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97-513Council File # Q � " SL� Ordinance # Green Sheet # 35330 t��—, i f=. �� Fs F ;� t�.. � ,;��.�`i;�_ Presented By 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 Re£erred To Co�nittee: Date RESOLVED: That application, ID #B-04755, for a new State Class B Gambling Premise Pezmit by St. Paul Sast Athletic Association at Moose's Locker Room, 1177 Clarence Street, be and the same is hereby approved. �� r �� Requested by Department of: Of£ice of License Insnections and Environmental Prot c.ion Adopted by Council: Adoption Certified by Council Hy_ Approved By RESOLUTION CITY OF SAINT PAUL, MINNESOTA 35 -1 � ..� � Form Approved by City Attorney Approved by Mayor £or Suknnission to Council By: Rn_c�� ** NEED COPY IMMEDIATELY ** l' 1,� DEPARTAENT�FFICHCOUNGL DATEINRIATED GREEN SHEE N° � 3.5330 LIEP - - - - CONTACT PEfiSON 8 PHONE �NITtAVDATE INRfAfJDATE �DEPARTMEM'DIflECfOfl �CT'COUNCII William F. Gunther - 266-9132 "�" ��TYATTORNEI' � CITYCIERK MUST BE ON WUNCIL AG DA BY (DATE) �� BUDGET DIqECTOH � FIN. & MGT. SERVICES DIR. ROUiING H22.T1R : �� O ��'OR (OR ASSISTANn � TOTAL # OF SIGNANRE PAGES ' (CLIP ALL LOCATIONS FOR SIGNATURE) ACTKKJ HEQUESiED: Jackie Pearson on behalf of St. Paul East Athletic Association requests Council approval of eheir application for a new State Class B Gambling Premise Permit, ID ��B-04755, at Moose's Locker Room, 1177 Clarence Street. pECAMMENDAS�ONS' Apprwe (A� a Fle�eft �R� PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLIOWING pUEST10NS: _ PLANNING COMMISSION _ CNIL SERVICE CAMMISSION i. Has this persoNfirm ever worked untler a contract for Mis departmen[? � _ CIB CqMMI7TEE _ YES NO _ SiAFF 2. Has this persoMrm ever been a city employee? — YES NO _ �ISTR7CT COUPT _ 3. DoeS ihis persoMirm ssess a Skill not normall essed po y poss by any current ciry employee? SUPPOR75 WHICH COUNCIL O&IELTIVE7 YES NO Explain all yes an8wers on separete sheet and attach to green aheet INIMTINQ PR�BIEM, ISSUE, OPPORTUNITY {W�w, Wp3t, When, Wh¢re, Why): , , �� QR � 4 �ssa ��Y ��a��Y ADVANTAGES IF APPROVED: " � DISADVANTAGES IFAPPROVED: 7A 7�f:9^?.."^.$'.�`'ze,� %';'.�7'.�F`.��' �� i�� ___�. -._W�= DISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OF TRANSACTION 3 COSTlREYENUE BUDGETED (CiqCLE ONE) YES NO iUNDING SOURCE AC7IVITY NUMBER FINANCIAL INFOflMATION. (EXPLA�N) Greensneet #. L.t.E.P. REVIEW CHECKLIS7 Date: /��'S�3 In TraCker?_ MP'n Received ! APP'n Processed LiCense ID # B-04755 LiCenSe Type: State Class B Camb] ing�remise Permi t Company Name: St. Paul East Athletic Association DBA: St. Paul East Athletic Association BuSinessAddresss: 1177 Clarence St. (Moose's Locker Room)BUSinessPho�re: 778-8751 Contact Name/Address: Jackie Pearson/CEO Home Phone: 778-8751 Date to Council LabelS Ordered: N{A Public Hearing Date: r 9`7 Notice Sent to Applicant: � Notice Sent to Public: District Councl #:. Ward #: nF Departmentf Date Inspections Comments City Attorney � �o �� y19� �f�/g� Environmental Heaith / � �� Fire i "�� ( �icetlse Site Pian Received:_ Lease ReCeived: �� / J ! Police �� Uh ��2G&7" (L (�lt� T?77��-Q' ! � � Zoning /��' � . ' _' ,,..� ' 1 v v � � G } 4 i _ ' s 1 , F ` - Y , I , w'� , . •� � 5 ; N � 2 , i� . _ � � � { ��`.� x ,� ,, � , �� _ �� :� 9� S1� � ' . ,_ , , £ n. � , "' � � 'FOR_BOARD USE ONLS' � 1G274 , � - , _ �� ," �`SASER_- . ' , ��i) � _ . . , , - . . . ". . - . � PPlt ;:::.>.;� - � . , FEE ..,��' , sx { i � �;M"uinesota'i.atvfici GambIxrtg N'�"MES - Premises;Permit Application,; „Part l,of 2 DAl'� � ,�` `. � � . ' �. ��`'�+ r ._ - ' � ✓ -� . r _ . _ i � y � , 3 Y- - ? / �:✓'M�. /��/"' �fi� l ..✓e�"� y✓ "��y,� ' '1� � � ^s' �9��,�� a. � � � y . �� ✓-��'j � M ��.4� a�p - a �`. .�.��' So �••� ^so.w ,j. e o A Iz CQ�ttilL r�.'� ,,., k;�,>'s.i�.< x. r'`�'.i',z�� ¢z+�,, w'� • sn,��S�., •:• �as��""�.v. .. . . .F_ . ..,.. _ .. . � � . . _ , ' ' ., . . . - � Cfass ot prem�ses Pe�snk . : , ' '-- : .,, � . Renewa4 - � R � .� ;ft . . (oheck oae) ' Organizat+on 6ase licen'se number d � 7 �SS �] A(S400J PulFiabs, tip6oards paddlewheels, raffies, birigo Premises pertiiR�number ' �� [j�8'�5250) Puii-tabs, 5pboards, paddlewheeis, mffies , � New .- � ❑ � (5200) &ngo onty ' �� ; � ,��..�.. ;, . , . , � . " � D (5750) Elaftles onSy , , - ,:y�;•.z:d�xn..::n,„z^�m' `� 4. `,. ,llC � r.+� /�+Sm�mR`.'j<.. � ;.> ."b' . q • � .- o.. �°"�.: �7 �h s m'�; �JJ'gL1TLYZ,Q�Yf1R��;'.,. OTI7LQ�IG7Lu��:zYi"'�s>"�`s��%sa<��r' '§_ �a�"�.•'...M�"'�� .e NameoE�ganization:: � � t �; � , � ,• ,� ,, - , , S-F. Aai,v L�� ct:sfi�` �N--fi{� Ce�f rc� �ssco,r' � � � _ 8usiness Address ot Organ�zstion - Street a P. O Box {Oo not use the address ot your ;gam6ling maaager) �� . � �.S � �' .: S �t �Y fA%ODC� , . , ' , f ' , ' ,� , ..'. Cit � State �� -' ZiD Code '� Counry ;- �' , Dayt�me phoae numbet S-�• {�c�,JL i ' M1V ! , �5'Sf�l� �Z�mse`c . t J �; ,.. , Name of chief executive oKeer (pruiot beyour gambiing manage� ,, ., ,,, �, � Tide, ",� �, ',,:, , � DayCme phone number �c3e#Cie, � ��Pc�'�;soiv , , ��,�r'es�c�e'rt`7" � t � i,; , , Bingo Occasionsi i �,, '' �� ` f' - ��, � �i � � ; � � , �� ff apptying for a class A o'r C permii: flll i.� 3ays and beginrnng &;`endin� hours of biiigo occas�ons ' No more than seven btiigo occasions may 6e conducted byEyour organization per week :. �ay Bcgfnning/End�g Honas �,- ' Day ' Beginning/Endirig Hours -.� Day. � Beg[cv�tng /Ending Hovrs �m ' _ , � , to � _ � , , � : - � , , i�� . : . , . � . , . , , t , to A � -' � i : � to " �o p �.: !� 7ry �v 'i�. � 1 ., �, ,.. � � �. 1 4to� i� f � if � If bmgo will not be coaducted check here Li� ' � r � i� I.:� t ,f .. , ' � #.' � 3 t a �: � - , ? i i . Gambli yev^" a'ta�,Yp Z`X'F-'4%>" aY a fr .. ,• 3'� � c' 1' �. � No- 1 a .. '� x a eC �� s ng�em3ses�rnsation a r s �. -y fi`v �� ^��,�� ,`�j -�c�y��'�� ° � Name of estabiahment where gamblNg wdl be conducted �Sveet Address (do not use a post oflKe box a�mber) �oose s� Lb' k i-e:i».� t tZ�?� CC ev�„, ,.p ,. `S�'�O4.�t,��5'�"y�1�e � , Is the premises locatecf wrttun' aty.limiis? ;„�Yes O No II no, is township � iorganized � unorganized �O unincorporated , Gity and Counry where gambGrn� pseimseslis OR Township and Counry where gambli�g premises is bcated d oumde ot c�ry hmrts � $�F-. ��r�L `' �.ti�se �f � S��auZ . Nt+iJ. .�'v�>O 6."� ; Name and address ot legai bwner at premise -�Ciry i, �. '�. State ' .� Zrp Code .. ,S'�eJC-? ��u�� f< ��hgli�'ti �$�.S�evC , '°Y�XJ, "�:v'.� -- Dnes your arganizaliog awn th �n7d�rg where the gambiing will be wnducted? Q YES ..�. NO - ��, �. E^' �, - ,;; 1f no. auaeh the fofbwing: - � �, . . . . � ' ' ��, "'� . . � � -� e' 'a copy of the lease (form LG2C12) with tsrms for at least one year. ' �� . �, t y., ; ,�� ' � � �'� a copy of a sketch of the Iloor pian with dimensions, showing what portion is being tea"sed.�� ';�� , . � .�!A�lease and sketch are not raquired for Class D appiicaoons. '� q" � ..., .. _ .. ..: _ _ _ ' ' _. �t5,t ^ 5 _ - -. ,,,. :..`�:c» ; ..� .. . ' • .- x s .{N'.Cx � ` - :,.4 ;, o . , � � ,a„�.a> �` z �: AddreSS of sto C'S ace of gairibliri�equipment .17s �rt �P a ao �X �Um�r .- �a� ,:. - Address , Ciry ' State t Zrpcode. - , ' , �' � r t I 'Z Z � C � Y'e�� < e ��` S �t � �� t . ln�t1 j SS� a d � � � �;'. ; � � ` ' � � � - � ° - � � � �,� � � , ' „y, ;. �: � , . � � , � �.f_ . . I' i i � � i I i � ��4 '� � ' i ' . � � '� � _ . . . , i ' � � f �� , i .i .�¶Y.�'• � , i �' :�.,� . v �� ;�y s, _ _ , , ._,., 3 H l b) gyl/bbH ., - �Sb3 � q1�.S�� r � ' :,_.' - �MitmesataLnw,fui�Garnblcttg;� � � � �'` � .t Premise Permit Applicatian - Part 2 of 2% 1 , ......... ......._,r-.. rv � w �viinis. , . . >•xr.:J:. ad,s;r°�''i� � �� z ��„.'�' � � f ' :a � ,:_hr. �-..'� /:l ^ is,'"R .�i's`/...�i.:%s7'; "`r �r.; �M �s�' . • ' ^ N : . Gdrs�tiia �irnk'`.A�'ccountT aimtfiibi?y�;,,<z�::�r x �� u � , , ' , . ; gank Acmunt Number - � . ` s - oS�/NO/�`j"�.��Iz� J�lif1�K � ,t.,_ �03�La3��_`± ,� mm r � . / � �� nkAddress ' °,,.' , . � . �- __ ' a �-:��637 , . r3si � s�-:�.. 5-� ,�� mn� , , , ,:... ....__W.� ....�.._�,.�... ..��w_�«� ��.�� ...; ....%. )i 2a- Qr..:� l/v--w�-r.::.ra,w>.J, o.-..`....�._._ . .. ..,� .. . , � - - ame ,, , � ,, ressi . �, � . ; ' d , . . � ,.� . �acki,? ,Pe,�rir"s:v,✓t'�.� ISSt. ✓�'ircrwooG� <'�� 1 _��.'� ; ...� � � " r� , . �,: � � � �/1ZEn F , ��.,. , c`�e�m�es '�l7�efJm.'!�o'v'�c_h ��S��tYlav2�r4nJ�- : 5� �Cr � � E..<. � � � . � ' . � x '��, . yr�;..'2:�%r- t'. r L�, f t'^�+'-:y`<c'3.»a� 3x9 Y � � � .. , �i�5 �'`y �'^'�°'m� '� � �i �� . , ...t/w,..;.; . ' � + st4cr i�'"n•",G;%v;'" S''7'"i''.+s<�j�,'$,��.�,�.,'%Y � .�'��<4✓'"iu ...�'�3 ��.�.'"'<�o�� AcScuowledgeaieri��,�"��; .,� � ..;tY' F :h 9 .. �CX�.wl�.,.N^�; . .. . .�w...: .. ' ' ' �. .. K!..rz. C,amhllnQ S te Authorization ' •i arit the chiaf executive oHicer of the organizatwn; -;s . I hereby cnnsent thaE bcal law enforcement officers; the •I assume fuli responsibiliry.ior the fair and law�uf opeTa• , board or agents of tha'board, oi the commissione� of tion'of all aotivities to be conduded; . ; revenua or public safety, or agents of.the camrrnssioners, .� W ��( fami(i�rize myself with the laws of Minnesota' may enter the premises to,enforce the law. ' , governing lawful gambling and rules ofi the board and '., Bank Records Inforinatioa� ', '' �' agrae 'rf liceil'sad, t'o abide by those laws and niies , � The board is authorized to inspect tMe bank,records bf;the � includmg amendmants, to them ; :, j gambling account whanevar necessary to futtill •any appl�eaiwn iMormation w�li ba subrtiitt9d� requiremenu of c'urrent g'ambling,rules and law 'to the board arid bcal un8;of govarriment wdhin t0�days' , i Oafh ,�� . , � �� • � , of tfie chan�e; and �ya� ° � . �' � 3 f � � { declace that � U ' . � "i ,' � •I`understand,that failure to prov�de iequired mforrimatiorf , •1 fiave read this applicaUOri and' ai� informatwn submitted br oroviding,falsa or misleadmg miortnatwn may r'e in , to :he ix�asd is trus�, accurate,and compiete; . ,' ', , , }he deniai or revocation of the license: �� i�� _� •ait otherrequ�red'+�itormaGOn has bee'n fully disclosed; , �;" � � � � � Date - Signature of chiet � zecutrve officet �� , � � � �� i� "',:75 ��}�� 'C." 'i+i .. ` � . �. � — ii "�.i' � , ; � , ' .. � w .�� fi - r �^n2'�?'F�`y �' s> 3 � Y�°� m,�rx'� a� a' i � ',s��h"� 'r'1^rc�rl.�',"tv � f r . 3>"*C �&�� 3 � �&� �.' Loc �1 � ver,nmertt Ackrzauitedgemett,f ` .fr.., e. � 1 3fl ��'/f x�/.' ..F``� ��;3 � ��E„ }�� ' 4, A coov ot the '� �� nit ot anvernme�it s r�esoluiion a'w ,'� 7. 7he ci[y must sign lhis appl�eatron ti the gambting;prem-' ��na th�s aooticatron must be attacfied ta this aoo6c�tioni' ises is bcated wrthin` c+ty (imrtsi;,� �'� �, n i,;r, "' S. If tMs application is,deo�ed by the l�eal unK,of govemment, ' 2. The counry "A�7D townsh�p �rt�ust sign this applicaYion it ,� shontd not be submitted to the G3rti6Gng CQntPol 6oar�. the gambLng prem�ises a located wrth�n a township. `. ' ,. i,, ; !, 3. The tocai vnrt govemment (city or�counry) must pass a'i', Townsh�p: By s�gnatuFe bekw, the towaship. acknow�edge's � resoluCwn specificatly apprwin j; or deny�ng this app('ieatioa.; thet the orga�nizatx�n is apply�ng tor'a,premises ¢errtiit witBin ��'� i .X`. „ j _ _ , �. , , � � : � - 'township timiis c: t - k ry" _ - . , r t . . . � � Townshi� ' �9 � � Cit ` or Count "�� .< < ; City or ry Name''� ',� , _ I Township'Name . , s ` t , t � � { �' { � �r . Signa e ot pecson' ,. v+ng . .'' Signature of person receiving apPricatwn ; ' - ' �t�� ' �,' Date Received Title - ' . . Date Recervad � 1 � .. � ,�� j� - ,'�� x � a i„ � , , .� ' ., . , _� �i , � . -� I . ' Refer to the irvvtruciions �SOr required agac,hments. �,` ' ' ,� , , , �, _. , �'� §, � �' , _ . < . � ,,,, � � s ' � , , ` _ ' , ; , ; ` - �, � . Mail to: Gam6t(ng Conlroi Board ' � � � , , � � . , � r i ��:' , Rouwood Plaza Scuth.3rd Floor � . , ' tx , � " � � 1717 Wi Courity Rosd 9 � ,' .. , . � LG2�4(Part 2)�� , ° Roaevt0e. MN 55113 � ��" , � . .��,� , �� ,� '� � � ., ' �' 'i ' . , p T ( Il� 1 { � 1 ��; ' � �r.��plfe.�4.. .,. ' .. , . � _ _ -, .:.. .kef�.f�w#e�-�,exs xv.� Council File # Q � " SL� Ordinance # Green Sheet # 35330 t��—, i f=. �� Fs F ;� t�.. � ,;��.�`i;�_ Presented By 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 Re£erred To Co�nittee: Date RESOLVED: That application, ID #B-04755, for a new State Class B Gambling Premise Pezmit by St. Paul Sast Athletic Association at Moose's Locker Room, 1177 Clarence Street, be and the same is hereby approved. �� r �� Requested by Department of: Of£ice of License Insnections and Environmental Prot c.ion Adopted by Council: Adoption Certified by Council Hy_ Approved By RESOLUTION CITY OF SAINT PAUL, MINNESOTA 35 -1 � ..� � Form Approved by City Attorney Approved by Mayor £or Suknnission to Council By: Rn_c�� ** NEED COPY IMMEDIATELY ** l' 1,� DEPARTAENT�FFICHCOUNGL DATEINRIATED GREEN SHEE N° � 3.5330 LIEP - - - - CONTACT PEfiSON 8 PHONE �NITtAVDATE INRfAfJDATE �DEPARTMEM'DIflECfOfl �CT'COUNCII William F. Gunther - 266-9132 "�" ��TYATTORNEI' � CITYCIERK MUST BE ON WUNCIL AG DA BY (DATE) �� BUDGET DIqECTOH � FIN. & MGT. SERVICES DIR. ROUiING H22.T1R : �� O ��'OR (OR ASSISTANn � TOTAL # OF SIGNANRE PAGES ' (CLIP ALL LOCATIONS FOR SIGNATURE) ACTKKJ HEQUESiED: Jackie Pearson on behalf of St. Paul East Athletic Association requests Council approval of eheir application for a new State Class B Gambling Premise Permit, ID ��B-04755, at Moose's Locker Room, 1177 Clarence Street. pECAMMENDAS�ONS' Apprwe (A� a Fle�eft �R� PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLIOWING pUEST10NS: _ PLANNING COMMISSION _ CNIL SERVICE CAMMISSION i. Has this persoNfirm ever worked untler a contract for Mis departmen[? � _ CIB CqMMI7TEE _ YES NO _ SiAFF 2. Has this persoMrm ever been a city employee? — YES NO _ �ISTR7CT COUPT _ 3. DoeS ihis persoMirm ssess a Skill not normall essed po y poss by any current ciry employee? SUPPOR75 WHICH COUNCIL O&IELTIVE7 YES NO Explain all yes an8wers on separete sheet and attach to green aheet INIMTINQ PR�BIEM, ISSUE, OPPORTUNITY {W�w, Wp3t, When, Wh¢re, Why): , , �� QR � 4 �ssa ��Y ��a��Y ADVANTAGES IF APPROVED: " � DISADVANTAGES IFAPPROVED: 7A 7�f:9^?.."^.$'.�`'ze,� %';'.�7'.�F`.��' �� i�� ___�. -._W�= DISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OF TRANSACTION 3 COSTlREYENUE BUDGETED (CiqCLE ONE) YES NO iUNDING SOURCE AC7IVITY NUMBER FINANCIAL INFOflMATION. (EXPLA�N) Greensneet #. L.t.E.P. REVIEW CHECKLIS7 Date: /��'S�3 In TraCker?_ MP'n Received ! APP'n Processed LiCense ID # B-04755 LiCenSe Type: State Class B Camb] ing�remise Permi t Company Name: St. Paul East Athletic Association DBA: St. Paul East Athletic Association BuSinessAddresss: 1177 Clarence St. (Moose's Locker Room)BUSinessPho�re: 778-8751 Contact Name/Address: Jackie Pearson/CEO Home Phone: 778-8751 Date to Council LabelS Ordered: N{A Public Hearing Date: r 9`7 Notice Sent to Applicant: � Notice Sent to Public: District Councl #:. Ward #: nF Departmentf Date Inspections Comments City Attorney � �o �� y19� �f�/g� Environmental Heaith / � �� Fire i "�� ( �icetlse Site Pian Received:_ Lease ReCeived: �� / J ! Police �� Uh ��2G&7" (L (�lt� T?77��-Q' ! � � Zoning /��' � . ' _' ,,..� ' 1 v v � � G } 4 i _ ' s 1 , F ` - Y , I , w'� , . •� � 5 ; N � 2 , i� . _ � � � { ��`.� x ,� ,, � , �� _ �� :� 9� S1� � ' . ,_ , , £ n. � , "' � � 'FOR_BOARD USE ONLS' � 1G274 , � - , _ �� ," �`SASER_- . ' , ��i) � _ . . , , - . . . ". . - . � PPlt ;:::.>.;� - � . , FEE ..,��' , sx { i � �;M"uinesota'i.atvfici GambIxrtg N'�"MES - Premises;Permit Application,; „Part l,of 2 DAl'� � ,�` `. � � . ' �. ��`'�+ r ._ - ' � ✓ -� . r _ . _ i � y � , 3 Y- - ? / �:✓'M�. /��/"' �fi� l ..✓e�"� y✓ "��y,� ' '1� � � ^s' �9��,�� a. � � � y . �� ✓-��'j � M ��.4� a�p - a �`. .�.��' So �••� ^so.w ,j. e o A Iz CQ�ttilL r�.'� ,,., k;�,>'s.i�.< x. r'`�'.i',z�� ¢z+�,, w'� • sn,��S�., •:• �as��""�.v. .. . . .F_ . ..,.. _ .. . � � . . _ , ' ' ., . . . - � Cfass ot prem�ses Pe�snk . : , ' '-- : .,, � . Renewa4 - � R � .� ;ft . . (oheck oae) ' Organizat+on 6ase licen'se number d � 7 �SS �] A(S400J PulFiabs, tip6oards paddlewheels, raffies, birigo Premises pertiiR�number ' �� [j�8'�5250) Puii-tabs, 5pboards, paddlewheeis, mffies , � New .- � ❑ � (5200) &ngo onty ' �� ; � ,��..�.. ;, . , . , � . " � D (5750) Elaftles onSy , , - ,:y�;•.z:d�xn..::n,„z^�m' `� 4. `,. ,llC � r.+� /�+Sm�mR`.'j<.. � ;.> ."b' . q • � .- o.. �°"�.: �7 �h s m'�; �JJ'gL1TLYZ,Q�Yf1R��;'.,. OTI7LQ�IG7Lu��:zYi"'�s>"�`s��%sa<��r' '§_ �a�"�.•'...M�"'�� .e NameoE�ganization:: � � t �; � , � ,• ,� ,, - , , S-F. Aai,v L�� ct:sfi�` �N--fi{� Ce�f rc� �ssco,r' � � � _ 8usiness Address ot Organ�zstion - Street a P. O Box {Oo not use the address ot your ;gam6ling maaager) �� . � �.S � �' .: S �t �Y fA%ODC� , . , ' , f ' , ' ,� , ..'. Cit � State �� -' ZiD Code '� Counry ;- �' , Dayt�me phoae numbet S-�• {�c�,JL i ' M1V ! , �5'Sf�l� �Z�mse`c . t J �; ,.. , Name of chief executive oKeer (pruiot beyour gambiing manage� ,, ., ,,, �, � Tide, ",� �, ',,:, , � DayCme phone number �c3e#Cie, � ��Pc�'�;soiv , , ��,�r'es�c�e'rt`7" � t � i,; , , Bingo Occasionsi i �,, '' �� ` f' - ��, � �i � � ; � � , �� ff apptying for a class A o'r C permii: flll i.� 3ays and beginrnng &;`endin� hours of biiigo occas�ons ' No more than seven btiigo occasions may 6e conducted byEyour organization per week :. �ay Bcgfnning/End�g Honas �,- ' Day ' Beginning/Endirig Hours -.� Day. � Beg[cv�tng /Ending Hovrs �m ' _ , � , to � _ � , , � : - � , , i�� . : . , . � . , . , , t , to A � -' � i : � to " �o p �.: !� 7ry �v 'i�. � 1 ., �, ,.. � � �. 1 4to� i� f � if � If bmgo will not be coaducted check here Li� ' � r � i� I.:� t ,f .. , ' � #.' � 3 t a �: � - , ? i i . Gambli yev^" a'ta�,Yp Z`X'F-'4%>" aY a fr .. ,• 3'� � c' 1' �. � No- 1 a .. '� x a eC �� s ng�em3ses�rnsation a r s �. -y fi`v �� ^��,�� ,`�j -�c�y��'�� ° � Name of estabiahment where gamblNg wdl be conducted �Sveet Address (do not use a post oflKe box a�mber) �oose s� Lb' k i-e:i».� t tZ�?� CC ev�„, ,.p ,. `S�'�O4.�t,��5'�"y�1�e � , Is the premises locatecf wrttun' aty.limiis? ;„�Yes O No II no, is township � iorganized � unorganized �O unincorporated , Gity and Counry where gambGrn� pseimseslis OR Township and Counry where gambli�g premises is bcated d oumde ot c�ry hmrts � $�F-. ��r�L `' �.ti�se �f � S��auZ . Nt+iJ. .�'v�>O 6."� ; Name and address ot legai bwner at premise -�Ciry i, �. '�. State ' .� Zrp Code .. ,S'�eJC-? ��u�� f< ��hgli�'ti �$�.S�evC , '°Y�XJ, "�:v'.� -- Dnes your arganizaliog awn th �n7d�rg where the gambiing will be wnducted? Q YES ..�. NO - ��, �. E^' �, - ,;; 1f no. auaeh the fofbwing: - � �, . . . . � ' ' ��, "'� . . � � -� e' 'a copy of the lease (form LG2C12) with tsrms for at least one year. ' �� . �, t y., ; ,�� ' � � �'� a copy of a sketch of the Iloor pian with dimensions, showing what portion is being tea"sed.�� ';�� , . � .�!A�lease and sketch are not raquired for Class D appiicaoons. '� q" � ..., .. _ .. ..: _ _ _ ' ' _. �t5,t ^ 5 _ - -. ,,,. :..`�:c» ; ..� .. . ' • .- x s .{N'.Cx � ` - :,.4 ;, o . , � � ,a„�.a> �` z �: AddreSS of sto C'S ace of gairibliri�equipment .17s �rt �P a ao �X �Um�r .- �a� ,:. - Address , Ciry ' State t Zrpcode. - , ' , �' � r t I 'Z Z � C � Y'e�� < e ��` S �t � �� t . ln�t1 j SS� a d � � � �;'. ; � � ` ' � � � - � ° - � � � �,� � � , ' „y, ;. �: � , . � � , � �.f_ . . I' i i � � i I i � ��4 '� � ' i ' . � � '� � _ . . . , i ' � � f �� , i .i .�¶Y.�'• � , i �' :�.,� . v �� ;�y s, _ _ , , ._,., 3 H l b) gyl/bbH ., - �Sb3 � q1�.S�� r � ' :,_.' - �MitmesataLnw,fui�Garnblcttg;� � � � �'` � .t Premise Permit Applicatian - Part 2 of 2% 1 , ......... ......._,r-.. rv � w �viinis. , . . >•xr.:J:. ad,s;r°�''i� � �� z ��„.'�' � � f ' :a � ,:_hr. �-..'� /:l ^ is,'"R .�i's`/...�i.:%s7'; "`r �r.; �M �s�' . • ' ^ N : . Gdrs�tiia �irnk'`.A�'ccountT aimtfiibi?y�;,,<z�::�r x �� u � , , ' , . ; gank Acmunt Number - � . ` s - oS�/NO/�`j"�.��Iz� J�lif1�K � ,t.,_ �03�La3��_`± ,� mm r � . / � �� nkAddress ' °,,.' , . � . �- __ ' a �-:��637 , . r3si � s�-:�.. 5-� ,�� mn� , , , ,:... ....__W.� ....�.._�,.�... ..��w_�«� ��.�� ...; ....%. )i 2a- Qr..:� l/v--w�-r.::.ra,w>.J, o.-..`....�._._ . .. ..,� .. . , � - - ame ,, , � ,, ressi . �, � . ; ' d , . . � ,.� . �acki,? ,Pe,�rir"s:v,✓t'�.� ISSt. ✓�'ircrwooG� <'�� 1 _��.'� ; ...� � � " r� , . �,: � � � �/1ZEn F , ��.,. , c`�e�m�es '�l7�efJm.'!�o'v'�c_h ��S��tYlav2�r4nJ�- : 5� �Cr � � E..<. � � � . � ' . � x '��, . yr�;..'2:�%r- t'. r L�, f t'^�+'-:y`<c'3.»a� 3x9 Y � � � .. , �i�5 �'`y �'^'�°'m� '� � �i �� . , ...t/w,..;.; . ' � + st4cr i�'"n•",G;%v;'" S''7'"i''.+s<�j�,'$,��.�,�.,'%Y � .�'��<4✓'"iu ...�'�3 ��.�.'"'<�o�� AcScuowledgeaieri��,�"��; .,� � ..;tY' F :h 9 .. �CX�.wl�.,.N^�; . .. . .�w...: .. ' ' ' �. .. K!..rz. C,amhllnQ S te Authorization ' •i arit the chiaf executive oHicer of the organizatwn; -;s . I hereby cnnsent thaE bcal law enforcement officers; the •I assume fuli responsibiliry.ior the fair and law�uf opeTa• , board or agents of tha'board, oi the commissione� of tion'of all aotivities to be conduded; . ; revenua or public safety, or agents of.the camrrnssioners, .� W ��( fami(i�rize myself with the laws of Minnesota' may enter the premises to,enforce the law. ' , governing lawful gambling and rules ofi the board and '., Bank Records Inforinatioa� ', '' �' agrae 'rf liceil'sad, t'o abide by those laws and niies , � The board is authorized to inspect tMe bank,records bf;the � includmg amendmants, to them ; :, j gambling account whanevar necessary to futtill •any appl�eaiwn iMormation w�li ba subrtiitt9d� requiremenu of c'urrent g'ambling,rules and law 'to the board arid bcal un8;of govarriment wdhin t0�days' , i Oafh ,�� . , � �� • � , of tfie chan�e; and �ya� ° � . �' � 3 f � � { declace that � U ' . � "i ,' � •I`understand,that failure to prov�de iequired mforrimatiorf , •1 fiave read this applicaUOri and' ai� informatwn submitted br oroviding,falsa or misleadmg miortnatwn may r'e in , to :he ix�asd is trus�, accurate,and compiete; . ,' ', , , }he deniai or revocation of the license: �� i�� _� •ait otherrequ�red'+�itormaGOn has bee'n fully disclosed; , �;" � � � � � Date - Signature of chiet � zecutrve officet �� , � � � �� i� "',:75 ��}�� 'C." 'i+i .. ` � . �. � — ii "�.i' � , ; � , ' .. � w .�� fi - r �^n2'�?'F�`y �' s> 3 � Y�°� m,�rx'� a� a' i � ',s��h"� 'r'1^rc�rl.�',"tv � f r . 3>"*C �&�� 3 � �&� �.' Loc �1 � ver,nmertt Ackrzauitedgemett,f ` .fr.., e. � 1 3fl ��'/f x�/.' ..F``� ��;3 � ��E„ }�� ' 4, A coov ot the '� �� nit ot anvernme�it s r�esoluiion a'w ,'� 7. 7he ci[y must sign lhis appl�eatron ti the gambting;prem-' ��na th�s aooticatron must be attacfied ta this aoo6c�tioni' ises is bcated wrthin` c+ty (imrtsi;,� �'� �, n i,;r, "' S. If tMs application is,deo�ed by the l�eal unK,of govemment, ' 2. The counry "A�7D townsh�p �rt�ust sign this applicaYion it ,� shontd not be submitted to the G3rti6Gng CQntPol 6oar�. the gambLng prem�ises a located wrth�n a township. `. ' ,. i,, ; !, 3. The tocai vnrt govemment (city or�counry) must pass a'i', Townsh�p: By s�gnatuFe bekw, the towaship. acknow�edge's � resoluCwn specificatly apprwin j; or deny�ng this app('ieatioa.; thet the orga�nizatx�n is apply�ng tor'a,premises ¢errtiit witBin ��'� i .X`. „ j _ _ , �. , , � � : � - 'township timiis c: t - k ry" _ - . , r t . . . � � Townshi� ' �9 � � Cit ` or Count "�� .< < ; City or ry Name''� ',� , _ I Township'Name . , s ` t , t � � { �' { � �r . Signa e ot pecson' ,. v+ng . .'' Signature of person receiving apPricatwn ; ' - ' �t�� ' �,' Date Received Title - ' . . Date Recervad � 1 � .. � ,�� j� - ,'�� x � a i„ � , , .� ' ., . , _� �i , � . -� I . ' Refer to the irvvtruciions �SOr required agac,hments. �,` ' ' ,� , , , �, _. , �'� §, � �' , _ . < . � ,,,, � � s ' � , , ` _ ' , ; , ; ` - �, � . Mail to: Gam6t(ng Conlroi Board ' � � � , , � � . , � r i ��:' , Rouwood Plaza Scuth.3rd Floor � . , ' tx , � " � � 1717 Wi Courity Rosd 9 � ,' .. , . � LG2�4(Part 2)�� , ° Roaevt0e. MN 55113 � ��" , � . .��,� , �� ,� '� � � ., ' �' 'i ' . , p T ( Il� 1 { � 1 ��; ' � �r.��plfe.�4.. .,. ' .. , . � _ _ -, .:.. .kef�.f�w#e�-�,exs xv.� Council File # Q � " SL� Ordinance # Green Sheet # 35330 t��—, i f=. �� Fs F ;� t�.. � ,;��.�`i;�_ Presented By 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 Re£erred To Co�nittee: Date RESOLVED: That application, ID #B-04755, for a new State Class B Gambling Premise Pezmit by St. Paul Sast Athletic Association at Moose's Locker Room, 1177 Clarence Street, be and the same is hereby approved. �� r �� Requested by Department of: Of£ice of License Insnections and Environmental Prot c.ion Adopted by Council: Adoption Certified by Council Hy_ Approved By RESOLUTION CITY OF SAINT PAUL, MINNESOTA 35 -1 � ..� � Form Approved by City Attorney Approved by Mayor £or Suknnission to Council By: Rn_c�� ** NEED COPY IMMEDIATELY ** l' 1,� DEPARTAENT�FFICHCOUNGL DATEINRIATED GREEN SHEE N° � 3.5330 LIEP - - - - CONTACT PEfiSON 8 PHONE �NITtAVDATE INRfAfJDATE �DEPARTMEM'DIflECfOfl �CT'COUNCII William F. Gunther - 266-9132 "�" ��TYATTORNEI' � CITYCIERK MUST BE ON WUNCIL AG DA BY (DATE) �� BUDGET DIqECTOH � FIN. & MGT. SERVICES DIR. ROUiING H22.T1R : �� O ��'OR (OR ASSISTANn � TOTAL # OF SIGNANRE PAGES ' (CLIP ALL LOCATIONS FOR SIGNATURE) ACTKKJ HEQUESiED: Jackie Pearson on behalf of St. Paul East Athletic Association requests Council approval of eheir application for a new State Class B Gambling Premise Permit, ID ��B-04755, at Moose's Locker Room, 1177 Clarence Street. pECAMMENDAS�ONS' Apprwe (A� a Fle�eft �R� PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLIOWING pUEST10NS: _ PLANNING COMMISSION _ CNIL SERVICE CAMMISSION i. Has this persoNfirm ever worked untler a contract for Mis departmen[? � _ CIB CqMMI7TEE _ YES NO _ SiAFF 2. Has this persoMrm ever been a city employee? — YES NO _ �ISTR7CT COUPT _ 3. DoeS ihis persoMirm ssess a Skill not normall essed po y poss by any current ciry employee? SUPPOR75 WHICH COUNCIL O&IELTIVE7 YES NO Explain all yes an8wers on separete sheet and attach to green aheet INIMTINQ PR�BIEM, ISSUE, OPPORTUNITY {W�w, Wp3t, When, Wh¢re, Why): , , �� QR � 4 �ssa ��Y ��a��Y ADVANTAGES IF APPROVED: " � DISADVANTAGES IFAPPROVED: 7A 7�f:9^?.."^.$'.�`'ze,� %';'.�7'.�F`.��' �� i�� ___�. -._W�= DISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OF TRANSACTION 3 COSTlREYENUE BUDGETED (CiqCLE ONE) YES NO iUNDING SOURCE AC7IVITY NUMBER FINANCIAL INFOflMATION. (EXPLA�N) Greensneet #. L.t.E.P. REVIEW CHECKLIS7 Date: /��'S�3 In TraCker?_ MP'n Received ! APP'n Processed LiCense ID # B-04755 LiCenSe Type: State Class B Camb] ing�remise Permi t Company Name: St. Paul East Athletic Association DBA: St. Paul East Athletic Association BuSinessAddresss: 1177 Clarence St. (Moose's Locker Room)BUSinessPho�re: 778-8751 Contact Name/Address: Jackie Pearson/CEO Home Phone: 778-8751 Date to Council LabelS Ordered: N{A Public Hearing Date: r 9`7 Notice Sent to Applicant: � Notice Sent to Public: District Councl #:. Ward #: nF Departmentf Date Inspections Comments City Attorney � �o �� y19� �f�/g� Environmental Heaith / � �� Fire i "�� ( �icetlse Site Pian Received:_ Lease ReCeived: �� / J ! Police �� Uh ��2G&7" (L (�lt� T?77��-Q' ! � � Zoning /��' � . ' _' ,,..� ' 1 v v � � G } 4 i _ ' s 1 , F ` - Y , I , w'� , . •� � 5 ; N � 2 , i� . _ � � � { ��`.� x ,� ,, � , �� _ �� :� 9� S1� � ' . ,_ , , £ n. � , "' � � 'FOR_BOARD USE ONLS' � 1G274 , � - , _ �� ," �`SASER_- . ' , ��i) � _ . . , , - . . . ". . - . � PPlt ;:::.>.;� - � . , FEE ..,��' , sx { i � �;M"uinesota'i.atvfici GambIxrtg N'�"MES - Premises;Permit Application,; „Part l,of 2 DAl'� � ,�` `. � � . ' �. ��`'�+ r ._ - ' � ✓ -� . r _ . _ i � y � , 3 Y- - ? / �:✓'M�. /��/"' �fi� l ..✓e�"� y✓ "��y,� ' '1� � � ^s' �9��,�� a. � � � y . �� ✓-��'j � M ��.4� a�p - a �`. .�.��' So �••� ^so.w ,j. e o A Iz CQ�ttilL r�.'� ,,., k;�,>'s.i�.< x. r'`�'.i',z�� ¢z+�,, w'� • sn,��S�., •:• �as��""�.v. .. . . .F_ . ..,.. _ .. . � � . . _ , ' ' ., . . . - � Cfass ot prem�ses Pe�snk . : , ' '-- : .,, � . Renewa4 - � R � .� ;ft . . (oheck oae) ' Organizat+on 6ase licen'se number d � 7 �SS �] A(S400J PulFiabs, tip6oards paddlewheels, raffies, birigo Premises pertiiR�number ' �� [j�8'�5250) Puii-tabs, 5pboards, paddlewheeis, mffies , � New .- � ❑ � (5200) &ngo onty ' �� ; � ,��..�.. ;, . , . , � . " � D (5750) Elaftles onSy , , - ,:y�;•.z:d�xn..::n,„z^�m' `� 4. `,. ,llC � r.+� /�+Sm�mR`.'j<.. � ;.> ."b' . q • � .- o.. �°"�.: �7 �h s m'�; �JJ'gL1TLYZ,Q�Yf1R��;'.,. OTI7LQ�IG7Lu��:zYi"'�s>"�`s��%sa<��r' '§_ �a�"�.•'...M�"'�� .e NameoE�ganization:: � � t �; � , � ,• ,� ,, - , , S-F. Aai,v L�� ct:sfi�` �N--fi{� Ce�f rc� �ssco,r' � � � _ 8usiness Address ot Organ�zstion - Street a P. O Box {Oo not use the address ot your ;gam6ling maaager) �� . � �.S � �' .: S �t �Y fA%ODC� , . , ' , f ' , ' ,� , ..'. Cit � State �� -' ZiD Code '� Counry ;- �' , Dayt�me phoae numbet S-�• {�c�,JL i ' M1V ! , �5'Sf�l� �Z�mse`c . t J �; ,.. , Name of chief executive oKeer (pruiot beyour gambiing manage� ,, ., ,,, �, � Tide, ",� �, ',,:, , � DayCme phone number �c3e#Cie, � ��Pc�'�;soiv , , ��,�r'es�c�e'rt`7" � t � i,; , , Bingo Occasionsi i �,, '' �� ` f' - ��, � �i � � ; � � , �� ff apptying for a class A o'r C permii: flll i.� 3ays and beginrnng &;`endin� hours of biiigo occas�ons ' No more than seven btiigo occasions may 6e conducted byEyour organization per week :. �ay Bcgfnning/End�g Honas �,- ' Day ' Beginning/Endirig Hours -.� Day. � Beg[cv�tng /Ending Hovrs �m ' _ , � , to � _ � , , � : - � , , i�� . : . , . � . , . , , t , to A � -' � i : � to " �o p �.: !� 7ry �v 'i�. � 1 ., �, ,.. � � �. 1 4to� i� f � if � If bmgo will not be coaducted check here Li� ' � r � i� I.:� t ,f .. , ' � #.' � 3 t a �: � - , ? i i . Gambli yev^" a'ta�,Yp Z`X'F-'4%>" aY a fr .. ,• 3'� � c' 1' �. � No- 1 a .. '� x a eC �� s ng�em3ses�rnsation a r s �. -y fi`v �� ^��,�� ,`�j -�c�y��'�� ° � Name of estabiahment where gamblNg wdl be conducted �Sveet Address (do not use a post oflKe box a�mber) �oose s� Lb' k i-e:i».� t tZ�?� CC ev�„, ,.p ,. `S�'�O4.�t,��5'�"y�1�e � , Is the premises locatecf wrttun' aty.limiis? ;„�Yes O No II no, is township � iorganized � unorganized �O unincorporated , Gity and Counry where gambGrn� pseimseslis OR Township and Counry where gambli�g premises is bcated d oumde ot c�ry hmrts � $�F-. ��r�L `' �.ti�se �f � S��auZ . Nt+iJ. .�'v�>O 6."� ; Name and address ot legai bwner at premise -�Ciry i, �. '�. State ' .� Zrp Code .. ,S'�eJC-? ��u�� f< ��hgli�'ti �$�.S�evC , '°Y�XJ, "�:v'.� -- Dnes your arganizaliog awn th �n7d�rg where the gambiing will be wnducted? Q YES ..�. NO - ��, �. E^' �, - ,;; 1f no. auaeh the fofbwing: - � �, . . . . � ' ' ��, "'� . . � � -� e' 'a copy of the lease (form LG2C12) with tsrms for at least one year. ' �� . �, t y., ; ,�� ' � � �'� a copy of a sketch of the Iloor pian with dimensions, showing what portion is being tea"sed.�� ';�� , . � .�!A�lease and sketch are not raquired for Class D appiicaoons. '� q" � ..., .. _ .. ..: _ _ _ ' ' _. �t5,t ^ 5 _ - -. ,,,. :..`�:c» ; ..� .. . ' • .- x s .{N'.Cx � ` - :,.4 ;, o . , � � ,a„�.a> �` z �: AddreSS of sto C'S ace of gairibliri�equipment .17s �rt �P a ao �X �Um�r .- �a� ,:. - Address , Ciry ' State t Zrpcode. - , ' , �' � r t I 'Z Z � C � Y'e�� < e ��` S �t � �� t . ln�t1 j SS� a d � � � �;'. ; � � ` ' � � � - � ° - � � � �,� � � , ' „y, ;. �: � , . � � , � �.f_ . . I' i i � � i I i � ��4 '� � ' i ' . � � '� � _ . . . , i ' � � f �� , i .i .�¶Y.�'• � , i �' :�.,� . v �� ;�y s, _ _ , , ._,., 3 H l b) gyl/bbH ., - �Sb3 � q1�.S�� r � ' :,_.' - �MitmesataLnw,fui�Garnblcttg;� � � � �'` � .t Premise Permit Applicatian - Part 2 of 2% 1 , ......... ......._,r-.. rv � w �viinis. , . . >•xr.:J:. ad,s;r°�''i� � �� z ��„.'�' � � f ' :a � ,:_hr. �-..'� /:l ^ is,'"R .�i's`/...�i.:%s7'; "`r �r.; �M �s�' . • ' ^ N : . Gdrs�tiia �irnk'`.A�'ccountT aimtfiibi?y�;,,<z�::�r x �� u � , , ' , . ; gank Acmunt Number - � . ` s - oS�/NO/�`j"�.��Iz� J�lif1�K � ,t.,_ �03�La3��_`± ,� mm r � . / � �� nkAddress ' °,,.' , . � . �- __ ' a �-:��637 , . r3si � s�-:�.. 5-� ,�� mn� , , , ,:... ....__W.� ....�.._�,.�... ..��w_�«� ��.�� ...; ....%. )i 2a- Qr..:� l/v--w�-r.::.ra,w>.J, o.-..`....�._._ . .. ..,� .. . , � - - ame ,, , � ,, ressi . �, � . ; ' d , . . � ,.� . �acki,? ,Pe,�rir"s:v,✓t'�.� ISSt. ✓�'ircrwooG� <'�� 1 _��.'� ; ...� � � " r� , . �,: � � � �/1ZEn F , ��.,. , c`�e�m�es '�l7�efJm.'!�o'v'�c_h ��S��tYlav2�r4nJ�- : 5� �Cr � � E..<. � � � . � ' . � x '��, . yr�;..'2:�%r- t'. r L�, f t'^�+'-:y`<c'3.»a� 3x9 Y � � � .. , �i�5 �'`y �'^'�°'m� '� � �i �� . , ...t/w,..;.; . ' � + st4cr i�'"n•",G;%v;'" S''7'"i''.+s<�j�,'$,��.�,�.,'%Y � .�'��<4✓'"iu ...�'�3 ��.�.'"'<�o�� AcScuowledgeaieri��,�"��; .,� � ..;tY' F :h 9 .. �CX�.wl�.,.N^�; . .. . .�w...: .. ' ' ' �. .. K!..rz. C,amhllnQ S te Authorization ' •i arit the chiaf executive oHicer of the organizatwn; -;s . I hereby cnnsent thaE bcal law enforcement officers; the •I assume fuli responsibiliry.ior the fair and law�uf opeTa• , board or agents of tha'board, oi the commissione� of tion'of all aotivities to be conduded; . ; revenua or public safety, or agents of.the camrrnssioners, .� W ��( fami(i�rize myself with the laws of Minnesota' may enter the premises to,enforce the law. ' , governing lawful gambling and rules ofi the board and '., Bank Records Inforinatioa� ', '' �' agrae 'rf liceil'sad, t'o abide by those laws and niies , � The board is authorized to inspect tMe bank,records bf;the � includmg amendmants, to them ; :, j gambling account whanevar necessary to futtill •any appl�eaiwn iMormation w�li ba subrtiitt9d� requiremenu of c'urrent g'ambling,rules and law 'to the board arid bcal un8;of govarriment wdhin t0�days' , i Oafh ,�� . , � �� • � , of tfie chan�e; and �ya� ° � . �' � 3 f � � { declace that � U ' . � "i ,' � •I`understand,that failure to prov�de iequired mforrimatiorf , •1 fiave read this applicaUOri and' ai� informatwn submitted br oroviding,falsa or misleadmg miortnatwn may r'e in , to :he ix�asd is trus�, accurate,and compiete; . ,' ', , , }he deniai or revocation of the license: �� i�� _� •ait otherrequ�red'+�itormaGOn has bee'n fully disclosed; , �;" � � � � � Date - Signature of chiet � zecutrve officet �� , � � � �� i� "',:75 ��}�� 'C." 'i+i .. ` � . �. � — ii "�.i' � , ; � , ' .. � w .�� fi - r �^n2'�?'F�`y �' s> 3 � Y�°� m,�rx'� a� a' i � ',s��h"� 'r'1^rc�rl.�',"tv � f r . 3>"*C �&�� 3 � �&� �.' Loc �1 � ver,nmertt Ackrzauitedgemett,f ` .fr.., e. � 1 3fl ��'/f x�/.' ..F``� ��;3 � ��E„ }�� ' 4, A coov ot the '� �� nit ot anvernme�it s r�esoluiion a'w ,'� 7. 7he ci[y must sign lhis appl�eatron ti the gambting;prem-' ��na th�s aooticatron must be attacfied ta this aoo6c�tioni' ises is bcated wrthin` c+ty (imrtsi;,� �'� �, n i,;r, "' S. If tMs application is,deo�ed by the l�eal unK,of govemment, ' 2. The counry "A�7D townsh�p �rt�ust sign this applicaYion it ,� shontd not be submitted to the G3rti6Gng CQntPol 6oar�. the gambLng prem�ises a located wrth�n a township. `. ' ,. i,, ; !, 3. The tocai vnrt govemment (city or�counry) must pass a'i', Townsh�p: By s�gnatuFe bekw, the towaship. acknow�edge's � resoluCwn specificatly apprwin j; or deny�ng this app('ieatioa.; thet the orga�nizatx�n is apply�ng tor'a,premises ¢errtiit witBin ��'� i .X`. „ j _ _ , �. , , � � : � - 'township timiis c: t - k ry" _ - . , r t . . . � � Townshi� ' �9 � � Cit ` or Count "�� .< < ; City or ry Name''� ',� , _ I Township'Name . , s ` t , t � � { �' { � �r . Signa e ot pecson' ,. v+ng . .'' Signature of person receiving apPricatwn ; ' - ' �t�� ' �,' Date Received Title - ' . . Date Recervad � 1 � .. � ,�� j� - ,'�� x � a i„ � , , .� ' ., . , _� �i , � . -� I . ' Refer to the irvvtruciions �SOr required agac,hments. �,` ' ' ,� , , , �, _. , �'� §, � �' , _ . < . � ,,,, � � s ' � , , ` _ ' , ; , ; ` - �, � . Mail to: Gam6t(ng Conlroi Board ' � � � , , � � . , � r i ��:' , Rouwood Plaza Scuth.3rd Floor � . , ' tx , � " � � 1717 Wi Courity Rosd 9 � ,' .. , . � LG2�4(Part 2)�� , ° Roaevt0e. MN 55113 � ��" , � . .��,� , �� ,� '� � � ., ' �' 'i ' . , p T ( Il� 1 { � 1 ��; ' � �r.��plfe.�4.. .,. ' .. , . � _ _ -, .:.. .kef�.f�w#e�-�,exs xv.�