97-1485Council File �` �� — �4�
Ordinance #
Green Sheet � 50251
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Presented By
Refezred To
RE50LVED: That application, ID #B-00963, for a State Class B Gambling Premise Permit by
Church of St. Bernard at Lendway•s Bar, 6Q9 IIniversity Avenue W., be and the
same is hereby approved.
Requested by Department of:
Adoption Certified by Council Secretary
BY:� 4��-�...
.
Approved by Mayor: Date 1 t,2G /F'7-
By: y � �
• - •-�-- �-s-. •�- -.•
9 ! • } J I ' 1 ' • - • �
�, Tf
Form Approved by City At ne�
)
By' - ? `h? �� -
Approved by ayor for Submission to
Council
By:
RESOLUTIOIV
CITY Of SAINT PAUL, MINNESOTA ��
Adopted by Council: Date � \p ,1���(
N°_ 50251
AFFlCE/COUNQL � DATE WRIATED 9� /4Ps
LIEP. GREEN SHEE
CONiACT PERSON d �HONE INITIAL/pqTE MITIAVDA7E
� OEPARTMENT DIRECTOR � QTYCOUNQL
William.F. Gunther — 266-9132 ussicx �cirrnrrow�v �anc�EaK
MUST BE ON CpUNCIL AC�ENDA B1' (UATE) HUMBER FOR O BUW ET DIRECTOR � FIN. 8 MGt. SEflVICES DIR.
� NOUTING
H28I1Rg' ro(, O OFDEH O �,�pYOF (OR AS$I5fANn O
TOTAL # OF SIGNATURE AAGES (CLIP ALL LOCATIONS FOH SIGNATURE) .
ACTION PE�UESTED:
Rev. Michael Anderson on behalf of Church of St. Bernard requests Council
approval of their application for a State Class B Gambling Premise Permit, ID 4�B-00963,
at Lendway's Bar, 609 University Avenue W.
RECAMMENDATIONS Approve (A) or Rejed (R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS:
_ PIANNING COMMISSION _ CNIL SERVICE COMMISSION �� Has this personRirm ever worketl untler a contract for this department?
_ CIB CAMMITfEE _ YES NO
_ STAFG 2- Has this personffrm ever been a city employee?
— VES (JO
, DIStAtCT COURi _ 3. Does this person/firm possess a skiil not normally possessetl by any curcent ciry empioyee?
SUPPOFTS WHICH COUNCII O&IECTIVE� YES NO
Explain all yes answers on separata aheet enO ettech to grean sheet
INRIATING PROBLEM, ISSUE, OPPORTUNI7Y (VJha, What. When, Whera. Why)�
ADVANTAGESIFAPPROVEO: -
�ISAOYANTAGES IF 0.PPROVE�.
DISADVANTAGES IP NOTAPPROVED�
� � �
� OCT 3 9 i�97
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGET D(CI RCL`E ONE) — YES .�-
FUNDIIdG SOURCE kCTIVITY NUMBER
FINANCIAL INFORMATION (EXPLAIN)
uHi"It7�1�YU l.uIVIKU� � ItL�b1L UCt 1( 9(
°. LG2S4 .
• P•2s917
MinnPSOta Lawfxi2 Gcmbting
Premises Pezxnit Applicstion - Pas� 1 of 2
10�02 N P
FOft 80ARD USE ONLY
BASE �
PP x �
Fce
CF{cGIC - -- 1
lMTIALS '- .'_ �
a�r� I
�
U Rer.e:aa1 � . . . .. ..
Orya�izaGan base 1'tcense number
firemises �pemit rumSSr
j� Ne,'v
�.h �f- �t �,( �
ass ot C�^anizauon - SSeet a P. O 5cz �Do nct use Uie aC:
U . /SS� , ,�I.�� .
� c�' l��/V .�',
�
ezec ^ive on;ar (pn.�t be ��r ysT�lin9 msr,zqer)
A� � - � -
.if/'
�; �r
�.:igu v�c:a�tUps . . -
<f app:yjs.g ;cr a class A �r C?er�it, �11 in dzys ar.d begL�s.L�,� & cndi�g houas of bL*.go cCCZSiors: ��:.
No more Lhan stvtn bL^.gp occasiorl5 z:.ay be cbnducttd by your or�an+�ation per week. ;$''"
. :.zy B��:u.L^.gJ£adir.q Hcu:s Day B�p.�uLag/Ending �:curs Bay 8:;4uung /£nd:ng Hovis
:o � to � to . .
a __ to �_ �
:o If bfn�o mill noi be coadec:c3, chccY hore
� ''?t..
n me ot es• Ol:snment whare blu�q wtll D6 cOr.�uc:etl tre9f ,jCCress {o� not use post ot�ice numb r) ��"
�C�uj�a�i�� , 1�Dg ��n�vp.f'si-�,� �h.�h�.�.�J L,�� `�;..,
Ss th0 premises Sxa: witl�in city fimits9 Yea � No tf no, is townihip � organite � unorganized O �nin�rperated �
Cief and Counry wnera gambGng premises is Ixa7Ed OR Tnwnship and Coun,y where gam�ling premises is loca;ed if ouisidg oF t'ty limits �_
�•�!�'!t./, t��� i/�dl. ( ..
�Vama
cwner
yo::r aryanizabon own ;hs buit�ing where LhE gamblinq will be anCuctaC7 p Y�S ��NO
. if ra, anach the fcUcxing: . .
�•. a mpy ot the k�ase (torm LG202) with terms for at least me year.
' a capy of d sket:tt of the Awt ptan'wiLh dir..ens;anz, shouing wnat �[tion is being leased.
� �� A leasa arxJ sketeh a�e not teq�ired for Clats D ao
•_:.......:. ___�.�„_.. .._....�,._>_�.__._.....,...,..__.
0
0
class c; pren;:c: ?emit -
(check ene) -
[] A t5<0�1 PuihtaSs, :ipS�ar�s. pa�:ewheets, ra"fes, biry�o .
� 6�5250) Polf-,2bs, tipboarVS, pad�l2wheeis, ra"�es., _,:
�I C (520�) &nyo on;y
❑ D (5750) rtafl7es ony
_..i.c.
:r;
. ::4,`. -".
': : i.z
'.;: :
o°'�.�` ;��
...� �
�i<:tX::
�.
• 'y%1WS: � ,
;sr�?.�a' .
:.p'; '
' ,'ti:� lr.: .
�, i`.'.
-� y. .
sa,���� � Nc �ar, � ,=,a�
��
=i :bl_ �.J?
Oct 17 97 10:0� No.00? ?.vo
�1 am fha chini executive oHicar of iho organ'¢aY�:^;
•1 assume full rasponsiblity fct tha fair and lawful cpara�
tion of ail adivi;ies to oe qndu� ed;
•! wilf famiiiariz9 myseli with tha laws cf Minnesc;a
govamir,n iav,iul yambliog and rules ot tne bozr: aad
agrea. ;!icensed, to aoide by those laws and rules,
inc!uding amendmants t� them;
•any.c�anges in app(icat;on iniarrtia;ion will be scb^�r„sd
to the board and bc�.I unc �! govsrnmant v.•ithin 10 C�ys
ot ;he change; and
•I uncQrs;and that tailure to provide raquired infor;�,ation
or provi='ing false or misieadinq iniorratior, may resui; n
the danial or revo:at;on of the 1'�canse.
I hersby coaser,t that foczi law sniorcement ef�i�rs, tna
board cr agen:s ei tha board, er the cammissione' oi
�evenua cr oubl�, sae,y, or aoon;s cf the crnissionars,
r..sy er,iar tha p:aRises to enforce the law.
Ba;.b Records Informatioa
Tne �ard is au:ho, ;a i^spe� ths bank rr,;,^rCS o�?he
gar,.bii�; ac;oun, whersva; ascassa.y to fuHill
raquiroments ot current gar,.din;, r.:les snd lzw.
Oath
I declara?hat:
�! ^nve :s2C :hIS 3ppiicaticn and all irtorra��,n s::nn�ed
to the b�are s trua, �curate and .�:mpiete;
•all pthar re:uired in�ormation ^as baen fu:!y dis�cse�;
5. The cty 'm4st sign this aoplication ii the gambGng p�sm-
ises is iocated within city fimits.
2. The c�unty •'AND towr.snip•' must si�n?his appiicaticn i}
tha ganbling �tenises is located wflhin 2 township.
3. Ths locai un� govatnmeni (c'y cr county) must pas5 a
resciu;ior spec�ficatly aroroving or denying th�s a?pi'Katicn.
4, A c^'+v �f �hs b^al unR 01 �overnmant'S reso(u'ion a�-
�mvin� this ao,�;jcatio� mus�be anached to this aooSics�ion.
5. tf this appiication is danied by the bcal unit ot govarnmeri,
it should nct be submitted ic tha Gamoling Contrct 9oard,
7ownship: By signature bslow, 'he townshio zcxnowls6ges
that lha arganization is appiying for a prsmises permi; wit!�in
towrship limi:s.
Ciry ot Counry Name
L —
/' "
Signa�Wa of p rson racaivin .ap
� �� -
iiue � 6�j�r�J� �'`
Township NAma
SiqnaT��e of peraon �ecalvinp application
.E�atB RE^8ivep � Tttle
16—�/�7
Cate Aeceiretl
neler a;na ins9veions tor recared ar,achment_.
Uaii (�; isnbllnp Co^trol Ho�rd
aosawood PNu Soulh, �rd ��oor
7?�1 W. ^-�ouniy Ro.d 2
acs�v)Ile� 3.IN SS::J �
_..25:(pert :!
�Slnrzesota Lau�,F.�t Gtzmbiing `
Premise �e�rzit Apgiication - Pa.�.� 2 of 2 q1—�y�,
Council File �` �� — �4�
Ordinance #
Green Sheet � 50251
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Presented By
Refezred To
RE50LVED: That application, ID #B-00963, for a State Class B Gambling Premise Permit by
Church of St. Bernard at Lendway•s Bar, 6Q9 IIniversity Avenue W., be and the
same is hereby approved.
Requested by Department of:
Adoption Certified by Council Secretary
BY:� 4��-�...
.
Approved by Mayor: Date 1 t,2G /F'7-
By: y � �
• - •-�-- �-s-. •�- -.•
9 ! • } J I ' 1 ' • - • �
�, Tf
Form Approved by City At ne�
)
By' - ? `h? �� -
Approved by ayor for Submission to
Council
By:
RESOLUTIOIV
CITY Of SAINT PAUL, MINNESOTA ��
Adopted by Council: Date � \p ,1���(
N°_ 50251
AFFlCE/COUNQL � DATE WRIATED 9� /4Ps
LIEP. GREEN SHEE
CONiACT PERSON d �HONE INITIAL/pqTE MITIAVDA7E
� OEPARTMENT DIRECTOR � QTYCOUNQL
William.F. Gunther — 266-9132 ussicx �cirrnrrow�v �anc�EaK
MUST BE ON CpUNCIL AC�ENDA B1' (UATE) HUMBER FOR O BUW ET DIRECTOR � FIN. 8 MGt. SEflVICES DIR.
� NOUTING
H28I1Rg' ro(, O OFDEH O �,�pYOF (OR AS$I5fANn O
TOTAL # OF SIGNATURE AAGES (CLIP ALL LOCATIONS FOH SIGNATURE) .
ACTION PE�UESTED:
Rev. Michael Anderson on behalf of Church of St. Bernard requests Council
approval of their application for a State Class B Gambling Premise Permit, ID 4�B-00963,
at Lendway's Bar, 609 University Avenue W.
RECAMMENDATIONS Approve (A) or Rejed (R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS:
_ PIANNING COMMISSION _ CNIL SERVICE COMMISSION �� Has this personRirm ever worketl untler a contract for this department?
_ CIB CAMMITfEE _ YES NO
_ STAFG 2- Has this personffrm ever been a city employee?
— VES (JO
, DIStAtCT COURi _ 3. Does this person/firm possess a skiil not normally possessetl by any curcent ciry empioyee?
SUPPOFTS WHICH COUNCII O&IECTIVE� YES NO
Explain all yes answers on separata aheet enO ettech to grean sheet
INRIATING PROBLEM, ISSUE, OPPORTUNI7Y (VJha, What. When, Whera. Why)�
ADVANTAGESIFAPPROVEO: -
�ISAOYANTAGES IF 0.PPROVE�.
DISADVANTAGES IP NOTAPPROVED�
� � �
� OCT 3 9 i�97
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGET D(CI RCL`E ONE) — YES .�-
FUNDIIdG SOURCE kCTIVITY NUMBER
FINANCIAL INFORMATION (EXPLAIN)
uHi"It7�1�YU l.uIVIKU� � ItL�b1L UCt 1( 9(
°. LG2S4 .
• P•2s917
MinnPSOta Lawfxi2 Gcmbting
Premises Pezxnit Applicstion - Pas� 1 of 2
10�02 N P
FOft 80ARD USE ONLY
BASE �
PP x �
Fce
CF{cGIC - -- 1
lMTIALS '- .'_ �
a�r� I
�
U Rer.e:aa1 � . . . .. ..
Orya�izaGan base 1'tcense number
firemises �pemit rumSSr
j� Ne,'v
�.h �f- �t �,( �
ass ot C�^anizauon - SSeet a P. O 5cz �Do nct use Uie aC:
U . /SS� , ,�I.�� .
� c�' l��/V .�',
�
ezec ^ive on;ar (pn.�t be ��r ysT�lin9 msr,zqer)
A� � - � -
.if/'
�; �r
�.:igu v�c:a�tUps . . -
<f app:yjs.g ;cr a class A �r C?er�it, �11 in dzys ar.d begL�s.L�,� & cndi�g houas of bL*.go cCCZSiors: ��:.
No more Lhan stvtn bL^.gp occasiorl5 z:.ay be cbnducttd by your or�an+�ation per week. ;$''"
. :.zy B��:u.L^.gJ£adir.q Hcu:s Day B�p.�uLag/Ending �:curs Bay 8:;4uung /£nd:ng Hovis
:o � to � to . .
a __ to �_ �
:o If bfn�o mill noi be coadec:c3, chccY hore
� ''?t..
n me ot es• Ol:snment whare blu�q wtll D6 cOr.�uc:etl tre9f ,jCCress {o� not use post ot�ice numb r) ��"
�C�uj�a�i�� , 1�Dg ��n�vp.f'si-�,� �h.�h�.�.�J L,�� `�;..,
Ss th0 premises Sxa: witl�in city fimits9 Yea � No tf no, is townihip � organite � unorganized O �nin�rperated �
Cief and Counry wnera gambGng premises is Ixa7Ed OR Tnwnship and Coun,y where gam�ling premises is loca;ed if ouisidg oF t'ty limits �_
�•�!�'!t./, t��� i/�dl. ( ..
�Vama
cwner
yo::r aryanizabon own ;hs buit�ing where LhE gamblinq will be anCuctaC7 p Y�S ��NO
. if ra, anach the fcUcxing: . .
�•. a mpy ot the k�ase (torm LG202) with terms for at least me year.
' a capy of d sket:tt of the Awt ptan'wiLh dir..ens;anz, shouing wnat �[tion is being leased.
� �� A leasa arxJ sketeh a�e not teq�ired for Clats D ao
•_:.......:. ___�.�„_.. .._....�,._>_�.__._.....,...,..__.
0
0
class c; pren;:c: ?emit -
(check ene) -
[] A t5<0�1 PuihtaSs, :ipS�ar�s. pa�:ewheets, ra"fes, biry�o .
� 6�5250) Polf-,2bs, tipboarVS, pad�l2wheeis, ra"�es., _,:
�I C (520�) &nyo on;y
❑ D (5750) rtafl7es ony
_..i.c.
:r;
. ::4,`. -".
': : i.z
'.;: :
o°'�.�` ;��
...� �
�i<:tX::
�.
• 'y%1WS: � ,
;sr�?.�a' .
:.p'; '
' ,'ti:� lr.: .
�, i`.'.
-� y. .
sa,���� � Nc �ar, � ,=,a�
��
=i :bl_ �.J?
Oct 17 97 10:0� No.00? ?.vo
�1 am fha chini executive oHicar of iho organ'¢aY�:^;
•1 assume full rasponsiblity fct tha fair and lawful cpara�
tion of ail adivi;ies to oe qndu� ed;
•! wilf famiiiariz9 myseli with tha laws cf Minnesc;a
govamir,n iav,iul yambliog and rules ot tne bozr: aad
agrea. ;!icensed, to aoide by those laws and rules,
inc!uding amendmants t� them;
•any.c�anges in app(icat;on iniarrtia;ion will be scb^�r„sd
to the board and bc�.I unc �! govsrnmant v.•ithin 10 C�ys
ot ;he change; and
•I uncQrs;and that tailure to provide raquired infor;�,ation
or provi='ing false or misieadinq iniorratior, may resui; n
the danial or revo:at;on of the 1'�canse.
I hersby coaser,t that foczi law sniorcement ef�i�rs, tna
board cr agen:s ei tha board, er the cammissione' oi
�evenua cr oubl�, sae,y, or aoon;s cf the crnissionars,
r..sy er,iar tha p:aRises to enforce the law.
Ba;.b Records Informatioa
Tne �ard is au:ho, ;a i^spe� ths bank rr,;,^rCS o�?he
gar,.bii�; ac;oun, whersva; ascassa.y to fuHill
raquiroments ot current gar,.din;, r.:les snd lzw.
Oath
I declara?hat:
�! ^nve :s2C :hIS 3ppiicaticn and all irtorra��,n s::nn�ed
to the b�are s trua, �curate and .�:mpiete;
•all pthar re:uired in�ormation ^as baen fu:!y dis�cse�;
5. The cty 'm4st sign this aoplication ii the gambGng p�sm-
ises is iocated within city fimits.
2. The c�unty •'AND towr.snip•' must si�n?his appiicaticn i}
tha ganbling �tenises is located wflhin 2 township.
3. Ths locai un� govatnmeni (c'y cr county) must pas5 a
resciu;ior spec�ficatly aroroving or denying th�s a?pi'Katicn.
4, A c^'+v �f �hs b^al unR 01 �overnmant'S reso(u'ion a�-
�mvin� this ao,�;jcatio� mus�be anached to this aooSics�ion.
5. tf this appiication is danied by the bcal unit ot govarnmeri,
it should nct be submitted ic tha Gamoling Contrct 9oard,
7ownship: By signature bslow, 'he townshio zcxnowls6ges
that lha arganization is appiying for a prsmises permi; wit!�in
towrship limi:s.
Ciry ot Counry Name
L —
/' "
Signa�Wa of p rson racaivin .ap
� �� -
iiue � 6�j�r�J� �'`
Township NAma
SiqnaT��e of peraon �ecalvinp application
.E�atB RE^8ivep � Tttle
16—�/�7
Cate Aeceiretl
neler a;na ins9veions tor recared ar,achment_.
Uaii (�; isnbllnp Co^trol Ho�rd
aosawood PNu Soulh, �rd ��oor
7?�1 W. ^-�ouniy Ro.d 2
acs�v)Ile� 3.IN SS::J �
_..25:(pert :!
�Slnrzesota Lau�,F.�t Gtzmbiing `
Premise �e�rzit Apgiication - Pa.�.� 2 of 2 q1—�y�,
Council File �` �� — �4�
Ordinance #
Green Sheet � 50251
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Presented By
Refezred To
RE50LVED: That application, ID #B-00963, for a State Class B Gambling Premise Permit by
Church of St. Bernard at Lendway•s Bar, 6Q9 IIniversity Avenue W., be and the
same is hereby approved.
Requested by Department of:
Adoption Certified by Council Secretary
BY:� 4��-�...
.
Approved by Mayor: Date 1 t,2G /F'7-
By: y � �
• - •-�-- �-s-. •�- -.•
9 ! • } J I ' 1 ' • - • �
�, Tf
Form Approved by City At ne�
)
By' - ? `h? �� -
Approved by ayor for Submission to
Council
By:
RESOLUTIOIV
CITY Of SAINT PAUL, MINNESOTA ��
Adopted by Council: Date � \p ,1���(
N°_ 50251
AFFlCE/COUNQL � DATE WRIATED 9� /4Ps
LIEP. GREEN SHEE
CONiACT PERSON d �HONE INITIAL/pqTE MITIAVDA7E
� OEPARTMENT DIRECTOR � QTYCOUNQL
William.F. Gunther — 266-9132 ussicx �cirrnrrow�v �anc�EaK
MUST BE ON CpUNCIL AC�ENDA B1' (UATE) HUMBER FOR O BUW ET DIRECTOR � FIN. 8 MGt. SEflVICES DIR.
� NOUTING
H28I1Rg' ro(, O OFDEH O �,�pYOF (OR AS$I5fANn O
TOTAL # OF SIGNATURE AAGES (CLIP ALL LOCATIONS FOH SIGNATURE) .
ACTION PE�UESTED:
Rev. Michael Anderson on behalf of Church of St. Bernard requests Council
approval of their application for a State Class B Gambling Premise Permit, ID 4�B-00963,
at Lendway's Bar, 609 University Avenue W.
RECAMMENDATIONS Approve (A) or Rejed (R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS:
_ PIANNING COMMISSION _ CNIL SERVICE COMMISSION �� Has this personRirm ever worketl untler a contract for this department?
_ CIB CAMMITfEE _ YES NO
_ STAFG 2- Has this personffrm ever been a city employee?
— VES (JO
, DIStAtCT COURi _ 3. Does this person/firm possess a skiil not normally possessetl by any curcent ciry empioyee?
SUPPOFTS WHICH COUNCII O&IECTIVE� YES NO
Explain all yes answers on separata aheet enO ettech to grean sheet
INRIATING PROBLEM, ISSUE, OPPORTUNI7Y (VJha, What. When, Whera. Why)�
ADVANTAGESIFAPPROVEO: -
�ISAOYANTAGES IF 0.PPROVE�.
DISADVANTAGES IP NOTAPPROVED�
� � �
� OCT 3 9 i�97
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGET D(CI RCL`E ONE) — YES .�-
FUNDIIdG SOURCE kCTIVITY NUMBER
FINANCIAL INFORMATION (EXPLAIN)
uHi"It7�1�YU l.uIVIKU� � ItL�b1L UCt 1( 9(
°. LG2S4 .
• P•2s917
MinnPSOta Lawfxi2 Gcmbting
Premises Pezxnit Applicstion - Pas� 1 of 2
10�02 N P
FOft 80ARD USE ONLY
BASE �
PP x �
Fce
CF{cGIC - -- 1
lMTIALS '- .'_ �
a�r� I
�
U Rer.e:aa1 � . . . .. ..
Orya�izaGan base 1'tcense number
firemises �pemit rumSSr
j� Ne,'v
�.h �f- �t �,( �
ass ot C�^anizauon - SSeet a P. O 5cz �Do nct use Uie aC:
U . /SS� , ,�I.�� .
� c�' l��/V .�',
�
ezec ^ive on;ar (pn.�t be ��r ysT�lin9 msr,zqer)
A� � - � -
.if/'
�; �r
�.:igu v�c:a�tUps . . -
<f app:yjs.g ;cr a class A �r C?er�it, �11 in dzys ar.d begL�s.L�,� & cndi�g houas of bL*.go cCCZSiors: ��:.
No more Lhan stvtn bL^.gp occasiorl5 z:.ay be cbnducttd by your or�an+�ation per week. ;$''"
. :.zy B��:u.L^.gJ£adir.q Hcu:s Day B�p.�uLag/Ending �:curs Bay 8:;4uung /£nd:ng Hovis
:o � to � to . .
a __ to �_ �
:o If bfn�o mill noi be coadec:c3, chccY hore
� ''?t..
n me ot es• Ol:snment whare blu�q wtll D6 cOr.�uc:etl tre9f ,jCCress {o� not use post ot�ice numb r) ��"
�C�uj�a�i�� , 1�Dg ��n�vp.f'si-�,� �h.�h�.�.�J L,�� `�;..,
Ss th0 premises Sxa: witl�in city fimits9 Yea � No tf no, is townihip � organite � unorganized O �nin�rperated �
Cief and Counry wnera gambGng premises is Ixa7Ed OR Tnwnship and Coun,y where gam�ling premises is loca;ed if ouisidg oF t'ty limits �_
�•�!�'!t./, t��� i/�dl. ( ..
�Vama
cwner
yo::r aryanizabon own ;hs buit�ing where LhE gamblinq will be anCuctaC7 p Y�S ��NO
. if ra, anach the fcUcxing: . .
�•. a mpy ot the k�ase (torm LG202) with terms for at least me year.
' a capy of d sket:tt of the Awt ptan'wiLh dir..ens;anz, shouing wnat �[tion is being leased.
� �� A leasa arxJ sketeh a�e not teq�ired for Clats D ao
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0
0
class c; pren;:c: ?emit -
(check ene) -
[] A t5<0�1 PuihtaSs, :ipS�ar�s. pa�:ewheets, ra"fes, biry�o .
� 6�5250) Polf-,2bs, tipboarVS, pad�l2wheeis, ra"�es., _,:
�I C (520�) &nyo on;y
❑ D (5750) rtafl7es ony
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Oct 17 97 10:0� No.00? ?.vo
�1 am fha chini executive oHicar of iho organ'¢aY�:^;
•1 assume full rasponsiblity fct tha fair and lawful cpara�
tion of ail adivi;ies to oe qndu� ed;
•! wilf famiiiariz9 myseli with tha laws cf Minnesc;a
govamir,n iav,iul yambliog and rules ot tne bozr: aad
agrea. ;!icensed, to aoide by those laws and rules,
inc!uding amendmants t� them;
•any.c�anges in app(icat;on iniarrtia;ion will be scb^�r„sd
to the board and bc�.I unc �! govsrnmant v.•ithin 10 C�ys
ot ;he change; and
•I uncQrs;and that tailure to provide raquired infor;�,ation
or provi='ing false or misieadinq iniorratior, may resui; n
the danial or revo:at;on of the 1'�canse.
I hersby coaser,t that foczi law sniorcement ef�i�rs, tna
board cr agen:s ei tha board, er the cammissione' oi
�evenua cr oubl�, sae,y, or aoon;s cf the crnissionars,
r..sy er,iar tha p:aRises to enforce the law.
Ba;.b Records Informatioa
Tne �ard is au:ho, ;a i^spe� ths bank rr,;,^rCS o�?he
gar,.bii�; ac;oun, whersva; ascassa.y to fuHill
raquiroments ot current gar,.din;, r.:les snd lzw.
Oath
I declara?hat:
�! ^nve :s2C :hIS 3ppiicaticn and all irtorra��,n s::nn�ed
to the b�are s trua, �curate and .�:mpiete;
•all pthar re:uired in�ormation ^as baen fu:!y dis�cse�;
5. The cty 'm4st sign this aoplication ii the gambGng p�sm-
ises is iocated within city fimits.
2. The c�unty •'AND towr.snip•' must si�n?his appiicaticn i}
tha ganbling �tenises is located wflhin 2 township.
3. Ths locai un� govatnmeni (c'y cr county) must pas5 a
resciu;ior spec�ficatly aroroving or denying th�s a?pi'Katicn.
4, A c^'+v �f �hs b^al unR 01 �overnmant'S reso(u'ion a�-
�mvin� this ao,�;jcatio� mus�be anached to this aooSics�ion.
5. tf this appiication is danied by the bcal unit ot govarnmeri,
it should nct be submitted ic tha Gamoling Contrct 9oard,
7ownship: By signature bslow, 'he townshio zcxnowls6ges
that lha arganization is appiying for a prsmises permi; wit!�in
towrship limi:s.
Ciry ot Counry Name
L —
/' "
Signa�Wa of p rson racaivin .ap
� �� -
iiue � 6�j�r�J� �'`
Township NAma
SiqnaT��e of peraon �ecalvinp application
.E�atB RE^8ivep � Tttle
16—�/�7
Cate Aeceiretl
neler a;na ins9veions tor recared ar,achment_.
Uaii (�; isnbllnp Co^trol Ho�rd
aosawood PNu Soulh, �rd ��oor
7?�1 W. ^-�ouniy Ro.d 2
acs�v)Ile� 3.IN SS::J �
_..25:(pert :!
�Slnrzesota Lau�,F.�t Gtzmbiing `
Premise �e�rzit Apgiication - Pa.�.� 2 of 2 q1—�y�,