........,..
► ................. ,>:::.::.,;::::::.;>::::.:.�:;��.:�::�:::.,._-:--..........:,.. :�:::<«.�>::;;._,_,..:,:;>;:.::;:.;:�.;;:::.:::.:.;;;:.>..:::><�:,�:;;;:..,;;:.;:.;:::.;�;.;:.;:.:
, +�,� ........... .,„:.,f...x..,-..„.� .....,.,x��: ..:...
;.•:.:,.. fe�.• ,,..{..;>.a�3°...<.....:�.•.•.::.: :.�#:•:.,:��:::�.•.,�::.;�.;�..::,;fi:.y�..
5C?�i:::>i;: .N. .:Y`:;}r''iin" �.F... i,F�::.{,.:..�i:_:l... .:y✓. "
; = ' ' ::;. � :.�:.�:.�::::.�t:.•. .,..r;.;_ :w::t.. ,.
. . ..........,,.;•>�t.. � ..... . ..... ... ..:.
��:t311O ::::.::•:.::.:..r{r;Y�;i:�.'aY ,•:::.r..;.:'•;•:;•::.;ti>:;,....;.:., :. „�•:: r ,:::'x•:. . ...::.,.;.,...,-, :::. .
ra� oa...:.::.�........ ..... . �. ..y �i .�:.::�.::.: . :... ,. r.. ::n.><»::�:��x�.
.�.,�"� �.... ............:::.:.�. ..............�..v;..,I._...._. :v:i::Ll,..{...{ .:::!f:n;..,Pkn _ �'..�..:i... ..MQ RCx ...+n..}ff.... S.r ...9nYw::4'e'vi:�S.�i::i.f'2:"r::.>:i2
, .. .......:::::::::.:.:..::.�.:.::::::::::::::::::::::::..:.....:. •"F.P7FSy.?•..v....:�::.:^�=-: .:.. ... : .:.:. ,..r�. �n.;;;r::..�:
i. ..>�..�..:�::.:.:,..::,.:,�:.::::.�,.................�:...........................:.:rvwn��... .. ................:..r..0'.i':'F.•iYY.�.n.S&T. .::!.:i:'�F.;���•$�•:.y:,..:::n. '-:attoii?i}i:a:f:::.:::::::n.:i•is:n•.iii::.�.::t�?»::::::!;::::
...,.,.:.. z}�y2�!a����a-#-��r........ .......:.... � ...�:,. ::::.
....::.,.:
Y. y/ _. .,.::. ,,,..:. ;..:.
QaAI ff� lllW IW 1��IfIL!
�"' �ifl�(N8ft1i
Bonlc A000a�t Number
.�,_� �rx� Nar��-�'�a.�-,� ���d��" l���c�►a . 5s3�C��
:;,�,. Bank Address .� City Stame I�p Code
��, j ` 1 t /�,� .
.:;°_. �7� ,fJ. Letc�lw 7''0 !,l ��4.c.�14 �, ,4-c.c.! f /( i a.h. SSro�
;E�:�
<;�_ Name. .ar►d OW o/persons au�f►aaed b sgn d�eeks and malai d9posns ard wiM�drawala.
�"=. i
� N� Addre:s Title-
'^f-:. , /
,Y... � `( �77. ���'��'��t �/UC �`�
;�_`. /�
/ , ,G"�2 �L'fI''��1/IJ ����� 7 (..O I'K t� H'tl� I'P�1 �(.�l 1
„ti.,;
:�
��. , � . � 9� _ a�9i
. . ,
LGZ14
�: - .
� . Mi�u�sota Lau�ful Cambiin�
:�:_° _
L� �. Premise Permit Applicatio� - Part 3
,:����
���
:-:.�_
.�;._
... . ....v.::.::: ,:>:....::::;<.:;«<:::.:.:,..:;.>..KV.::.:.:::<.:<.:<::.r.v.;,.:..:::.:,,.. ,:..�.:..,.::..::.::..v . .:.............,.. .. . . . ... .... .
',v'Y,"".v,h{:.:r..w:fl""v.- ..IY'Y.^.::::::::v:::'i.}:?}��;+vxx r
:n...........::::' �t...::.4.:.....::::.�:.:..... v.......... ... .4.::Y..;�{{x.��.v..,-�;s.Mn.�.;�:;::.:•n•.;{n;{yHyr•� v�
N.....�. .•:::::::.�::v:r::v:�.:�}}i•:n}::::::v:�. ..... ... \..i-{.:::.�::::::.... ...... ...: f...::.....v f. .:. 3'.::3'?x '+}iYyvi;ny i�?i}'I..�
...........::.. ............ n.. . .e..:.::v.�:::.� ...............�..::F::::....:::4•.v.v.n.......� : .:.ri.x;.. : .rR�..�.n. n... �....:::t::iR::i
..R��. ??r'>i:?;:..........c•.S>i:�::'��:::::: :::l��T�:�:i::�::.:..�:::.�:.:..hr.v.-i4.::::.:.ii>. ..�i.................. ...:::�::....... . ff::.;,T.'.;;r:;y�.y� X.:.n::,.,-. .
.. :r.:.r.;r.;}. .,-;... x•:v:A:M:m:.::..:+M. r...�:....:::....... ....r..::yx.�:^."i:nii}:i:{_:ti:.M.,G;n}_1{in;.}v:A.:{$v�$4.�.�+L. ....L:..:
, ... ... . . ... ....... .n.v.. .......• �i . ....._�................�....:..........:n .},. ..r`.;}.rv::$.,�rw'•',:W-�t"�,'.-{.-^ _:i$:«{
..�'..� .; , :- . .......:--:.-:::::::.+.•:.:+--r:�-.::-::•::::::::._,.;�'................... . .......::::c•:.�::�:.: .++•��} ...:..:... ..,.....t......:::::::•� :�:::%4:n:::'fi�:;�:i::;::;::�i
!.u.:�.i.. ::.5?-?-:::.�.......��-. ..Mry::::::::.�::•::.::�..y .r.j,v,.C.J.y} n}�.,-;.:.:::::•: .$.x :t..�{:•...}f::r•'k:i:;:r:�::r•:.lv::..
..-0...:..::n�:.�: .T � ii::tnz:. .A\{.J:w.. .r/;Y4:i4:
iv.i-��::ii:v'i:i:iii:Y' :::\�$:�vi:ti:�C:�ii�i:`�:'v:+i�vi:r.+'•ii ...fi::•i•:.}}w:n::i+..i:::...
Ac�nooale� em <:»<>::.::::..�...... ...... k::::
..... � f < ro�;::;;>;.......:•:.+.�: . .�.......,"-'-„' ..�...
'.._ � ......,, •
<...... . ... ..•::.:�:::::::.�::.�..:.::::::..•:?>•.,•;,.,Y'...:::...;:.:::.::._.i;.::•:::a::::i•.�::.... -.....,:::.:`:'..<?::2`•:o:`.�i:>5:
,._ ::: :.::.. :::.. :.:: ..... ::u.. �. .. . > '
'�c: .
� Gamblin�Site Authorization
� I hea►by consent that local law enforcemerrt offie�s,the board or agents of tha board,or tfw commissioner af rwrenue or
publ'�c safety,or ageMts of the commissioners,may enter tha premise to enforoe the law.
Bank Records Inform�tioa
The board is authoriled to insped tha bank reoords of the gambling aocount whenever nacessary to fu��l
t requirements oi current gamjbling ruks and law.
I dedare thad:
1 have read this ication and ali information submitted to the board;
All iniormation is t e,axurate and complete;
All other required i fotmation has been tulhr disdosed;
I am tha chief axe�utiva officar of the organization;
I assumo full resp�nsibil'ity for the tait and lawful gambling and rules of tho board and agroa.�ticensad.
to abida byi those ws and►ules,indudu�g amendments to them;
A membership list�f the organization w�be available within seven days after it is requosted by the bosrd;
" Any changes in a�plication i�ormation wiN ba submitted to tha board and bpl govemmaM within 10
days of tha changp;and
A tartnin�fo�plar�will ba submittad to tfw board wRhin 15 days of tha tarmination of aN pramisa parmits. .
`:,; Failura to provido Irequirad i�ormation a providing lalsa u�formation may rosult in tha danial or revoption of tho
�`�' license.
:�..
_;;:::
���- Siqnaare of ch' ex p�
�;:�. - a - 7 -�" J
..
�:-: ..: .... . ::::...>:::,:::.:>:::: ..... .......
. .: ':.;-i:::::; . .:...... .......�.......:.-...... �:.......... , ...:.:..::::.•.:::..:::::::::i.'p: :;.}••i4::r.iv+:i.iii'�:�Y�:' ::•i'i.:i::i::::�� •::ic:.:.:
� �v;: ' .. � .�... . �:.. •i.•::: r...n......... :.:n:::.:v}Y.�y::.•
: .. ...._ ':....:.........:::��:::.:.. ....::::... ::::: �r::::::.�:: .:::.. .... . .........� .. 4•_?):;;:}i>j:4.v;C ...�:i
'Gt... . . �� ... . ... .. .:... ................. ..... ....,-.v:--�:::.:,;.};r:::��.....vi:�}i:6`f.�\•i}i::iiii�:•':i::i:.,v',:.i: v{.yr{n:iitii"4ii::i�'?vi:
..?�c.__::_.. .•r;�..,•, ..;.}:.:.>:.,..,!•,::r.i:•:�:�:i3:'�:" •ii5:2:f:'.n�t:.,{.r{..Y.v.;.:.;a'rii;:•°'c.:>r.�'.•�i ...i'•>:;:.:.:R?'•:;:•
:;ri
�E
�8�::::; YC :.;:.,.::.>:>:.::>:.::{,;:»>:.�s:v .:::�: �.7;:::�.n:��`--�:<>v%<,<> :;:;::�$�v<;:
CIIf�AC�LII4WTCt� CtII1�II�. `"'�
..
:,
^r _-:__ ::.:. .;...... - x < �.>:.:,,..,.:,�:.: u� ��x� .
'* �.� .::.�...� ..... . :k t ...k'�.if} rrs {i<�?s r _ {
g�,C.... . .... ..... ._... •:::. .. ..c...a
�' 1. The ciy'must si9n�tho yambling promisas is located wilhin citylimits.
��� 2. The courrty"ANO tow�hship•'must sign'rf th�
,w�,:;:, gambfiny promisas is located within a township.
: :;�;;,:.: 3. Tha bcal govemment�city or courri�r)must pass a resoiu6on specif'�cally approving or denying tha�plication.
•�=.- 4. A copy of tha nesolutialn approving tha appli�tio�must ba attached to the application.
�"������ 5. lications which are!de�ied tha local
-�-.- App by goveming body should not be submittted to tha Gambling Control Division.
:�-�.� . -
�� TownshiQ: By sgnatura babw,tha township adcnowledgea that tha organization is applying for a pramises parm�within
_ township limits.
X.^•."
.�y t�.:
���: Clty ot County, Tovmshlp••
z t:,;
� .�
_- �Y N� ` Tovrnship Name
:;�;�y'-
-x;',-,`..
i-;�' a o lieation • Signahire of person recaivin0 aPplicadon
t:`�
,:�; . .
T � ru� �a a��
:�U;:;. �/
.: ersor,de verW,a aPa� m ��w bodf►
'.'ia .
x•= ; �.ooM►nsl,ip: p oryar�zad �un�xga�ed •p u�in�orpa�awa
' Rof��to th� Instrucitons fo�th�nqulnd attsd�nMnts Mail to: DepartmaM of Gaming -
Gambling CoMrd Division
Rosewcod Ptaza South,3rd Floor
1711 W. Counry Road B
Roseville, MN 55113