The URL can be used to link to this page

97-200Council File # �_� � F . �' � � � � �� Presented B� Referred To Ordinance # 1 2 3 4 RESOLVED: That application, ID #8-04567, for a new State Class B Gambling Premise Permit by Children's Program of Northern Ireland at Patrick's Lounge, 1318 W. Larpenteur Ave., be and the same is hereby approved. s 6 Requested by Department of: 7 Yea Nays Absent 8 B a� cT —�- 9 �'?�'Ma"°"' � Office of License. Inspections and 10 Harris — 7 11 Me a� � EnviroxLmental Protection 13 Thun� � By: �A.U�'�a.- �� te Adoption Certified by Council Secretary Form Approved by City Attorney BY � �c°=��,..�.va�_ g � / / y: � � �/.,�_ Approved by Mayor: Date �� s 3 / /� Approved by Mayor for Submisaion to �� Council BY: L_� By: Green Sheet# 35434 Adopted by Council: Date �,Q�, �G _\�qt`( 9�—� ern ** NEED COPY IMMEDIATELY ** ' � �—' � DEPARTMENT/OFFICE/CAUNCIL DATEINITIATED GREEN SHEE _ N_ 35�434 LIEP - -- CONTACT PERSON & PHONE � DEPARTMENT DIRECTOR O CRV CAUNp� �N�T�AL/DATE William F. Gunther - 266-9132 ^ss�cN �cmarroaNev DaTrc�AK MUST BE ON COUNCIL AGENDA BV (DATE) RU ❑ BUDGET DIRECTOR O FIN. 8 MGT. SEflVICES DIP. Hearin : 07- o Z�i LJ OROEN �MAYOfl(ORASSISTANn O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS POR SIGNATURE) � ACfiON qEQUE57ED: Cheryl Rerner on behalf of Children`s Program of Northern Ireland requests Council approval of their application for a new State Class B Gambling Premise Permit (ID 9104567) at Patrick's Lounge, 1318 W. Larpenteur Avenue. RECAMMENDA7IONS: Approve (A) w Reject (R) pERSONAL SERVICE CONTRACTS MUS7 ANSWEFi TNE FOLLOWING QUESTIONS: _ PLpNNING COMMISSION _ CMl SERVICE CAMMISSION �� Has Mi5 persoNfirm ever worked under a contract fOr this deparhnen[? - _ CIB COMMfiTEE _ YES NO _ SiAFF _ Z. Ha5 ihis perSOnKrm ever been a city employee? YES NO _ DISTRIC7 COUR7 , 3. Does this rsonMirm ossess a skill not normal � pe p ty possessed by any curteM city employee. SUPPORTSWHICHCOUNCILO&IECTIVE? VES NO Explain all yes answers on separete ahcet and attach to green sheet INITIATING PROBLEM, ISSUE, OPP�RTUNITY (Wtw, What, When. Where, Why). �� '� o r��'Y':'a �, JAN 1 � 1997 �� a�p�v�� ADVANTACaESIFAPPROVED: " DISADVANTAGESIFAPPROVEO: �QU�C�� esearC� �penLer E_�� 11 T997 DISADVANTAGES IF NOT APPROVED: TOTALAMOUNTOFTHANSACTION S COST/REVENUEBUDGETED(CIRCLEONE) YES NO FUNDIHG SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION. (EXPLAIN) . 9 7�� o 0 Greensneet # 35434 L.I.E.P. REVIEW CHECKLIST �ate: / In Tf8Ck8(? ApP'n Received / ApP'n Processed LicenselD # B-04567 _ License Type: State Class B 6ambline Premise Permit Company Name: Children's Program of Northern Ireland DBA: Children's Program �f NnrrhP,-n TrP1an� Business Addresss: 1318 W. Larpenteur Ave. (Patrick's) Business Phone: 920-3520 CoMact Name/Address: Chervl Kerner/CEO Home Phone: 9 0–'�5 0 Date to Council Research: 2025 Centre Pointe Blvd. I/270 St. Paul 55120-1259 Public Hearing Date: ��/7 Labels Ordered: N/A Notice Sent to Applicant: District Council #: 10 Notice Sent to Public: Ward Department/ Date Inspections Comments City Attorney � Lf �/��f"/�� f�j9� Environmental Health 0� /� Fire �1� License �� P�� — Lease Received: �� l Police /� �T✓ 6 Zoning ��/ G � � LG214 n,zvs,� MZR7IPSDLQ LQillf[LI GQ77IbTLRg Premises Permit AppIication - Part 1 of 2 � Aenewal Organizalion base license number Premises pertnit oumber New Name o( Organization C Ft+ ta;a2EY� S ' snuavon - svee[ or r. � Po�n-rE $LVp '� FOR BOARD USE ONLY BASE � PP : FEE CHECK 1N{TIALS DATE Ciass of premises permit (check one) J A($400) Pull-tabs, tipbo�ds, pa�'lewheels, 2ffles, bingo 1� B 55250) Pu!!-tabs, tipboards, pad�ewheels, ra4fles ❑ C (5200) Bingo only ❑ D(stso) Rati3esonry 12tZ.+ar� i�t��'� (Do not use the address of your gamt �. Z7n mn . SSIZD-( (nnnot be your gambiing manager) Title Daytime phone number (t�iZ)9 �-3S2Zj Day6me phone numbei ((�IZ� SzZ7�51 Bingo Occasions If apphring for a ciass A or.0 permit, fill in days and beginntn� & ending hours of bingo occasions: No more than seven bingo occasions may be cbnducted by your or�anization per week Day Beginning/Ending Houn Day - Begyuring/Ending Hours Day Bcginning /Ending Hours to _ to _ to Ifbingo will not be conducted, check hore �' ,.:.,.,.,.< .:.. ..:.:.. :.......::.:��;. , .:.;:s.>. -:............_..::. �905 �I1fOFIT28�0II- -_.. .< . ,. � " .. - - �--' . . ...... . ... _ ... . -...,, . . .. :.... .. . ......: .... ... .... . ..._ . .,.... :: :re garnb ing will be conducted Street Address (do not use a post office box num �, fi!a�o�r�G f(,t�c�,vo � / Z/.F ��J /_,a,�? P� �T�,.iQ �r/L�� 5 57� s Is u5e premises Iocated within ciry Iimits? �'Yes C No If no, is township C organized � unorganized � unincorporated Ciry and Count�where gambfing premises is located OR Toimship and County where gambGng premises is located if outside of ciry Gmits � antl aanress of Iegal owner of prem�ses .... Gity _ State _ _- Zip Code �Nl� �� ./�`�o � N� :Q,eco�� , Fii�i�� e �.�r-c� S 50� your o�ganization own the builduig where tlie gambling will be conducted? p YES � NO If no, attach the folbwing: . - . . . .. ��.- . ,- � _ . .. ... . _ . • a copy of the tease (fwm LG202) wiih terms for at least one year. . • a copy of a skeich of the Boor plan with dmensions, showing what por5on is being leased. A lease and sketch are not required for Ciass D appliczbons. ..�. ` �. i_._r ....:...:...: ":�;:[:: �:: � � - �..�_::.>_:.:..>„<.. ..�:.:r :::. .. ..:..::�.,...:;�.�::._<: f:::...:::,�_�::�_�:::....::__.<:�.:..::r. . . .._ . . , , �,. : Address of storage space of gamblin e uS ment 'oo �r �< a Po �X ��mtpf = ... - - - g �LQ_ Address Clty State ZQ code 1318 W LW��4'"rrt"U2 �'�rku� mv� SSti�3 Mirutesota Lau�ful Gambiing Prernise Pernut Application - Part 2 of 2 �� Bank A�unt -� 2�3`� � 9�-�ov vv,r� �EmzN�, ICd'rric�2. S�t4 Yl�co��r. AvtS m(�S mr�5S41�1 crZ�/P2es�DCnr �a�- lL--�-rr�e �eop w�.�. Kkvr. S Sr�a�,��nr�S��S rv,�ma� � I hereby c�nsent that bcal law en(orcement officers, the board or agents of the board, or the commissioner of revenue or publ"�c safety, or agents of the commissioners, may enter the pramises to enforce the law. Bank Records Information The board is authorized to insped the bank records of the gambling account whenever necessary to fuHill requirements of current gambling rules and law. Oath I declare that: •I have read this application and all informafion submitied to the board is true, accurate and mmplete; •ali other equired information has been fuily disclosed; - Signature o: c�hief exer,{iy officer / _ 1. The city'must signThis application if the gambling prem- ises is located within ciry limits. 2. The county "AND township•• must sign this application 'rf the gambiing premises is located within a township. 3. The local unit government {city or county) must pass a resolution specifically approving or denying this application. �I me�B� mvm.� e�2.. •I am the cfiief executive officar of the organization; •I assume full responsibility for the fair and lavrful opera- tion of all adivities to be conduded; •I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the board and agree, "rf licensed, to abide by ihose laws and rules, including amendments to them; •any changes in application information will be submitted to the board and bcal unit of government within 70 days of the change; and •I undersiand thzt failure to provide rzquired information or providing fafsa or misleading information may resuit in the denial or revocation of the licanse. �� .«�� . ... . . � .�.� - 4. A coov of the bcal unit of aovernment's resolution ao- p�vino this aoolication muct be attached to tnis aoolication 5. if this application is denied by the bcal unit of government, B shouid not be submittad to the Gambling Control Board. - Township: By signature below, the township acknowfedges that the organization is applying for a premises permit within township limits. � � . .. _ �it ' or count " Townshi " Ciry or Counry Narne � - . Township Name G; f fl� _ _- - - . .......... . ... .._... . , .. --- - =. - _ - :. _. . ._ .... -. - - - __. :. � - ... _. . ... . _ . , .... . . . �,.. - . . .. .. .. ...:. ..... .. .. 'pl'anatur�Rf gelsA �eceiving�adpfica0on �_ ._. SignaNre of person receiving application `1 L 1Vt/I V Title J ` Date Y._ _ 1,. � _ �,.. �- -- • I ! Aeter to the insWCiions for required avachments. Mail to: Gambilnp Control Board '� Rouwood Plaza South, 3rd Ftoor 7777 W. County Road S ftoaevilie, 1AN 55773 Title I Date Received LG214(Part 2) Council File # �_� � F . �' � � � � �� Presented B� Referred To Ordinance # 1 2 3 4 RESOLVED: That application, ID #8-04567, for a new State Class B Gambling Premise Permit by Children's Program of Northern Ireland at Patrick's Lounge, 1318 W. Larpenteur Ave., be and the same is hereby approved. s 6 Requested by Department of: 7 Yea Nays Absent 8 B a� cT —�- 9 �'?�'Ma"°"' � Office of License. Inspections and 10 Harris — 7 11 Me a� � EnviroxLmental Protection 13 Thun� � By: �A.U�'�a.- �� te Adoption Certified by Council Secretary Form Approved by City Attorney BY � �c°=��,..�.va�_ g � / / y: � � �/.,�_ Approved by Mayor: Date �� s 3 / /� Approved by Mayor for Submisaion to �� Council BY: L_� By: Green Sheet# 35434 Adopted by Council: Date �,Q�, �G _\�qt`( 9�—� ern ** NEED COPY IMMEDIATELY ** ' � �—' � DEPARTMENT/OFFICE/CAUNCIL DATEINITIATED GREEN SHEE _ N_ 35�434 LIEP - -- CONTACT PERSON & PHONE � DEPARTMENT DIRECTOR O CRV CAUNp� �N�T�AL/DATE William F. Gunther - 266-9132 ^ss�cN �cmarroaNev DaTrc�AK MUST BE ON COUNCIL AGENDA BV (DATE) RU ❑ BUDGET DIRECTOR O FIN. 8 MGT. SEflVICES DIP. Hearin : 07- o Z�i LJ OROEN �MAYOfl(ORASSISTANn O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS POR SIGNATURE) � ACfiON qEQUE57ED: Cheryl Rerner on behalf of Children`s Program of Northern Ireland requests Council approval of their application for a new State Class B Gambling Premise Permit (ID 9104567) at Patrick's Lounge, 1318 W. Larpenteur Avenue. RECAMMENDA7IONS: Approve (A) w Reject (R) pERSONAL SERVICE CONTRACTS MUS7 ANSWEFi TNE FOLLOWING QUESTIONS: _ PLpNNING COMMISSION _ CMl SERVICE CAMMISSION �� Has Mi5 persoNfirm ever worked under a contract fOr this deparhnen[? - _ CIB COMMfiTEE _ YES NO _ SiAFF _ Z. Ha5 ihis perSOnKrm ever been a city employee? YES NO _ DISTRIC7 COUR7 , 3. Does this rsonMirm ossess a skill not normal � pe p ty possessed by any curteM city employee. SUPPORTSWHICHCOUNCILO&IECTIVE? VES NO Explain all yes answers on separete ahcet and attach to green sheet INITIATING PROBLEM, ISSUE, OPP�RTUNITY (Wtw, What, When. Where, Why). �� '� o r��'Y':'a �, JAN 1 � 1997 �� a�p�v�� ADVANTACaESIFAPPROVED: " DISADVANTAGESIFAPPROVEO: �QU�C�� esearC� �penLer E_�� 11 T997 DISADVANTAGES IF NOT APPROVED: TOTALAMOUNTOFTHANSACTION S COST/REVENUEBUDGETED(CIRCLEONE) YES NO FUNDIHG SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION. (EXPLAIN) . 9 7�� o 0 Greensneet # 35434 L.I.E.P. REVIEW CHECKLIST �ate: / In Tf8Ck8(? ApP'n Received / ApP'n Processed LicenselD # B-04567 _ License Type: State Class B 6ambline Premise Permit Company Name: Children's Program of Northern Ireland DBA: Children's Program �f NnrrhP,-n TrP1an� Business Addresss: 1318 W. Larpenteur Ave. (Patrick's) Business Phone: 920-3520 CoMact Name/Address: Chervl Kerner/CEO Home Phone: 9 0–'�5 0 Date to Council Research: 2025 Centre Pointe Blvd. I/270 St. Paul 55120-1259 Public Hearing Date: ��/7 Labels Ordered: N/A Notice Sent to Applicant: District Council #: 10 Notice Sent to Public: Ward Department/ Date Inspections Comments City Attorney � Lf �/��f"/�� f�j9� Environmental Health 0� /� Fire �1� License �� P�� — Lease Received: �� l Police /� �T✓ 6 Zoning ��/ G � � LG214 n,zvs,� MZR7IPSDLQ LQillf[LI GQ77IbTLRg Premises Permit AppIication - Part 1 of 2 � Aenewal Organizalion base license number Premises pertnit oumber New Name o( Organization C Ft+ ta;a2EY� S ' snuavon - svee[ or r. � Po�n-rE $LVp '� FOR BOARD USE ONLY BASE � PP : FEE CHECK 1N{TIALS DATE Ciass of premises permit (check one) J A($400) Pull-tabs, tipbo�ds, pa�'lewheels, 2ffles, bingo 1� B 55250) Pu!!-tabs, tipboards, pad�ewheels, ra4fles ❑ C (5200) Bingo only ❑ D(stso) Rati3esonry 12tZ.+ar� i�t��'� (Do not use the address of your gamt �. Z7n mn . SSIZD-( (nnnot be your gambiing manager) Title Daytime phone number (t�iZ)9 �-3S2Zj Day6me phone numbei ((�IZ� SzZ7�51 Bingo Occasions If apphring for a ciass A or.0 permit, fill in days and beginntn� & ending hours of bingo occasions: No more than seven bingo occasions may be cbnducted by your or�anization per week Day Beginning/Ending Houn Day - Begyuring/Ending Hours Day Bcginning /Ending Hours to _ to _ to Ifbingo will not be conducted, check hore �' ,.:.,.,.,.< .:.. ..:.:.. :.......::.:��;. , .:.;:s.>. -:............_..::. �905 �I1fOFIT28�0II- -_.. .< . ,. � " .. - - �--' . . ...... . ... _ ... . -...,, . . .. :.... .. . ......: .... ... .... . ..._ . .,.... :: :re garnb ing will be conducted Street Address (do not use a post office box num �, fi!a�o�r�G f(,t�c�,vo � / Z/.F ��J /_,a,�? P� �T�,.iQ �r/L�� 5 57� s Is u5e premises Iocated within ciry Iimits? �'Yes C No If no, is township C organized � unorganized � unincorporated Ciry and Count�where gambfing premises is located OR Toimship and County where gambGng premises is located if outside of ciry Gmits � antl aanress of Iegal owner of prem�ses .... Gity _ State _ _- Zip Code �Nl� �� ./�`�o � N� :Q,eco�� , Fii�i�� e �.�r-c� S 50� your o�ganization own the builduig where tlie gambling will be conducted? p YES � NO If no, attach the folbwing: . - . . . .. ��.- . ,- � _ . .. ... . _ . • a copy of the tease (fwm LG202) wiih terms for at least one year. . • a copy of a skeich of the Boor plan with dmensions, showing what por5on is being leased. A lease and sketch are not required for Ciass D appliczbons. ..�. ` �. i_._r ....:...:...: ":�;:[:: �:: � � - �..�_::.>_:.:..>„<.. ..�:.:r :::. .. ..:..::�.,...:;�.�::._<: f:::...:::,�_�::�_�:::....::__.<:�.:..::r. . . .._ . . , , �,. : Address of storage space of gamblin e uS ment 'oo �r �< a Po �X ��mtpf = ... - - - g �LQ_ Address Clty State ZQ code 1318 W LW��4'"rrt"U2 �'�rku� mv� SSti�3 Mirutesota Lau�ful Gambiing Prernise Pernut Application - Part 2 of 2 �� Bank A�unt -� 2�3`� � 9�-�ov vv,r� �EmzN�, ICd'rric�2. S�t4 Yl�co��r. AvtS m(�S mr�5S41�1 crZ�/P2es�DCnr �a�- lL--�-rr�e �eop w�.�. Kkvr. S Sr�a�,��nr�S��S rv,�ma� � I hereby c�nsent that bcal law en(orcement officers, the board or agents of the board, or the commissioner of revenue or publ"�c safety, or agents of the commissioners, may enter the pramises to enforce the law. Bank Records Information The board is authorized to insped the bank records of the gambling account whenever necessary to fuHill requirements of current gambling rules and law. Oath I declare that: •I have read this application and all informafion submitied to the board is true, accurate and mmplete; •ali other equired information has been fuily disclosed; - Signature o: c�hief exer,{iy officer / _ 1. The city'must signThis application if the gambling prem- ises is located within ciry limits. 2. The county "AND township•• must sign this application 'rf the gambiing premises is located within a township. 3. The local unit government {city or county) must pass a resolution specifically approving or denying this application. �I me�B� mvm.� e�2.. •I am the cfiief executive officar of the organization; •I assume full responsibility for the fair and lavrful opera- tion of all adivities to be conduded; •I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the board and agree, "rf licensed, to abide by ihose laws and rules, including amendments to them; •any changes in application information will be submitted to the board and bcal unit of government within 70 days of the change; and •I undersiand thzt failure to provide rzquired information or providing fafsa or misleading information may resuit in the denial or revocation of the licanse. �� .«�� . ... . . � .�.� - 4. A coov of the bcal unit of aovernment's resolution ao- p�vino this aoolication muct be attached to tnis aoolication 5. if this application is denied by the bcal unit of government, B shouid not be submittad to the Gambling Control Board. - Township: By signature below, the township acknowfedges that the organization is applying for a premises permit within township limits. � � . .. _ �it ' or count " Townshi " Ciry or Counry Narne � - . Township Name G; f fl� _ _- - - . .......... . ... .._... . , .. --- - =. - _ - :. _. . ._ .... -. - - - __. :. � - ... _. . ... . _ . , .... . . . �,.. - . . .. .. .. ...:. ..... .. .. 'pl'anatur�Rf gelsA �eceiving�adpfica0on �_ ._. SignaNre of person receiving application `1 L 1Vt/I V Title J ` Date Y._ _ 1,. � _ �,.. �- -- • I ! Aeter to the insWCiions for required avachments. Mail to: Gambilnp Control Board '� Rouwood Plaza South, 3rd Ftoor 7777 W. County Road S ftoaevilie, 1AN 55773 Title I Date Received LG214(Part 2) Council File # �_� � F . �' � � � � �� Presented B� Referred To Ordinance # 1 2 3 4 RESOLVED: That application, ID #8-04567, for a new State Class B Gambling Premise Permit by Children's Program of Northern Ireland at Patrick's Lounge, 1318 W. Larpenteur Ave., be and the same is hereby approved. s 6 Requested by Department of: 7 Yea Nays Absent 8 B a� cT —�- 9 �'?�'Ma"°"' � Office of License. Inspections and 10 Harris — 7 11 Me a� � EnviroxLmental Protection 13 Thun� � By: �A.U�'�a.- �� te Adoption Certified by Council Secretary Form Approved by City Attorney BY � �c°=��,..�.va�_ g � / / y: � � �/.,�_ Approved by Mayor: Date �� s 3 / /� Approved by Mayor for Submisaion to �� Council BY: L_� By: Green Sheet# 35434 Adopted by Council: Date �,Q�, �G _\�qt`( 9�—� ern ** NEED COPY IMMEDIATELY ** ' � �—' � DEPARTMENT/OFFICE/CAUNCIL DATEINITIATED GREEN SHEE _ N_ 35�434 LIEP - -- CONTACT PERSON & PHONE � DEPARTMENT DIRECTOR O CRV CAUNp� �N�T�AL/DATE William F. Gunther - 266-9132 ^ss�cN �cmarroaNev DaTrc�AK MUST BE ON COUNCIL AGENDA BV (DATE) RU ❑ BUDGET DIRECTOR O FIN. 8 MGT. SEflVICES DIP. Hearin : 07- o Z�i LJ OROEN �MAYOfl(ORASSISTANn O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS POR SIGNATURE) � ACfiON qEQUE57ED: Cheryl Rerner on behalf of Children`s Program of Northern Ireland requests Council approval of their application for a new State Class B Gambling Premise Permit (ID 9104567) at Patrick's Lounge, 1318 W. Larpenteur Avenue. RECAMMENDA7IONS: Approve (A) w Reject (R) pERSONAL SERVICE CONTRACTS MUS7 ANSWEFi TNE FOLLOWING QUESTIONS: _ PLpNNING COMMISSION _ CMl SERVICE CAMMISSION �� Has Mi5 persoNfirm ever worked under a contract fOr this deparhnen[? - _ CIB COMMfiTEE _ YES NO _ SiAFF _ Z. Ha5 ihis perSOnKrm ever been a city employee? YES NO _ DISTRIC7 COUR7 , 3. Does this rsonMirm ossess a skill not normal � pe p ty possessed by any curteM city employee. SUPPORTSWHICHCOUNCILO&IECTIVE? VES NO Explain all yes answers on separete ahcet and attach to green sheet INITIATING PROBLEM, ISSUE, OPP�RTUNITY (Wtw, What, When. Where, Why). �� '� o r��'Y':'a �, JAN 1 � 1997 �� a�p�v�� ADVANTACaESIFAPPROVED: " DISADVANTAGESIFAPPROVEO: �QU�C�� esearC� �penLer E_�� 11 T997 DISADVANTAGES IF NOT APPROVED: TOTALAMOUNTOFTHANSACTION S COST/REVENUEBUDGETED(CIRCLEONE) YES NO FUNDIHG SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION. (EXPLAIN) . 9 7�� o 0 Greensneet # 35434 L.I.E.P. REVIEW CHECKLIST �ate: / In Tf8Ck8(? ApP'n Received / ApP'n Processed LicenselD # B-04567 _ License Type: State Class B 6ambline Premise Permit Company Name: Children's Program of Northern Ireland DBA: Children's Program �f NnrrhP,-n TrP1an� Business Addresss: 1318 W. Larpenteur Ave. (Patrick's) Business Phone: 920-3520 CoMact Name/Address: Chervl Kerner/CEO Home Phone: 9 0–'�5 0 Date to Council Research: 2025 Centre Pointe Blvd. I/270 St. Paul 55120-1259 Public Hearing Date: ��/7 Labels Ordered: N/A Notice Sent to Applicant: District Council #: 10 Notice Sent to Public: Ward Department/ Date Inspections Comments City Attorney � Lf �/��f"/�� f�j9� Environmental Health 0� /� Fire �1� License �� P�� — Lease Received: �� l Police /� �T✓ 6 Zoning ��/ G � � LG214 n,zvs,� MZR7IPSDLQ LQillf[LI GQ77IbTLRg Premises Permit AppIication - Part 1 of 2 � Aenewal Organizalion base license number Premises pertnit oumber New Name o( Organization C Ft+ ta;a2EY� S ' snuavon - svee[ or r. � Po�n-rE $LVp '� FOR BOARD USE ONLY BASE � PP : FEE CHECK 1N{TIALS DATE Ciass of premises permit (check one) J A($400) Pull-tabs, tipbo�ds, pa�'lewheels, 2ffles, bingo 1� B 55250) Pu!!-tabs, tipboards, pad�ewheels, ra4fles ❑ C (5200) Bingo only ❑ D(stso) Rati3esonry 12tZ.+ar� i�t��'� (Do not use the address of your gamt �. Z7n mn . SSIZD-( (nnnot be your gambiing manager) Title Daytime phone number (t�iZ)9 �-3S2Zj Day6me phone numbei ((�IZ� SzZ7�51 Bingo Occasions If apphring for a ciass A or.0 permit, fill in days and beginntn� & ending hours of bingo occasions: No more than seven bingo occasions may be cbnducted by your or�anization per week Day Beginning/Ending Houn Day - Begyuring/Ending Hours Day Bcginning /Ending Hours to _ to _ to Ifbingo will not be conducted, check hore �' ,.:.,.,.,.< .:.. ..:.:.. :.......::.:��;. , .:.;:s.>. -:............_..::. �905 �I1fOFIT28�0II- -_.. .< . ,. � " .. - - �--' . . ...... . ... _ ... . -...,, . . .. :.... .. . ......: .... ... .... . ..._ . .,.... :: :re garnb ing will be conducted Street Address (do not use a post office box num �, fi!a�o�r�G f(,t�c�,vo � / Z/.F ��J /_,a,�? P� �T�,.iQ �r/L�� 5 57� s Is u5e premises Iocated within ciry Iimits? �'Yes C No If no, is township C organized � unorganized � unincorporated Ciry and Count�where gambfing premises is located OR Toimship and County where gambGng premises is located if outside of ciry Gmits � antl aanress of Iegal owner of prem�ses .... Gity _ State _ _- Zip Code �Nl� �� ./�`�o � N� :Q,eco�� , Fii�i�� e �.�r-c� S 50� your o�ganization own the builduig where tlie gambling will be conducted? p YES � NO If no, attach the folbwing: . - . . . .. ��.- . ,- � _ . .. ... . _ . • a copy of the tease (fwm LG202) wiih terms for at least one year. . • a copy of a skeich of the Boor plan with dmensions, showing what por5on is being leased. A lease and sketch are not required for Ciass D appliczbons. ..�. ` �. i_._r ....:...:...: ":�;:[:: �:: � � - �..�_::.>_:.:..>„<.. ..�:.:r :::. .. ..:..::�.,...:;�.�::._<: f:::...:::,�_�::�_�:::....::__.<:�.:..::r. . . .._ . . , , �,. : Address of storage space of gamblin e uS ment 'oo �r �< a Po �X ��mtpf = ... - - - g �LQ_ Address Clty State ZQ code 1318 W LW��4'"rrt"U2 �'�rku� mv� SSti�3 Mirutesota Lau�ful Gambiing Prernise Pernut Application - Part 2 of 2 �� Bank A�unt -� 2�3`� � 9�-�ov vv,r� �EmzN�, ICd'rric�2. S�t4 Yl�co��r. AvtS m(�S mr�5S41�1 crZ�/P2es�DCnr �a�- lL--�-rr�e �eop w�.�. Kkvr. S Sr�a�,��nr�S��S rv,�ma� � I hereby c�nsent that bcal law en(orcement officers, the board or agents of the board, or the commissioner of revenue or publ"�c safety, or agents of the commissioners, may enter the pramises to enforce the law. Bank Records Information The board is authorized to insped the bank records of the gambling account whenever necessary to fuHill requirements of current gambling rules and law. Oath I declare that: •I have read this application and all informafion submitied to the board is true, accurate and mmplete; •ali other equired information has been fuily disclosed; - Signature o: c�hief exer,{iy officer / _ 1. The city'must signThis application if the gambling prem- ises is located within ciry limits. 2. The county "AND township•• must sign this application 'rf the gambiing premises is located within a township. 3. The local unit government {city or county) must pass a resolution specifically approving or denying this application. �I me�B� mvm.� e�2.. •I am the cfiief executive officar of the organization; •I assume full responsibility for the fair and lavrful opera- tion of all adivities to be conduded; •I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the board and agree, "rf licensed, to abide by ihose laws and rules, including amendments to them; •any changes in application information will be submitted to the board and bcal unit of government within 70 days of the change; and •I undersiand thzt failure to provide rzquired information or providing fafsa or misleading information may resuit in the denial or revocation of the licanse. �� .«�� . ... . . � .�.� - 4. A coov of the bcal unit of aovernment's resolution ao- p�vino this aoolication muct be attached to tnis aoolication 5. if this application is denied by the bcal unit of government, B shouid not be submittad to the Gambling Control Board. - Township: By signature below, the township acknowfedges that the organization is applying for a premises permit within township limits. � � . .. _ �it ' or count " Townshi " Ciry or Counry Narne � - . Township Name G; f fl� _ _- - - . .......... . ... .._... . , .. --- - =. - _ - :. _. . ._ .... -. - - - __. :. � - ... _. . ... . _ . , .... . . . �,.. - . . .. .. .. ...:. ..... .. .. 'pl'anatur�Rf gelsA �eceiving�adpfica0on �_ ._. SignaNre of person receiving application `1 L 1Vt/I V Title J ` Date Y._ _ 1,. � _ �,.. �- -- • I ! Aeter to the insWCiions for required avachments. Mail to: Gambilnp Control Board '� Rouwood Plaza South, 3rd Ftoor 7777 W. County Road S ftoaevilie, 1AN 55773 Title I Date Received LG214(Part 2)