97-261� C �� i : �
:
�� ' `: �
Council File � `� �
RESOLUTION
OF, S/�11NT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
1
2
3
4
RESOLVED: That application, ID #8-04567, for a new State Class B Gambling Premise
Permit by Children's Program of Notthern Zreland at Goby's G=ille 6 pub
at 472 Snelling Avenue S., be and the same is hereby approved.
5
6 Requeeted by Department of:
7 Yeas Navs Abaent
8 B a ce :✓
10 H rris ,� Office of License, Snspgctions and
12 ��M a��� ✓ EnvirorLmental Protection
1 3 T un e Y '
By: r��l.�: ;� ��
adoption C ifie by
1 � � A /
BY� __ \ ,/ �/�
Approved by Mayor� Date ? 5/� �
.��T By: \
Ordi.nance #
Green Sheet# 35423
5�
Form Approved by City Attorney
By: ��9,v�o � �Gt.���
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date //%Aq. /z, /%97
Qe1 1i �
** I3EED COPY Ih�DIATELY ** ` � ' �r �
DEPARiMENT/OFFICElCOUNGIL DATE INRIATED � REEN SH EE N_� 3 5 4 2 3
LIEP iNrtuwnre -- - - --" mmnvon're
CONTACf PEFi$ON & PHONE O DEPAFlSAhEM DIflE O CfTY COUNCIL
A581(9N CI7YATfORT1EY CISYCLEFK
William F. Gunther - 266-9132 ryUYBENFOR � �
M115T BE ON COUNCIL AGENDA BV (DA'fE) qqlnNG Q BUDGET DIRECfOR � FIN. & MGT. SERVICE$ DIR.
3 � A � OflOEp Q MAYOR (pR ASSISTAlfI ) O
earin : a�
TOTAL # OP SIGNA RE PAGES (CUP ALL LOCATIONS FOR SIGNATURE�
ACf1�N RE(1ttE5fED:
Cheryl ICerner on behalf of Children`s Program of Northern Ireland requests
Council approval of their application for a new State Class B Gambling Premi.se Permit
(ID 4IB-�4567) at �oby`s Grille & Pub, 472 Snelling Avenue S.
FECOMMENDATIONS: Approve (A) w Reject (fl) pEASONAL SENVICE CONSqACTS MUSS ANSW£H THE FOLLOWiNG �UESTIONS:
_ 1'LANNING COMMiSS10N _ CML SERVICE CAMMISSION �� �� �"s personttirm ever worked unaer a camacc fw this Cepartmem? -
_ CI6 COMMRTEE _ YES NO
—�� — 2. Has Mis person/firm ever been a city employee?
VES NO
_ DIS7HIC7 COURT _ 3. Dces this person/firm posse95 a sk711 not normall
y possessetl by any curtent ciry employee?
SUPPOqTS WHICH CAUNCIL OBJECTIVE? YES NO
Ezplain all yes enswers on seperete sheet and atteeh to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (Who. What, When, Where. Why):
'� q g�� � P F ES .,1��j
�� N�:�. F � r . <, , �.
� � .
� JAN � G 1997
C��� ����������
ADVANTAGES IF APPRWED: '
DISADVANTAGES IFAPPROVED:
�C?y�i�^���y� I'-�"1k�2�6Pad@3 FJ'�r`+i6LGa1
a��� Gi � 6��1
DISADVANTAGES �F NOTAPPROVED:
�. E�
c 1�.1�. �i y �'��7
TOTAL AMOUNT OF TRANSACTtON $ COST/REVENUE BUUGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBER
FINANGIAL INFOflMATION: (EXPLpIN� .
Greensheet # � 35423
In Tracker?__1.��_
7
L.I.E.P. REVIEW CHECKLIST Date: /,� �'�'�',
App'n Received / App'n Processed
Ucense ID # B-04567 License Type: State Class B Gamb� �ng PrPm� pP,-,�� t
Company Name: Children's ProQram of Northern Ireland DBA: ('h� l drPn' c Prng�-am nf Nnrr�,A,-„
Business Addresss: 472 SnellinQ Ave. S. (Gobv'sl Business Phone: 97n_�59n Zreland_
Contact NameJAddress: Ghervl Rerner/CEO Home Phone: q�n_3S�n
Date to Council Research: 202� �� �r Blvd. �t270 St. Paul 55120-1259
Public Hearing Date:_Y�1c�� � a 149'� Labels Ordered: N/A
Notice Sent to Applicant:��97 District Council #: 14
Notice Sent to Public: Ward #: �3
Department/ Date Inspections CommeMs
City Attomey � C�i' lTN� ��� L��f ��
�� 1�� �I9 �
Environmental
Health
/" / �
!
Fire
N��i
License Si�e a�en Rece�ved:_
Leasa Fteceivad:
�� �
Police
l� ��
Zoning
���
Kinnesota Lau�ful GambIing \
Premise Permit Application - Part 2 of 2 t��j -� ! .
ga�k pjamB � Bank Ac�unt Numtet
CH�c�St�r� B��c.. �IZb3
6ank,oxre5: c�ry um - a . . � � .
b?5 t�ariccc.PE-�- Av� Sr�a+n. r''�'"` 5510�
�'�u�. ��r7(n�-2 5uy t��co .-r t� 5 �Yl?t,s mn SSy !�1 t�er��ot+l+T" ^
�w� Lc-RH�f ir,00cu�c-c.,s �. �pFw�mnssa'7s '�'1rmBrYL.
1.-. __.. D._...�, �,.�o D_ __ __ _ IJ. „- C!�_.. mn c c�nc� vv� rma,,..� � .
o�ssr� Sb8 5��,-.vso� ST S�r�v� vrtn SS
Gambling Site Anthozizatioa •( am tfie ehief exeartive offcer of tfie organization;
i hereby caraaM that bcai law antorcement oificsrs, the •� assums futf responsbifity for the fair and lawiut opera-
board cr agants ef tfie board, or the qmmissionar of tion oi all adiviiies to be conduded; '
revenue or pubtic safety, or agents ot the pnmissioners, .� Wiil fam�iarize myseN wifh the laws oi Minnesota
may enter tfie premises to enforce the faw. governing lawFul gamb6ng and rules ot the board and
Baak ReCOrds Informatjon agree, it licensed, to abide by those laws and rules,
The bcard is authorized to insaed :he bank recards of the including amendments to them;
yambGng account whenevet necessary to tutfip •any changes in appficatien iriormation wili be subm'ated
rzquirements of current yambting r,.�les and izw, to the 6oard and bcal unit of governnent wRhin 10 deys '
Oath ot the chan9e; and
I dedare fhat: .__ ._ _ •I understand th2t failure to provide required information
•I Fave read this appiication and a!i in!ormation submiited or providing talse or misleading informaiion may resuft in
to ihe board is true, atturate and pmpiete; '- '-- '"' .= ' the denia! or revocatan of the license. -
•ati cther requ'ved information has bean tully ds�ciased; :;r... ;" : , - • . - .. - _ _
e
� ' ' Date
......:.__�.:_ . _.. ..- -. iz(z�1��..� . .. _
�
r . _r�= = �' ='"'=-= �' � `�==�-; ": ' 4. �A eoov of the bcal unB of oovernmenYS resolution ao- ..�_ . .
t. The city •musi sign this appl'ication if �he gambUng prem- proving this aooLcation must be artacfied to this aonfieation
ises is iocafed within dry Gmits: ','_;; --.'%,�'s;=� :'K :;;� =- : = 5. N this appGcation is denied by the bcal unrt o! govemmerrt,
2. The courrty "AND township•' _must sgn this app!'Kaiion �..�: n shoufd not be submitted to tha GambGng Control Board. •;:' ':
ihe gsmbling premises is bcaled wrthin a township. °""" . . , • ,
3. The loca! unR govemment (ciry w qunry) must pazs a - 7awnship: 8y signature bebw, the township acknowiedges
resolution specificaily epproving or denying ihis appl'icafion. �at the arganizafqn is applying ier a premises permit within ..
. _ . . .... .. .. .. .. . . . .. ... ...,....: ._.. .. towns p �mrts - -
_.. ...._ .� _. .. .. ... hi f . . _.. ,-'• - " .
_Gity or
-' �
r,ne
it •' _ . - - : . . _.. . _ . _ -- TOwnShi " --. . . . . _ .. .._ _.. - - . _. _ . . _ _ . _.
� - ; � :: : - � - _ 7ownship Name � :: - _ : -: . .:.:,,
�� � - "'e'�: t^:<.^ — : i. "�O' ':+'..F.�SY">': r.x.:t:= - _ .S".:.;. , _ t^�.= s .l�`�.}.:-..:.,_�:�. _, ; , t �
^ , ' -b.V... . -�+.ie.' .. ..F � _ . C.T] . .J: Li:�s3s >�' _ i:C. •""`
� •:-, ��' '
�s j pGetion � ri - �:.:x= �s_: -. , Signature of person reaivin9 aPPr�� _ .�%'_ "
!� , = �:'-�. "s.3:�-:'7." :;:`�,.�. :�� :.^:c:�P � i.l.= . . .. . , .
„�. '\
_ : �-:��ari�.o�'.� .
Reter w the insM+aicns tot required aearhments.
Mai( b: Gsmbtinp Controi Board
Rosewood Plsa Souih, 3rd Fioor
77it W. Counfy Aoid 8
Aoaevltte, IdN 55713
_. ..: � Tn� .--`.._.__ _..'.
._ Oata Received -- � - = �-
.... I .- _- � -- -- -
LG276(PsA 2)
t��mv+)
Y�._�
� C �� i : �
:
�� ' `: �
Council File � `� �
RESOLUTION
OF, S/�11NT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
1
2
3
4
RESOLVED: That application, ID #8-04567, for a new State Class B Gambling Premise
Permit by Children's Program of Notthern Zreland at Goby's G=ille 6 pub
at 472 Snelling Avenue S., be and the same is hereby approved.
5
6 Requeeted by Department of:
7 Yeas Navs Abaent
8 B a ce :✓
10 H rris ,� Office of License, Snspgctions and
12 ��M a��� ✓ EnvirorLmental Protection
1 3 T un e Y '
By: r��l.�: ;� ��
adoption C ifie by
1 � � A /
BY� __ \ ,/ �/�
Approved by Mayor� Date ? 5/� �
.��T By: \
Ordi.nance #
Green Sheet# 35423
5�
Form Approved by City Attorney
By: ��9,v�o � �Gt.���
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date //%Aq. /z, /%97
Qe1 1i �
** I3EED COPY Ih�DIATELY ** ` � ' �r �
DEPARiMENT/OFFICElCOUNGIL DATE INRIATED � REEN SH EE N_� 3 5 4 2 3
LIEP iNrtuwnre -- - - --" mmnvon're
CONTACf PEFi$ON & PHONE O DEPAFlSAhEM DIflE O CfTY COUNCIL
A581(9N CI7YATfORT1EY CISYCLEFK
William F. Gunther - 266-9132 ryUYBENFOR � �
M115T BE ON COUNCIL AGENDA BV (DA'fE) qqlnNG Q BUDGET DIRECfOR � FIN. & MGT. SERVICE$ DIR.
3 � A � OflOEp Q MAYOR (pR ASSISTAlfI ) O
earin : a�
TOTAL # OP SIGNA RE PAGES (CUP ALL LOCATIONS FOR SIGNATURE�
ACf1�N RE(1ttE5fED:
Cheryl ICerner on behalf of Children`s Program of Northern Ireland requests
Council approval of their application for a new State Class B Gambling Premi.se Permit
(ID 4IB-�4567) at �oby`s Grille & Pub, 472 Snelling Avenue S.
FECOMMENDATIONS: Approve (A) w Reject (fl) pEASONAL SENVICE CONSqACTS MUSS ANSW£H THE FOLLOWiNG �UESTIONS:
_ 1'LANNING COMMiSS10N _ CML SERVICE CAMMISSION �� �� �"s personttirm ever worked unaer a camacc fw this Cepartmem? -
_ CI6 COMMRTEE _ YES NO
—�� — 2. Has Mis person/firm ever been a city employee?
VES NO
_ DIS7HIC7 COURT _ 3. Dces this person/firm posse95 a sk711 not normall
y possessetl by any curtent ciry employee?
SUPPOqTS WHICH CAUNCIL OBJECTIVE? YES NO
Ezplain all yes enswers on seperete sheet and atteeh to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (Who. What, When, Where. Why):
'� q g�� � P F ES .,1��j
�� N�:�. F � r . <, , �.
� � .
� JAN � G 1997
C��� ����������
ADVANTAGES IF APPRWED: '
DISADVANTAGES IFAPPROVED:
�C?y�i�^���y� I'-�"1k�2�6Pad@3 FJ'�r`+i6LGa1
a��� Gi � 6��1
DISADVANTAGES �F NOTAPPROVED:
�. E�
c 1�.1�. �i y �'��7
TOTAL AMOUNT OF TRANSACTtON $ COST/REVENUE BUUGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBER
FINANGIAL INFOflMATION: (EXPLpIN� .
Greensheet # � 35423
In Tracker?__1.��_
7
L.I.E.P. REVIEW CHECKLIST Date: /,� �'�'�',
App'n Received / App'n Processed
Ucense ID # B-04567 License Type: State Class B Gamb� �ng PrPm� pP,-,�� t
Company Name: Children's ProQram of Northern Ireland DBA: ('h� l drPn' c Prng�-am nf Nnrr�,A,-„
Business Addresss: 472 SnellinQ Ave. S. (Gobv'sl Business Phone: 97n_�59n Zreland_
Contact NameJAddress: Ghervl Rerner/CEO Home Phone: q�n_3S�n
Date to Council Research: 202� �� �r Blvd. �t270 St. Paul 55120-1259
Public Hearing Date:_Y�1c�� � a 149'� Labels Ordered: N/A
Notice Sent to Applicant:��97 District Council #: 14
Notice Sent to Public: Ward #: �3
Department/ Date Inspections CommeMs
City Attomey � C�i' lTN� ��� L��f ��
�� 1�� �I9 �
Environmental
Health
/" / �
!
Fire
N��i
License Si�e a�en Rece�ved:_
Leasa Fteceivad:
�� �
Police
l� ��
Zoning
���
Kinnesota Lau�ful GambIing \
Premise Permit Application - Part 2 of 2 t��j -� ! .
ga�k pjamB � Bank Ac�unt Numtet
CH�c�St�r� B��c.. �IZb3
6ank,oxre5: c�ry um - a . . � � .
b?5 t�ariccc.PE-�- Av� Sr�a+n. r''�'"` 5510�
�'�u�. ��r7(n�-2 5uy t��co .-r t� 5 �Yl?t,s mn SSy !�1 t�er��ot+l+T" ^
�w� Lc-RH�f ir,00cu�c-c.,s �. �pFw�mnssa'7s '�'1rmBrYL.
1.-. __.. D._...�, �,.�o D_ __ __ _ IJ. „- C!�_.. mn c c�nc� vv� rma,,..� � .
o�ssr� Sb8 5��,-.vso� ST S�r�v� vrtn SS
Gambling Site Anthozizatioa •( am tfie ehief exeartive offcer of tfie organization;
i hereby caraaM that bcai law antorcement oificsrs, the •� assums futf responsbifity for the fair and lawiut opera-
board cr agants ef tfie board, or the qmmissionar of tion oi all adiviiies to be conduded; '
revenue or pubtic safety, or agents ot the pnmissioners, .� Wiil fam�iarize myseN wifh the laws oi Minnesota
may enter tfie premises to enforce the faw. governing lawFul gamb6ng and rules ot the board and
Baak ReCOrds Informatjon agree, it licensed, to abide by those laws and rules,
The bcard is authorized to insaed :he bank recards of the including amendments to them;
yambGng account whenevet necessary to tutfip •any changes in appficatien iriormation wili be subm'ated
rzquirements of current yambting r,.�les and izw, to the 6oard and bcal unit of governnent wRhin 10 deys '
Oath ot the chan9e; and
I dedare fhat: .__ ._ _ •I understand th2t failure to provide required information
•I Fave read this appiication and a!i in!ormation submiited or providing talse or misleading informaiion may resuft in
to ihe board is true, atturate and pmpiete; '- '-- '"' .= ' the denia! or revocatan of the license. -
•ati cther requ'ved information has bean tully ds�ciased; :;r... ;" : , - • . - .. - _ _
e
� ' ' Date
......:.__�.:_ . _.. ..- -. iz(z�1��..� . .. _
�
r . _r�= = �' ='"'=-= �' � `�==�-; ": ' 4. �A eoov of the bcal unB of oovernmenYS resolution ao- ..�_ . .
t. The city •musi sign this appl'ication if �he gambUng prem- proving this aooLcation must be artacfied to this aonfieation
ises is iocafed within dry Gmits: ','_;; --.'%,�'s;=� :'K :;;� =- : = 5. N this appGcation is denied by the bcal unrt o! govemmerrt,
2. The courrty "AND township•' _must sgn this app!'Kaiion �..�: n shoufd not be submitted to tha GambGng Control Board. •;:' ':
ihe gsmbling premises is bcaled wrthin a township. °""" . . , • ,
3. The loca! unR govemment (ciry w qunry) must pazs a - 7awnship: 8y signature bebw, the township acknowiedges
resolution specificaily epproving or denying ihis appl'icafion. �at the arganizafqn is applying ier a premises permit within ..
. _ . . .... .. .. .. .. . . . .. ... ...,....: ._.. .. towns p �mrts - -
_.. ...._ .� _. .. .. ... hi f . . _.. ,-'• - " .
_Gity or
-' �
r,ne
it •' _ . - - : . . _.. . _ . _ -- TOwnShi " --. . . . . _ .. .._ _.. - - . _. _ . . _ _ . _.
� - ; � :: : - � - _ 7ownship Name � :: - _ : -: . .:.:,,
�� � - "'e'�: t^:<.^ — : i. "�O' ':+'..F.�SY">': r.x.:t:= - _ .S".:.;. , _ t^�.= s .l�`�.}.:-..:.,_�:�. _, ; , t �
^ , ' -b.V... . -�+.ie.' .. ..F � _ . C.T] . .J: Li:�s3s >�' _ i:C. •""`
� •:-, ��' '
�s j pGetion � ri - �:.:x= �s_: -. , Signature of person reaivin9 aPPr�� _ .�%'_ "
!� , = �:'-�. "s.3:�-:'7." :;:`�,.�. :�� :.^:c:�P � i.l.= . . .. . , .
„�. '\
_ : �-:��ari�.o�'.� .
Reter w the insM+aicns tot required aearhments.
Mai( b: Gsmbtinp Controi Board
Rosewood Plsa Souih, 3rd Fioor
77it W. Counfy Aoid 8
Aoaevltte, IdN 55713
_. ..: � Tn� .--`.._.__ _..'.
._ Oata Received -- � - = �-
.... I .- _- � -- -- -
LG276(PsA 2)
t��mv+)
Y�._�
� C �� i : �
:
�� ' `: �
Council File � `� �
RESOLUTION
OF, S/�11NT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
1
2
3
4
RESOLVED: That application, ID #8-04567, for a new State Class B Gambling Premise
Permit by Children's Program of Notthern Zreland at Goby's G=ille 6 pub
at 472 Snelling Avenue S., be and the same is hereby approved.
5
6 Requeeted by Department of:
7 Yeas Navs Abaent
8 B a ce :✓
10 H rris ,� Office of License, Snspgctions and
12 ��M a��� ✓ EnvirorLmental Protection
1 3 T un e Y '
By: r��l.�: ;� ��
adoption C ifie by
1 � � A /
BY� __ \ ,/ �/�
Approved by Mayor� Date ? 5/� �
.��T By: \
Ordi.nance #
Green Sheet# 35423
5�
Form Approved by City Attorney
By: ��9,v�o � �Gt.���
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date //%Aq. /z, /%97
Qe1 1i �
** I3EED COPY Ih�DIATELY ** ` � ' �r �
DEPARiMENT/OFFICElCOUNGIL DATE INRIATED � REEN SH EE N_� 3 5 4 2 3
LIEP iNrtuwnre -- - - --" mmnvon're
CONTACf PEFi$ON & PHONE O DEPAFlSAhEM DIflE O CfTY COUNCIL
A581(9N CI7YATfORT1EY CISYCLEFK
William F. Gunther - 266-9132 ryUYBENFOR � �
M115T BE ON COUNCIL AGENDA BV (DA'fE) qqlnNG Q BUDGET DIRECfOR � FIN. & MGT. SERVICE$ DIR.
3 � A � OflOEp Q MAYOR (pR ASSISTAlfI ) O
earin : a�
TOTAL # OP SIGNA RE PAGES (CUP ALL LOCATIONS FOR SIGNATURE�
ACf1�N RE(1ttE5fED:
Cheryl ICerner on behalf of Children`s Program of Northern Ireland requests
Council approval of their application for a new State Class B Gambling Premi.se Permit
(ID 4IB-�4567) at �oby`s Grille & Pub, 472 Snelling Avenue S.
FECOMMENDATIONS: Approve (A) w Reject (fl) pEASONAL SENVICE CONSqACTS MUSS ANSW£H THE FOLLOWiNG �UESTIONS:
_ 1'LANNING COMMiSS10N _ CML SERVICE CAMMISSION �� �� �"s personttirm ever worked unaer a camacc fw this Cepartmem? -
_ CI6 COMMRTEE _ YES NO
—�� — 2. Has Mis person/firm ever been a city employee?
VES NO
_ DIS7HIC7 COURT _ 3. Dces this person/firm posse95 a sk711 not normall
y possessetl by any curtent ciry employee?
SUPPOqTS WHICH CAUNCIL OBJECTIVE? YES NO
Ezplain all yes enswers on seperete sheet and atteeh to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (Who. What, When, Where. Why):
'� q g�� � P F ES .,1��j
�� N�:�. F � r . <, , �.
� � .
� JAN � G 1997
C��� ����������
ADVANTAGES IF APPRWED: '
DISADVANTAGES IFAPPROVED:
�C?y�i�^���y� I'-�"1k�2�6Pad@3 FJ'�r`+i6LGa1
a��� Gi � 6��1
DISADVANTAGES �F NOTAPPROVED:
�. E�
c 1�.1�. �i y �'��7
TOTAL AMOUNT OF TRANSACTtON $ COST/REVENUE BUUGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE ACTIVITY NUMBER
FINANGIAL INFOflMATION: (EXPLpIN� .
Greensheet # � 35423
In Tracker?__1.��_
7
L.I.E.P. REVIEW CHECKLIST Date: /,� �'�'�',
App'n Received / App'n Processed
Ucense ID # B-04567 License Type: State Class B Gamb� �ng PrPm� pP,-,�� t
Company Name: Children's ProQram of Northern Ireland DBA: ('h� l drPn' c Prng�-am nf Nnrr�,A,-„
Business Addresss: 472 SnellinQ Ave. S. (Gobv'sl Business Phone: 97n_�59n Zreland_
Contact NameJAddress: Ghervl Rerner/CEO Home Phone: q�n_3S�n
Date to Council Research: 202� �� �r Blvd. �t270 St. Paul 55120-1259
Public Hearing Date:_Y�1c�� � a 149'� Labels Ordered: N/A
Notice Sent to Applicant:��97 District Council #: 14
Notice Sent to Public: Ward #: �3
Department/ Date Inspections CommeMs
City Attomey � C�i' lTN� ��� L��f ��
�� 1�� �I9 �
Environmental
Health
/" / �
!
Fire
N��i
License Si�e a�en Rece�ved:_
Leasa Fteceivad:
�� �
Police
l� ��
Zoning
���
Kinnesota Lau�ful GambIing \
Premise Permit Application - Part 2 of 2 t��j -� ! .
ga�k pjamB � Bank Ac�unt Numtet
CH�c�St�r� B��c.. �IZb3
6ank,oxre5: c�ry um - a . . � � .
b?5 t�ariccc.PE-�- Av� Sr�a+n. r''�'"` 5510�
�'�u�. ��r7(n�-2 5uy t��co .-r t� 5 �Yl?t,s mn SSy !�1 t�er��ot+l+T" ^
�w� Lc-RH�f ir,00cu�c-c.,s �. �pFw�mnssa'7s '�'1rmBrYL.
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o�ssr� Sb8 5��,-.vso� ST S�r�v� vrtn SS
Gambling Site Anthozizatioa •( am tfie ehief exeartive offcer of tfie organization;
i hereby caraaM that bcai law antorcement oificsrs, the •� assums futf responsbifity for the fair and lawiut opera-
board cr agants ef tfie board, or the qmmissionar of tion oi all adiviiies to be conduded; '
revenue or pubtic safety, or agents ot the pnmissioners, .� Wiil fam�iarize myseN wifh the laws oi Minnesota
may enter tfie premises to enforce the faw. governing lawFul gamb6ng and rules ot the board and
Baak ReCOrds Informatjon agree, it licensed, to abide by those laws and rules,
The bcard is authorized to insaed :he bank recards of the including amendments to them;
yambGng account whenevet necessary to tutfip •any changes in appficatien iriormation wili be subm'ated
rzquirements of current yambting r,.�les and izw, to the 6oard and bcal unit of governnent wRhin 10 deys '
Oath ot the chan9e; and
I dedare fhat: .__ ._ _ •I understand th2t failure to provide required information
•I Fave read this appiication and a!i in!ormation submiited or providing talse or misleading informaiion may resuft in
to ihe board is true, atturate and pmpiete; '- '-- '"' .= ' the denia! or revocatan of the license. -
•ati cther requ'ved information has bean tully ds�ciased; :;r... ;" : , - • . - .. - _ _
e
� ' ' Date
......:.__�.:_ . _.. ..- -. iz(z�1��..� . .. _
�
r . _r�= = �' ='"'=-= �' � `�==�-; ": ' 4. �A eoov of the bcal unB of oovernmenYS resolution ao- ..�_ . .
t. The city •musi sign this appl'ication if �he gambUng prem- proving this aooLcation must be artacfied to this aonfieation
ises is iocafed within dry Gmits: ','_;; --.'%,�'s;=� :'K :;;� =- : = 5. N this appGcation is denied by the bcal unrt o! govemmerrt,
2. The courrty "AND township•' _must sgn this app!'Kaiion �..�: n shoufd not be submitted to tha GambGng Control Board. •;:' ':
ihe gsmbling premises is bcaled wrthin a township. °""" . . , • ,
3. The loca! unR govemment (ciry w qunry) must pazs a - 7awnship: 8y signature bebw, the township acknowiedges
resolution specificaily epproving or denying ihis appl'icafion. �at the arganizafqn is applying ier a premises permit within ..
. _ . . .... .. .. .. .. . . . .. ... ...,....: ._.. .. towns p �mrts - -
_.. ...._ .� _. .. .. ... hi f . . _.. ,-'• - " .
_Gity or
-' �
r,ne
it •' _ . - - : . . _.. . _ . _ -- TOwnShi " --. . . . . _ .. .._ _.. - - . _. _ . . _ _ . _.
� - ; � :: : - � - _ 7ownship Name � :: - _ : -: . .:.:,,
�� � - "'e'�: t^:<.^ — : i. "�O' ':+'..F.�SY">': r.x.:t:= - _ .S".:.;. , _ t^�.= s .l�`�.}.:-..:.,_�:�. _, ; , t �
^ , ' -b.V... . -�+.ie.' .. ..F � _ . C.T] . .J: Li:�s3s >�' _ i:C. •""`
� •:-, ��' '
�s j pGetion � ri - �:.:x= �s_: -. , Signature of person reaivin9 aPPr�� _ .�%'_ "
!� , = �:'-�. "s.3:�-:'7." :;:`�,.�. :�� :.^:c:�P � i.l.= . . .. . , .
„�. '\
_ : �-:��ari�.o�'.� .
Reter w the insM+aicns tot required aearhments.
Mai( b: Gsmbtinp Controi Board
Rosewood Plsa Souih, 3rd Fioor
77it W. Counfy Aoid 8
Aoaevltte, IdN 55713
_. ..: � Tn� .--`.._.__ _..'.
._ Oata Received -- � - = �-
.... I .- _- � -- -- -
LG276(PsA 2)
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