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97-787Council File # �{.'� LQ ? ordinance # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 - --. Presented Referred To Greea Sheet # 35338 RESOLVED: That application, ID #8-02422, for a new State Class B Gambling Premise Permit by Midway Training Services, Inc. at Midway Lodge, 1964 University Ave. W., be and the same is hereby approved. RESOLUTION CITY OF SAINT PAUL, MINNESOTA �9 committee: nate Requested by Department of: Office of License, Ins,pections and / E�nviro�mental Protection By: \ .�.�i`^i^`� �i'�� Form Approved by City rney Adopted by Council: Date S 9''� BY: �/qq�,ri.Et� �GL,f,�„ U e Adoption Certi£ied by Council Secretary Approved by Mayor for Submission to BY. �� � Council i / / ZC`!� --Sy: Approved by Mayor: Date �l BY: f G� ** NEED COPY IMMEDIATELY ** a�_��J DE �ENT/OFFICE/COUNCIL DATEINITIATED GREEN SHEE N_ 35338' CANTACT PEFi50N & PHONE INfTIAVDATE �NfTIAVDA'fE �DEPARTMENTDIRECTOR OCITYCOUNCIL William F. Gunther - 266-9132 ^u�aN �arrnrro�+NEV Ocrrvc�aK NUYBER f-0R MUST BE ON COUNCIL AGENDA BY ( AT� p���� � BUDGET OIRECTOR � FW. S MGL SERVICES Olft. Hearing: �p OROEfl �MpypR(ORASSISTANn O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACfION REpUESTED: Barbara Kale on behalf of Midway Training Services, Inc, requests Council approval of their application for a new State Class B Gambling Premise Permit at Midway Lodge, 1964 IIniversity Avenue W. (ID ��B-02422) RECAMMENDA7IONS: Apprrne (A) or Reject (P) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS: _ PIANNING CAMMISSION _ CNIL SERVICE COMMISSION �� H25 tf115 peBONfirtn Cvef Wo(k2d undef a COnt2C[ fof thi5 deP2rtrtlent? _ C�B COMMrt7EE YES NO _ STqFF 2. Has this person/firtn ever been a ciTy employee? — YES NO _ DIS7RICT CAURi _ 3. Does this person/firm possess a skill not normally possessetl by any curten[ city employee? SUPPoRlSWHICHCOUNGLOBJECSiVE? YES NO Explain all yes enswers on separate sheet antl attach to green sheet INITIATING PROBLEM, ISSUE, OPPoRNNITV (Who, Wl�at, When, Where, Why�: ADVANTAGES IF APPROVED: DISADVANTAGESIFAPPROVED: ( 6 p � 4;5p+ n g� $f!>4'd+0&L� `�RU���,�.�,'3� EvC'3�.k:.l CrSYt i� j � 13�� . ,� DISADVANTAGES IF NOTAPPROVED: � - ' �� � TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO FUNDIfdG SOURCE NC7IVITY NUMBER FINANqAL INFORMATION� (EXPLAIN) Greensheet # �5338 L.I.E.P. REVIEW CHECKLIST Date: / R � �� � In Trackei'? 5�� 9�/ App'n Received / npp'R arocessed LicenselD # B-02422/State Oi License Type: State Class B Gamblin� Premise Permit Company Name: Midwav Trainin¢ Services. Inc. DBA: Midwav Training Services, Inc. Business Addresss: 1964 Universitv AVe. W. (Midwav LodQe) Business Phone: 641-0709 Contact Home Phone: 641-0709 Date to Council Public Hearing Date: �P I� 9� `7 I Notice SeM to Applicant:_�/ 9 %� Labels Ordered: N A District Council Notice Sent to Public:_�/�` Ward #: 04 Department/ Date Inspections Comments City Attorney f0 u� /�77� 5 �'�'/ 9 7 Environmental Health �'1� Fire �/� License site P�an aeceived:_ Lease Received: ��� Police R�B� Ch�,(1 /7 ��-�C`°� �J,�` f���9,b Zoning r"!� J _��:�,�����-;�, - �x=�.g �_ : :- ��- .- _. � � _ - "' _ _ ' . _: � _ ❑_ �� .�a -.;�. .�- _ ° Renewal.,�� �.- '� � ,�. - - - -- - '- Organization base I'�ce _ _-T_' -c-� ` - " Pre'mises permrt numb � — . � "_ New , : _' , #t �� F" y _ � yh��J'� �%a�-� .^ � s ..� .° �.. `� sM:g:!<Y=:<��.."'""Te.:^�::x;s�.�<.. 1?T'�CLTEL�Q�ILtTI �Of'I�ti -. Name of Organ¢aDOn '� F �r�a�,�y. T����; � n Business Address of Organiufioe -; c i.,. *+� � �av � o �`�i � Gry - �'_ ' � S �, ,,,. �; Name of chie( executive oKcer (carv sm, �a. If applying f �_' No more � �-. : � -, '- . 3!G .� ([� �' .._ � 8 \„2: .�_ ❑ C(52t ,-,,> I D l57: P.. li �X"t" .. � ,�/ V G,tr. � #�., ie address of your gambling manager; . : '33'+`.. Zip,Code�� �.�= Counrys��e:3r.�._ SS�/ � � `�P1�t�tS� , Title : .i:. _. �.:�,�g, C' EO - ��` � i beg+ Y� & end�*�g fiouxs nducted_by youi organiiatic a ���� , � � ��` �Y�4 . <:+u'"<c... "y:i�wa.._ . � ,�. ...: _ :.nJ . ,,. y . �i 3 < '"3., � . e�'Y�Sr_ °x :'r:.s'':°-j<:e�z - =` _ ..���� � _ s:f: _ � ,.-'- ?Gn`iw � . �� - - _ :.::. .......:...:....�:a.:..- . .�:xw,?:.a � : � .- ' . .,. _ � � _ �� 3ddlewheels, raffles, bingo � -- � � k 3d�levrheels, raffies -=;u- . - P a � + v - ; < �: t ^:�;r� .J '� .� . . a• .x.7S: ': � � �� � ,;?' ���'m.^��•w �'rk � . r �•..,2. '�3 y.te».. - - . SS.`u � GM A.�`F t �i.v� . r` F. a i" a'i -r �i' F .. �.Y.y S�i s�' P ,3 ,r> , - . _ .._ . � A �rt4_ � = Daytime ohone number•- � • �(y;a)��' 07`0�: _ . _ �" Daytime` phone number. . , c6�ai'6 y/ �o7op� ���.�<h,_-,� ���', ngq occasions: p < _ rweek.�;u>a >,,�astk? i, ,` - - - :�,_� , '�a ;: ;=: .;' . . � :xT. ;.;a;; c�;?� � -�-'-- -. ; � t ;`- _°,;=.� ` - , GainliIi' - - "� �3��' 8ank Namez. �="�G`.AyPr: � - ���^:3r� BankAddres :';�_= � . w . �� . L� - ,T..k= � � �Gy " 17E5/R�C'-. `I147i ,`� {-� ! C L I t� .Sl,� t� N5 Peri � *��a-y��9� � /83 o S'v Yrim e ^ ';l" `°a�= 'y1[f�76GYi.3ii61IJ�X6�51A .y - $ ,� !OLF1and(e:ear+ifStr �utd�s_=:l?�" ,>,,:µr..'s�r,� � ,.s„' � .,,,.,.M `w.zra_.r..PCj.�u"T e'L�'�..1"�+�.4 ��-.<_a..�...ty � �'� - i-f-RESS - i�17 =�yrhfjlllu6_f'�G.�= ' .�t '-S�� ot�l-ace �oov� SSv/ 6 � ss' f �!/�. �-- _A U e. �1 � �w o� , SSJaY i�1 Er''` (3 �(� - Gambling,S�te Atithorizatioa _',. =, r'. `•i am the chief executiy,e offcer of the organizafw� I hareb consent that bcal law eniorcement officers, the �"" " y �•I assume full rasponsiblity for the fa'ir and lavrf�l � board or agents of the board, or the commissioner of,_. - i , tion of all activities to be mnduded;;; _,; Y= ., revenue or publ'a safety, ar agents of the commissioners _�.� ;� will famifiarize m self with tha laws of Minnesot. may enter the premises to enforce the lawi-, _> >> �='�' yoverning lawful gambling,and rules of the board , Bank Records Snfozmation - - � agree, 'rf licensed, to abide by those laws and rule. TtSe 6oard is authoriied to insped the bank records of the inciuding amendments to them; � .__ qambling accourtt whenever necessary to tuKll _-�: ��� ;�, ,�.any shanges in application information will be sul �` 7equirements of current gambling rules and law �, �"" V to the board and_bcal unit oi govemment within U � Oath,.� � � i � � � � � � � of the change �and - � ti� -�;-� �.; "� ' 2� S declare tha2 �---�-----�—��- — � •1 understand ffizt failure to provide required infon r�. •i have read ihis a icatwn and ail informatbn submrtted `�`""°` „ PP� �, or providing false or misleadmg mtormatwn may r ' to the tioard is true, eccurata and comptefa; .�=".�=3°'r � � ' �` � ` � " ,, . � the demal or �evocatwn of the I�cense 4 ' •ali other required infoim`ation has been fuily disdosed;°_ ^�-- `� t� `°� '--�. £s ^� �- -�"° �: r �. S�gnature f ch�ei executrve off' r h �� �n _ ' Date< ��,,,� �� � =� � _ ` z.;' .' ' �. S .; s r 'v � r' � � .� yr�. "��5. . a d' `� � � ti} � ,_z F �-:- -� __. '��� � �o i...�---�,,.�-��r�.�~��.,�.5� 3Q_ q��,�.� l - � : �„ t :'�"1 ��� ; n �x �-?: � _� _, Council File # �{.'� LQ ? ordinance # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 - --. Presented Referred To Greea Sheet # 35338 RESOLVED: That application, ID #8-02422, for a new State Class B Gambling Premise Permit by Midway Training Services, Inc. at Midway Lodge, 1964 University Ave. W., be and the same is hereby approved. RESOLUTION CITY OF SAINT PAUL, MINNESOTA �9 committee: nate Requested by Department of: Office of License, Ins,pections and / E�nviro�mental Protection By: \ .�.�i`^i^`� �i'�� Form Approved by City rney Adopted by Council: Date S 9''� BY: �/qq�,ri.Et� �GL,f,�„ U e Adoption Certi£ied by Council Secretary Approved by Mayor for Submission to BY. �� F Council i / / ZC`!� --Sy: Approved by Mayor: Date �l BY: f G� ** NEED COPY IMMEDIATELY ** a�_��J DE �ENT/OFFICE/COUNCIL DATEINITIATED GREEN SHEE N_ 35338' CANTACT PEFi50N & PHONE INfTIAVDATE �NfTIAVDA'fE �DEPARTMENTDIRECTOR OCITYCOUNCIL William F. Gunther - 266-9132 ^u�aN �arrnrro�+NEV Ocrrvc�aK NUYBER f-0R MUST BE ON COUNCIL AGENDA BY ( AT� p���� � BUDGET OIRECTOR � FW. S MGL SERVICES Olft. Hearing: �p OROEfl �MpypR(ORASSISTANn O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACfION REpUESTED: Barbara Kale on behalf of Midway Training Services, Inc, requests Council approval of their application for a new State Class B Gambling Premise Permit at Midway Lodge, 1964 IIniversity Avenue W. (ID ��B-02422) RECAMMENDA7IONS: Apprrne (A) or Reject (P) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS: _ PIANNING CAMMISSION _ CNIL SERVICE COMMISSION �� H25 tf115 peBONfirtn Cvef Wo(k2d undef a COnt2C[ fof thi5 deP2rtrtlent? _ C�B COMMrt7EE YES NO _ STqFF 2. Has this person/firtn ever been a ciTy employee? — YES NO _ DIS7RICT CAURi _ 3. Does this person/firm possess a skill not normally possessetl by any curten[ city employee? SUPPoRlSWHICHCOUNGLOBJECSiVE? YES NO Explain all yes enswers on separate sheet antl attach to green sheet INITIATING PROBLEM, ISSUE, OPPoRNNITV (Who, Wl�at, When, Where, Why�: ADVANTAGES IF APPROVED: DISADVANTAGESIFAPPROVED: ( 6 p � 4;5p+ n g� $f!>4'd+0&L� `�RU���,�.�,'3� EvC'3�.k:.l CrSYt i� j � 13�� . ,� DISADVANTAGES IF NOTAPPROVED: � - ' �� � TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO FUNDIfdG SOURCE NC7IVITY NUMBER FINANqAL INFORMATION� (EXPLAIN) Greensheet # �5338 L.I.E.P. REVIEW CHECKLIST Date: / R � �� � In Trackei'? 5�� 9�/ App'n Received / npp'R arocessed LicenselD # B-02422/State Oi License Type: State Class B Gamblin� Premise Permit Company Name: Midwav Trainin¢ Services. Inc. DBA: Midwav Training Services, Inc. Business Addresss: 1964 Universitv AVe. W. (Midwav LodQe) Business Phone: 641-0709 Contact Home Phone: 641-0709 Date to Council Public Hearing Date: �P I� 9� `7 I Notice SeM to Applicant:_�/ 9 %� Labels Ordered: N A District Council Notice Sent to Public:_�/�` Ward #: 04 Department/ Date Inspections Comments City Attorney f0 u� /�77� 5 �'�'/ 9 7 Environmental Health �'1� Fire �/� License site P�an aeceived:_ Lease Received: ��� Police R�B� Ch�,(1 /7 ��-�C`°� �J,�` f���9,b Zoning r"!� J _��:�,�����-;�, - �x=�.g �_ : :- ��- .- _. � � _ - "' _ _ ' . _: � _ ❑_ �� .�a -.;�. .�- _ ° Renewal.,�� �.- '� � ,�. - - - -- - '- Organization base I'�ce _ _-T_' -c-� ` - " Pre'mises permrt numb � — . � "_ New , : _' , #t �� F" y _ � yh��J'� �%a�-� .^ � s ..� .° �.. `� sM:g:!<Y=:<��.."'""Te.:^�::x;s�.�<.. 1?T'�CLTEL�Q�ILtTI �Of'I�ti -. Name of Organ¢aDOn '� F �r�a�,�y. T����; � n Business Address of Organiufioe -; c i.,. *+� � �av � o �`�i � Gry - �'_ ' � S �, ,,,. �; Name of chie( executive oKcer (carv sm, �a. If applying f �_' No more � �-. : � -, '- . 3!G .� ([� �' .._ � 8 \„2: .�_ ❑ C(52t ,-,,> I D l57: P.. li �X"t" .. � ,�/ V G,tr. � #�., ie address of your gambling manager; . : '33'+`.. Zip,Code�� �.�= Counrys��e:3r.�._ SS�/ � � `�P1�t�tS� , Title : .i:. _. �.:�,�g, C' EO - ��` � i beg+ Y� & end�*�g fiouxs nducted_by youi organiiatic a ���� , � � ��` �Y�4 . <:+u'"<c... "y:i�wa.._ . � ,�. ...: _ :.nJ . ,,. y . �i 3 < '"3., � . e�'Y�Sr_ °x :'r:.s'':°-j<:e�z - =` _ ..���� � _ s:f: _ � ,.-'- ?Gn`iw � . �� - - _ :.::. .......:...:....�:a.:..- . .�:xw,?:.a � : � .- ' . .,. _ � � _ �� 3ddlewheels, raffles, bingo � -- � � k 3d�levrheels, raffies -=;u- . - P a � + v - ; < �: t ^:�;r� .J '� .� . . a• .x.7S: ': � � �� � ,;?' ���'m.^��•w �'rk � . r �•..,2. '�3 y.te».. - - . SS.`u � GM A.�`F t �i.v� . r` F. a i" a'i -r �i' F .. �.Y.y S�i s�' P ,3 ,r> , - . _ .._ . � A �rt4_ � = Daytime ohone number•- � • �(y;a)��' 07`0�: _ . _ �" Daytime` phone number. . , c6�ai'6 y/ �o7op� ���.�<h,_-,� ���', ngq occasions: p < _ rweek.�;u>a >,,�astk? i, ,` - - - :�,_� , '�a ;: ;=: .;' . . � :xT. ;.;a;; c�;?� � -�-'-- -. ; � t ;`- _°,;=.� ` - , GainliIi' - - "� �3��' 8ank Namez. �="�G`.AyPr: � - ���^:3r� BankAddres :';�_= � . w . �� . L� - ,T..k= � � �Gy " 17E5/R�C'-. `I147i ,`� {-� ! C L I t� .Sl,� t� N5 Peri � *��a-y��9� � /83 o S'v Yrim e ^ ';l" `°a�= 'y1[f�76GYi.3ii61IJ�X6�51A .y - $ ,� !OLF1and(e:ear+ifStr �utd�s_=:l?�" ,>,,:µr..'s�r,� � ,.s„' � .,,,.,.M `w.zra_.r..PCj.�u"T e'L�'�..1"�+�.4 ��-.<_a..�...ty � �'� - i-f-RESS - i�17 =�yrhfjlllu6_f'�G.�= ' .�t '-S�� ot�l-ace �oov� SSv/ 6 � ss' f �!/�. �-- _A U e. �1 � �w o� , SSJaY i�1 Er''` (3 �(� - Gambling,S�te Atithorizatioa _',. =, r'. `•i am the chief executiy,e offcer of the organizafw� I hareb consent that bcal law eniorcement officers, the �"" " y �•I assume full rasponsiblity for the fa'ir and lavrf�l � board or agents of the board, or the commissioner of,_. - i , tion of all activities to be mnduded;;; _,; Y= ., revenue or publ'a safety, ar agents of the commissioners _�.� ;� will famifiarize m self with tha laws of Minnesot. may enter the premises to enforce the lawi-, _> >> �='�' yoverning lawful gambling,and rules of the board , Bank Records Snfozmation - - � agree, 'rf licensed, to abide by those laws and rule. TtSe 6oard is authoriied to insped the bank records of the inciuding amendments to them; � .__ qambling accourtt whenever necessary to tuKll _-�: ��� ;�, ,�.any shanges in application information will be sul �` 7equirements of current gambling rules and law �, �"" V to the board and_bcal unit oi govemment within U � Oath,.� � � i � � � � � � � of the change �and - � ti� -�;-� �.; "� ' 2� S declare tha2 �---�-----�—��- — � •1 understand ffizt failure to provide required infon r�. •i have read ihis a icatwn and ail informatbn submrtted `�`""°` „ PP� �, or providing false or misleadmg mtormatwn may r ' to the tioard is true, eccurata and comptefa; .�=".�=3°'r � � ' �` � ` � " ,, . � the demal or �evocatwn of the I�cense 4 ' •ali other required infoim`ation has been fuily disdosed;°_ ^�-- `� t� `°� '--�. £s ^� �- -�"° �: r �. S�gnature f ch�ei executrve off' r h �� �n _ ' Date< ��,,,� �� � =� � _ ` z.;' .' ' �. S .; s r 'v � r' � � .� yr�. "��5. . a d' `� � � ti} � ,_z F �-:- -� __. '��� � �o i...�---�,,.�-��r�.�~��.,�.5� 3Q_ q��,�.� l - � : �„ t :'�"1 ��� ; n �x �-?: � _� _, Council File # �{.'� LQ ? ordinance # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 - --. Presented Referred To Greea Sheet # 35338 RESOLVED: That application, ID #8-02422, for a new State Class B Gambling Premise Permit by Midway Training Services, Inc. at Midway Lodge, 1964 University Ave. W., be and the same is hereby approved. RESOLUTION CITY OF SAINT PAUL, MINNESOTA �9 committee: nate Requested by Department of: Office of License, Ins,pections and / E�nviro�mental Protection By: \ .�.�i`^i^`� �i'�� Form Approved by City rney Adopted by Council: Date S 9''� BY: �/qq�,ri.Et� �GL,f,�„ U e Adoption Certi£ied by Council Secretary Approved by Mayor for Submission to BY. �� F Council i / / ZC`!� --Sy: Approved by Mayor: Date �l BY: f G� ** NEED COPY IMMEDIATELY ** a�_��J DE �ENT/OFFICE/COUNCIL DATEINITIATED GREEN SHEE N_ 35338' CANTACT PEFi50N & PHONE INfTIAVDATE �NfTIAVDA'fE �DEPARTMENTDIRECTOR OCITYCOUNCIL William F. Gunther - 266-9132 ^u�aN �arrnrro�+NEV Ocrrvc�aK NUYBER f-0R MUST BE ON COUNCIL AGENDA BY ( AT� p���� � BUDGET OIRECTOR � FW. S MGL SERVICES Olft. Hearing: �p OROEfl �MpypR(ORASSISTANn O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACfION REpUESTED: Barbara Kale on behalf of Midway Training Services, Inc, requests Council approval of their application for a new State Class B Gambling Premise Permit at Midway Lodge, 1964 IIniversity Avenue W. (ID ��B-02422) RECAMMENDA7IONS: Apprrne (A) or Reject (P) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS: _ PIANNING CAMMISSION _ CNIL SERVICE COMMISSION �� H25 tf115 peBONfirtn Cvef Wo(k2d undef a COnt2C[ fof thi5 deP2rtrtlent? _ C�B COMMrt7EE YES NO _ STqFF 2. Has this person/firtn ever been a ciTy employee? — YES NO _ DIS7RICT CAURi _ 3. Does this person/firm possess a skill not normally possessetl by any curten[ city employee? SUPPoRlSWHICHCOUNGLOBJECSiVE? YES NO Explain all yes enswers on separate sheet antl attach to green sheet INITIATING PROBLEM, ISSUE, OPPoRNNITV (Who, Wl�at, When, Where, Why�: ADVANTAGES IF APPROVED: DISADVANTAGESIFAPPROVED: ( 6 p � 4;5p+ n g� $f!>4'd+0&L� `�RU���,�.�,'3� EvC'3�.k:.l CrSYt i� j � 13�� . ,� DISADVANTAGES IF NOTAPPROVED: � - ' �� � TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO FUNDIfdG SOURCE NC7IVITY NUMBER FINANqAL INFORMATION� (EXPLAIN) Greensheet # �5338 L.I.E.P. REVIEW CHECKLIST Date: / R � �� � In Trackei'? 5�� 9�/ App'n Received / npp'R arocessed LicenselD # B-02422/State Oi License Type: State Class B Gamblin� Premise Permit Company Name: Midwav Trainin¢ Services. Inc. DBA: Midwav Training Services, Inc. Business Addresss: 1964 Universitv AVe. W. (Midwav LodQe) Business Phone: 641-0709 Contact Home Phone: 641-0709 Date to Council Public Hearing Date: �P I� 9� `7 I Notice SeM to Applicant:_�/ 9 %� Labels Ordered: N A District Council Notice Sent to Public:_�/�` Ward #: 04 Department/ Date Inspections Comments City Attorney f0 u� /�77� 5 �'�'/ 9 7 Environmental Health �'1� Fire �/� License site P�an aeceived:_ Lease Received: ��� Police R�B� Ch�,(1 /7 ��-�C`°� �J,�` f���9,b Zoning r"!� J _��:�,�����-;�, - �x=�.g �_ : :- ��- .- _. � � _ - "' _ _ ' . _: � _ ❑_ �� .�a -.;�. .�- _ ° Renewal.,�� �.- '� � ,�. - - - -- - '- Organization base I'�ce _ _-T_' -c-� ` - " Pre'mises permrt numb � — . � "_ New , : _' , #t �� F" y _ � yh��J'� �%a�-� .^ � s ..� .° �.. `� sM:g:!<Y=:<��.."'""Te.:^�::x;s�.�<.. 1?T'�CLTEL�Q�ILtTI �Of'I�ti -. Name of Organ¢aDOn '� F �r�a�,�y. T����; � n Business Address of Organiufioe -; c i.,. *+� � �av � o �`�i � Gry - �'_ ' � S �, ,,,. �; Name of chie( executive oKcer (carv sm, �a. If applying f �_' No more � �-. : � -, '- . 3!G .� ([� �' .._ � 8 \„2: .�_ ❑ C(52t ,-,,> I D l57: P.. li �X"t" .. � ,�/ V G,tr. � #�., ie address of your gambling manager; . : '33'+`.. Zip,Code�� �.�= Counrys��e:3r.�._ SS�/ � � `�P1�t�tS� , Title : .i:. _. �.:�,�g, C' EO - ��` � i beg+ Y� & end�*�g fiouxs nducted_by youi organiiatic a ���� , � � ��` �Y�4 . <:+u'"<c... "y:i�wa.._ . � ,�. ...: _ :.nJ . ,,. y . �i 3 < '"3., � . e�'Y�Sr_ °x :'r:.s'':°-j<:e�z - =` _ ..���� � _ s:f: _ � ,.-'- ?Gn`iw � . �� - - _ :.::. .......:...:....�:a.:..- . .�:xw,?:.a � : � .- ' . .,. _ � � _ �� 3ddlewheels, raffles, bingo � -- � � k 3d�levrheels, raffies -=;u- . - P a � + v - ; < �: t ^:�;r� .J '� .� . . a• .x.7S: ': � � �� � ,;?' ���'m.^��•w �'rk � . r �•..,2. '�3 y.te».. - - . SS.`u � GM A.�`F t �i.v� . r` F. a i" a'i -r �i' F .. �.Y.y S�i s�' P ,3 ,r> , - . _ .._ . � A �rt4_ � = Daytime ohone number•- � • �(y;a)��' 07`0�: _ . _ �" Daytime` phone number. . , c6�ai'6 y/ �o7op� ���.�<h,_-,� ���', ngq occasions: p < _ rweek.�;u>a >,,�astk? i, ,` - - - :�,_� , '�a ;: ;=: .;' . . � :xT. ;.;a;; c�;?� � -�-'-- -. ; � t ;`- _°,;=.� ` - , GainliIi' - - "� �3��' 8ank Namez. �="�G`.AyPr: � - ���^:3r� BankAddres :';�_= � . w . �� . L� - ,T..k= � � �Gy " 17E5/R�C'-. `I147i ,`� {-� ! C L I t� .Sl,� t� N5 Peri � *��a-y��9� � /83 o S'v Yrim e ^ ';l" `°a�= 'y1[f�76GYi.3ii61IJ�X6�51A .y - $ ,� !OLF1and(e:ear+ifStr �utd�s_=:l?�" ,>,,:µr..'s�r,� � ,.s„' � .,,,.,.M `w.zra_.r..PCj.�u"T e'L�'�..1"�+�.4 ��-.<_a..�...ty � �'� - i-f-RESS - i�17 =�yrhfjlllu6_f'�G.�= ' .�t '-S�� ot�l-ace �oov� SSv/ 6 � ss' f �!/�. �-- _A U e. �1 � �w o� , SSJaY i�1 Er''` (3 �(� - Gambling,S�te Atithorizatioa _',. =, r'. `•i am the chief executiy,e offcer of the organizafw� I hareb consent that bcal law eniorcement officers, the �"" " y �•I assume full rasponsiblity for the fa'ir and lavrf�l � board or agents of the board, or the commissioner of,_. - i , tion of all activities to be mnduded;;; _,; Y= ., revenue or publ'a safety, ar agents of the commissioners _�.� ;� will famifiarize m self with tha laws of Minnesot. may enter the premises to enforce the lawi-, _> >> �='�' yoverning lawful gambling,and rules of the board , Bank Records Snfozmation - - � agree, 'rf licensed, to abide by those laws and rule. TtSe 6oard is authoriied to insped the bank records of the inciuding amendments to them; � .__ qambling accourtt whenever necessary to tuKll _-�: ��� ;�, ,�.any shanges in application information will be sul �` 7equirements of current gambling rules and law �, �"" V to the board and_bcal unit oi govemment within U � Oath,.� � � i � � � � � � � of the change �and - � ti� -�;-� �.; "� ' 2� S declare tha2 �---�-----�—��- — � •1 understand ffizt failure to provide required infon r�. •i have read ihis a icatwn and ail informatbn submrtted `�`""°` „ PP� �, or providing false or misleadmg mtormatwn may r ' to the tioard is true, eccurata and comptefa; .�=".�=3°'r � � ' �` � ` � " ,, . � the demal or �evocatwn of the I�cense 4 ' •ali other required infoim`ation has been fuily disdosed;°_ ^�-- `� t� `°� '--�. £s ^� �- -�"° �: r �. S�gnature f ch�ei executrve off' r h �� �n _ ' Date< ��,,,� �� � =� � _ ` z.;' .' ' �. S .; s r 'v � r' � � .� yr�. "��5. . a d' `� � � ti} � ,_z F �-:- -� __. '��� � �o i...�---�,,.�-��r�.�~��.,�.5� 3Q_ q��,�.� l - � : �„ t :'�"1 ��� ; n �x �-?: � _� _,