98-191Council File � ` U — l� `
ordinance $
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OR1GfNAL
Presented By
Referred To
RESOLVED: That application (ID #B-00444) for a State Clasa B Gambling Premise Permit by
Minnesota Brass at Michael's, 1179 E. 7th Street. be and the same ie hereby
approoed.
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Green Sheet # 50480
��
Committee: Date
Requested by Department of:
Adopted by Council: Date � \\ _ � �{ �j �
Certified by Council Secretary
By:
Approved
�ti I�
Off�c of ; ns rnspections and
Env' me t e
By: � /� �
Form Approved by City Attor�
�
BY= � "(h4 �.. , � . .� c� ,�
Approved by Mayor for Submission to
Council
Byc
By:
N° 50480
QF _19 1
DEPARtMENT�OFFICEICOUNCIL DATE IHfT1ATED �� < < �
LIEP GREEN SHEE
CONTACT PERSON 8 PXONE INITIAVDATE INITIAVDATE
Q DEPARTMENT DIRECTOF � CITYCOUNGL
w1]. iam�F. unth r 2 — ASSIGN �dTYATTORNEY OQTVCLERK
MUST HE ON CAUNCIL AGENDA BV (DATE7 NUMBER FOR O BUDGET DIRECTOR O FIN. 8 MGT SEFVICES DIR.
POUTING
OPOEF O MAVOR (OR ASSI5TANT) ❑
arin : -11-
TOTAL # OF SIGNATURE PAGES (CLIP A�L LOCATIONS FOR SIGNATURE)
AC[ION REQUESiED.
Gavin Burnham on behalf of Minnesota Brass requests Council approval of their
application for a new State Class B Gambling Premise Permit, ID �/B-00444, at Michael's,
1179 E. 7th Street.
RECOMMENDFTIONS AOPpve (A) or Rejecl(R) PEflSONAL SERVICE CONTRACTS MUST ANSWER THE fOLLOWINCa QUESTIONS:
_ PLANNING COMMISSION _ CIVII SERVICE COMMISSION �� Ha5 thi5 person/Film ever worked under a contract for thi5 department?
_ CIB COMMffTEE _ �'ES NO
2. Has this personRirm ever been a c"rty empioyee?
_ SiAFF
— YES NO
_ DiSTRIC7COUai _ 3. Does this personlfirm possess a skill not normally possessetl by a�y current ctty employee?
SUPPORTS WHICH COUNCIL OBJECTIVE� YES NO
Explain all yes anawers on seperate eheet and enach to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (VJho. Whe1, When. Where. Why)
ADVANTAGES �FAPPROVED'
DISADVqNTAGES IF APPpOVED'
DISADVANTAOES IF NOTAPPROVED:
4de�i�'Q :; �'C:�+::wiur� �r -..;•
�k�e � ����
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) VES NO
FUNDIIdG SOURCE ACTIVITV NUMBER
FINANQAL INFOFFriAT10N (EXPLAIN)
�q l
' LG2'14
_, pavs+�
LJ
���
fOR BOARD USE ONLY
BASE x
PP x
Idinnesota Lazcfiti Gambiing CNECK
1NITI:+LS
Premises Permit Application - Part 1 of 2 p ��
�,f Appftca�orf
Clzss of przmises pemd
Aer.ewal � (check one)
Organizaticn base I"�cense number A- Oo 49 4 � A(5400) Pu1Ftz5s, tipbozr�'s, �adizwheels, r�9es, bingo
New
P:emises pertnit num'�r
� B(5250) Pull-tabs, tpbczrds, pad�ewheeis, ra�les
� C (5200) 3ingo onty -
❑ p (5150) r'3�-f;tes ony
ct icer (cannot be your gambling ma�a9er)
5510
6�1) 4�6_
)ayrime phone
61d) N86-'
I! appiying for a ci2ss A or C per•nit, fill in d2ys and beginni �& ending hours of birgo occasio2s:
No more than seven bingo occasions may be cbnducted by your organization per week.
Day Beginning/Ending Havrs Day Beg.nning/Ending Hours Day Begjnning /EndL^.g Hous
to _.
If bingo a not be conducted, check heze �
a
..�........ �.,__........._......._._ �_.._._.� --- - .. . _ .
/�'l'cFlacLS 11'1`i F �°� 5 �¢ -
� Is the premises iocatc� within city Iimits? � Yes � No �f no, is township � oryanized 0 unoraanized p unine�rporated
- City and Counry where gambfing premises is located OR 7ownship and Co�nty where gambGng premises is Iocated if outside of ci,y timits
- SawZ PavL SSlob I Rar+S��� —
-- -- Name and abdress of kga{ owner ot premises Cyty State Z�p Code
/��k'r_ �LaLCS 11 t� �� S�rc+- 5u� Pa.-� /n^' Ss to6
Does yow organiza6on own the buldng where the gambling will be conductetl? � t'ts � nti
'"" " if no, arach Lhe foflowing: � � .
" , _ • a copy of tl�e lease {torm LG202) with terms for at least one year.
- _ • a mpy of a sketch of the floor pian with dimensions, shovring what por4on is being leased.
.. - � - - A lease and sketch are not reGuired for Class D appliracons.
- _- - ,.. _.,-.. - ��-- . .; � - , . . - � - - :. ;:
� -_ .. ......,. .....� _ . ., ... ..:..... _ ... . _. ;.;
. . .. ..,_ . . :- -�
�-� AArir.��c'�nf c+nr�di+ SnarP �{�97I1b1�II¢-�C�7.2�DIIICIIt� 4nr+ot�*<_�a PO imb>r _-.;;;(
-= ,�+,� 41�7 �Ca��t•N OQ Va�.�a'S Ht5 MN 5512-7 - —
� 'ni : a) l 1�9 F?"'� 5T� sa�,wr P«��. /hr ss l 0 6
�✓t'NN25oZfF kJCR35_ �lC
Business Address ot Occaniz�LOn - Street or P. O 6ox (Do nct use the aodress of your g �bt�ng manager)
P_ o. {3oY �3 �t I _ . . -� -
Minnesota LawfuZ Gambling
Premise Permit Application - Part 2 of 2
Eank �ame
t=; r� :�
P,ank Ac�unt
��-Iql
0
isso F ��''- sTQ g�oon,; r,N .�sya s
v.+'z 3606 r 70� SY T�tvac�s<o�c Wl5 N.�So"76 l:u awvo�
A�- S<.v5a�v j 69 o w Cov �� 2 c1 G Qa3�ev i J.tN �i5113 j V�c< -Q�c.s; d�e.�T
ku2c Scr. � b t'� 1311 /'1'N�'�ch hcx. � Sr Pa � MN SStok 3 (3oa.-d_ �tcw�b��t
r _. rf ..� . iJO� i liMiil.•u� AV♦ S Mn1t MA/ _53'Yo6 •. Stc�oToTy
i hereby consent that bcal faw an`crczment officers, 2he
bozrd or acents of the board, or the conmissioner ot
revenua or public safety, or agents of the c�mmissioners,
may enter the prenises to enforce the law.
Bank Records Information
The board is euthorized to inspect the bank records of the
gambling account whenever necessary to fuHill
requiremanu of curren[ gambti�g rules and law.
Oath
I declare that:
•I ha�ee read this application and all iniornetion subm'f.:ed
to the board is trua, accurate and c�mpiete;
•ail other required information fizs been tulty disclosed;
7. The city'nust sigri this application if the gambling prem-
ises is Yocated wGhin city iimits.
2. The county •'AND Sownship'• must sgn this zpplication 'rf
the gambling premises is located wrhin a township. .
3. The local unit govarnment (ciry or counfy) must pass a
resolution specifically approving or denying this application.
- " � Ciry or Counry Name
C �� ( � .- , Si n�tur of i
� _ . - . _ tN.�•J r
,_ TiBe n
._ --_.-,/' - � � IJ.
Date
' _ � d � •
=� Aeter to the instructions fw required aaachmenu.
; ,: Mail to:
Gambilnq Control Board
Aosewood Pleza Soufh, 3rd F�oor
1717 W. County Roid B
poaevllie, MN 55113
•I an the chief executive officer of the crganization;
-0 assune Su1f rasponsi4ility for the izir znd 4avriu{ opera-
tion of zIl adivities to be conduded;
•1 wili familiarize myself with the Izws of Minnesota
governing Ia•.v�ui gambling and rules oi the board and
agree, rf licensed, to abide by those Izws and rules,
inciuding amendments to them;
•any changes in applicziion information will be submiC_d
to the baard and local unR of government within 10 days
of the change; and �
•I unders;and thzi failure to provide required informaiion
or providing false or misieading information may result in
the denial or revocation ofi the license.
4. A coov of the local unit oi oovernmenPs resolution ao-
Qrgvino t'�is aoolicaiion must be arached to this aoolication.
5. Ii this application is denied by the locai unit of government.
it shouid not be submitted to the Gambling Control Board.
Township: By signature below, the township acknowledges
that the organization is applying tor a premises permii within
township timits.
Township Name
Signature o( person receiving apptication
Title
I Date Received
LG214(Part2)
�A���il
Council File � ` U — l� `
ordinance $
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OR1GfNAL
Presented By
Referred To
RESOLVED: That application (ID #B-00444) for a State Clasa B Gambling Premise Permit by
Minnesota Brass at Michael's, 1179 E. 7th Street. be and the same ie hereby
approoed.
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Green Sheet # 50480
��
Committee: Date
Requested by Department of:
Adopted by Council: Date � \\ _ � �{ �j �
Certified by Council Secretary
By:
Approved
�ti I�
Off�c of ; ns rnspections and
Env' me t e
By: � /� �
Form Approved by City Attor�
�
BY= � "(h4 �.. , � . .� c� ,�
Approved by Mayor for Submission to
Council
Byc
By:
N° 50480
QF _19 1
DEPARtMENT�OFFICEICOUNCIL DATE IHfT1ATED �� < < �
LIEP GREEN SHEE
CONTACT PERSON 8 PXONE INITIAVDATE INITIAVDATE
Q DEPARTMENT DIRECTOF � CITYCOUNGL
w1]. iam�F. unth r 2 — ASSIGN �dTYATTORNEY OQTVCLERK
MUST HE ON CAUNCIL AGENDA BV (DATE7 NUMBER FOR O BUDGET DIRECTOR O FIN. 8 MGT SEFVICES DIR.
POUTING
OPOEF O MAVOR (OR ASSI5TANT) ❑
arin : -11-
TOTAL # OF SIGNATURE PAGES (CLIP A�L LOCATIONS FOR SIGNATURE)
AC[ION REQUESiED.
Gavin Burnham on behalf of Minnesota Brass requests Council approval of their
application for a new State Class B Gambling Premise Permit, ID �/B-00444, at Michael's,
1179 E. 7th Street.
RECOMMENDFTIONS AOPpve (A) or Rejecl(R) PEflSONAL SERVICE CONTRACTS MUST ANSWER THE fOLLOWINCa QUESTIONS:
_ PLANNING COMMISSION _ CIVII SERVICE COMMISSION �� Ha5 thi5 person/Film ever worked under a contract for thi5 department?
_ CIB COMMffTEE _ �'ES NO
2. Has this personRirm ever been a c"rty empioyee?
_ SiAFF
— YES NO
_ DiSTRIC7COUai _ 3. Does this personlfirm possess a skill not normally possessetl by a�y current ctty employee?
SUPPORTS WHICH COUNCIL OBJECTIVE� YES NO
Explain all yes anawers on seperate eheet and enach to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (VJho. Whe1, When. Where. Why)
ADVANTAGES �FAPPROVED'
DISADVqNTAGES IF APPpOVED'
DISADVANTAOES IF NOTAPPROVED:
4de�i�'Q :; �'C:�+::wiur� �r -..;•
�k�e � ����
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) VES NO
FUNDIIdG SOURCE ACTIVITV NUMBER
FINANQAL INFOFFriAT10N (EXPLAIN)
�q l
' LG2'14
_, pavs+�
LJ
���
fOR BOARD USE ONLY
BASE x
PP x
Idinnesota Lazcfiti Gambiing CNECK
1NITI:+LS
Premises Permit Application - Part 1 of 2 p ��
�,f Appftca�orf
Clzss of przmises pemd
Aer.ewal � (check one)
Organizaticn base I"�cense number A- Oo 49 4 � A(5400) Pu1Ftz5s, tipbozr�'s, �adizwheels, r�9es, bingo
New
P:emises pertnit num'�r
� B(5250) Pull-tabs, tpbczrds, pad�ewheeis, ra�les
� C (5200) 3ingo onty -
❑ p (5150) r'3�-f;tes ony
ct icer (cannot be your gambling ma�a9er)
5510
6�1) 4�6_
)ayrime phone
61d) N86-'
I! appiying for a ci2ss A or C per•nit, fill in d2ys and beginni �& ending hours of birgo occasio2s:
No more than seven bingo occasions may be cbnducted by your organization per week.
Day Beginning/Ending Havrs Day Beg.nning/Ending Hours Day Begjnning /EndL^.g Hous
to _.
If bingo a not be conducted, check heze �
a
..�........ �.,__........._......._._ �_.._._.� --- - .. . _ .
/�'l'cFlacLS 11'1`i F �°� 5 �¢ -
� Is the premises iocatc� within city Iimits? � Yes � No �f no, is township � oryanized 0 unoraanized p unine�rporated
- City and Counry where gambfing premises is located OR 7ownship and Co�nty where gambGng premises is Iocated if outside of ci,y timits
- SawZ PavL SSlob I Rar+S��� —
-- -- Name and abdress of kga{ owner ot premises Cyty State Z�p Code
/��k'r_ �LaLCS 11 t� �� S�rc+- 5u� Pa.-� /n^' Ss to6
Does yow organiza6on own the buldng where the gambling will be conductetl? � t'ts � nti
'"" " if no, arach Lhe foflowing: � � .
" , _ • a copy of tl�e lease {torm LG202) with terms for at least one year.
- _ • a mpy of a sketch of the floor pian with dimensions, shovring what por4on is being leased.
.. - � - - A lease and sketch are not reGuired for Class D appliracons.
- _- - ,.. _.,-.. - ��-- . .; � - , . . - � - - :. ;:
� -_ .. ......,. .....� _ . ., ... ..:..... _ ... . _. ;.;
. . .. ..,_ . . :- -�
�-� AArir.��c'�nf c+nr�di+ SnarP �{�97I1b1�II¢-�C�7.2�DIIICIIt� 4nr+ot�*<_�a PO imb>r _-.;;;(
-= ,�+,� 41�7 �Ca��t•N OQ Va�.�a'S Ht5 MN 5512-7 - —
� 'ni : a) l 1�9 F?"'� 5T� sa�,wr P«��. /hr ss l 0 6
�✓t'NN25oZfF kJCR35_ �lC
Business Address ot Occaniz�LOn - Street or P. O 6ox (Do nct use the aodress of your g �bt�ng manager)
P_ o. {3oY �3 �t I _ . . -� -
Minnesota LawfuZ Gambling
Premise Permit Application - Part 2 of 2
Eank �ame
t=; r� :�
P,ank Ac�unt
��-Iql
0
isso F ��''- sTQ g�oon,; r,N .�sya s
v.+'z 3606 r 70� SY T�tvac�s<o�c Wl5 N.�So"76 l:u awvo�
A�- S<.v5a�v j 69 o w Cov �� 2 c1 G Qa3�ev i J.tN �i5113 j V�c< -Q�c.s; d�e.�T
ku2c Scr. � b t'� 1311 /'1'N�'�ch hcx. � Sr Pa � MN SStok 3 (3oa.-d_ �tcw�b��t
r _. rf ..� . iJO� i liMiil.•u� AV♦ S Mn1t MA/ _53'Yo6 •. Stc�oToTy
i hereby consent that bcal faw an`crczment officers, 2he
bozrd or acents of the board, or the conmissioner ot
revenua or public safety, or agents of the c�mmissioners,
may enter the prenises to enforce the law.
Bank Records Information
The board is euthorized to inspect the bank records of the
gambling account whenever necessary to fuHill
requiremanu of curren[ gambti�g rules and law.
Oath
I declare that:
•I ha�ee read this application and all iniornetion subm'f.:ed
to the board is trua, accurate and c�mpiete;
•ail other required information fizs been tulty disclosed;
7. The city'nust sigri this application if the gambling prem-
ises is Yocated wGhin city iimits.
2. The county •'AND Sownship'• must sgn this zpplication 'rf
the gambling premises is located wrhin a township. .
3. The local unit govarnment (ciry or counfy) must pass a
resolution specifically approving or denying this application.
- " � Ciry or Counry Name
C �� ( � .- , Si n�tur of i
� _ . - . _ tN.�•J r
,_ TiBe n
._ --_.-,/' - � � IJ.
Date
' _ � d � •
=� Aeter to the instructions fw required aaachmenu.
; ,: Mail to:
Gambilnq Control Board
Aosewood Pleza Soufh, 3rd F�oor
1717 W. County Roid B
poaevllie, MN 55113
•I an the chief executive officer of the crganization;
-0 assune Su1f rasponsi4ility for the izir znd 4avriu{ opera-
tion of zIl adivities to be conduded;
•1 wili familiarize myself with the Izws of Minnesota
governing Ia•.v�ui gambling and rules oi the board and
agree, rf licensed, to abide by those Izws and rules,
inciuding amendments to them;
•any changes in applicziion information will be submiC_d
to the baard and local unR of government within 10 days
of the change; and �
•I unders;and thzi failure to provide required informaiion
or providing false or misieading information may result in
the denial or revocation ofi the license.
4. A coov of the local unit oi oovernmenPs resolution ao-
Qrgvino t'�is aoolicaiion must be arached to this aoolication.
5. Ii this application is denied by the locai unit of government.
it shouid not be submitted to the Gambling Control Board.
Township: By signature below, the township acknowledges
that the organization is applying tor a premises permii within
township timits.
Township Name
Signature o( person receiving apptication
Title
I Date Received
LG214(Part2)
�A���il
Council File � ` U — l� `
ordinance $
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
OR1GfNAL
Presented By
Referred To
RESOLVED: That application (ID #B-00444) for a State Clasa B Gambling Premise Permit by
Minnesota Brass at Michael's, 1179 E. 7th Street. be and the same ie hereby
approoed.
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Green Sheet # 50480
��
Committee: Date
Requested by Department of:
Adopted by Council: Date � \\ _ � �{ �j �
Certified by Council Secretary
By:
Approved
�ti I�
Off�c of ; ns rnspections and
Env' me t e
By: � /� �
Form Approved by City Attor�
�
BY= � "(h4 �.. , � . .� c� ,�
Approved by Mayor for Submission to
Council
Byc
By:
N° 50480
QF _19 1
DEPARtMENT�OFFICEICOUNCIL DATE IHfT1ATED �� < < �
LIEP GREEN SHEE
CONTACT PERSON 8 PXONE INITIAVDATE INITIAVDATE
Q DEPARTMENT DIRECTOF � CITYCOUNGL
w1]. iam�F. unth r 2 — ASSIGN �dTYATTORNEY OQTVCLERK
MUST HE ON CAUNCIL AGENDA BV (DATE7 NUMBER FOR O BUDGET DIRECTOR O FIN. 8 MGT SEFVICES DIR.
POUTING
OPOEF O MAVOR (OR ASSI5TANT) ❑
arin : -11-
TOTAL # OF SIGNATURE PAGES (CLIP A�L LOCATIONS FOR SIGNATURE)
AC[ION REQUESiED.
Gavin Burnham on behalf of Minnesota Brass requests Council approval of their
application for a new State Class B Gambling Premise Permit, ID �/B-00444, at Michael's,
1179 E. 7th Street.
RECOMMENDFTIONS AOPpve (A) or Rejecl(R) PEflSONAL SERVICE CONTRACTS MUST ANSWER THE fOLLOWINCa QUESTIONS:
_ PLANNING COMMISSION _ CIVII SERVICE COMMISSION �� Ha5 thi5 person/Film ever worked under a contract for thi5 department?
_ CIB COMMffTEE _ �'ES NO
2. Has this personRirm ever been a c"rty empioyee?
_ SiAFF
— YES NO
_ DiSTRIC7COUai _ 3. Does this personlfirm possess a skill not normally possessetl by a�y current ctty employee?
SUPPORTS WHICH COUNCIL OBJECTIVE� YES NO
Explain all yes anawers on seperate eheet and enach to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (VJho. Whe1, When. Where. Why)
ADVANTAGES �FAPPROVED'
DISADVqNTAGES IF APPpOVED'
DISADVANTAOES IF NOTAPPROVED:
4de�i�'Q :; �'C:�+::wiur� �r -..;•
�k�e � ����
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) VES NO
FUNDIIdG SOURCE ACTIVITV NUMBER
FINANQAL INFOFFriAT10N (EXPLAIN)
�q l
' LG2'14
_, pavs+�
LJ
���
fOR BOARD USE ONLY
BASE x
PP x
Idinnesota Lazcfiti Gambiing CNECK
1NITI:+LS
Premises Permit Application - Part 1 of 2 p ��
�,f Appftca�orf
Clzss of przmises pemd
Aer.ewal � (check one)
Organizaticn base I"�cense number A- Oo 49 4 � A(5400) Pu1Ftz5s, tipbozr�'s, �adizwheels, r�9es, bingo
New
P:emises pertnit num'�r
� B(5250) Pull-tabs, tpbczrds, pad�ewheeis, ra�les
� C (5200) 3ingo onty -
❑ p (5150) r'3�-f;tes ony
ct icer (cannot be your gambling ma�a9er)
5510
6�1) 4�6_
)ayrime phone
61d) N86-'
I! appiying for a ci2ss A or C per•nit, fill in d2ys and beginni �& ending hours of birgo occasio2s:
No more than seven bingo occasions may be cbnducted by your organization per week.
Day Beginning/Ending Havrs Day Beg.nning/Ending Hours Day Begjnning /EndL^.g Hous
to _.
If bingo a not be conducted, check heze �
a
..�........ �.,__........._......._._ �_.._._.� --- - .. . _ .
/�'l'cFlacLS 11'1`i F �°� 5 �¢ -
� Is the premises iocatc� within city Iimits? � Yes � No �f no, is township � oryanized 0 unoraanized p unine�rporated
- City and Counry where gambfing premises is located OR 7ownship and Co�nty where gambGng premises is Iocated if outside of ci,y timits
- SawZ PavL SSlob I Rar+S��� —
-- -- Name and abdress of kga{ owner ot premises Cyty State Z�p Code
/��k'r_ �LaLCS 11 t� �� S�rc+- 5u� Pa.-� /n^' Ss to6
Does yow organiza6on own the buldng where the gambling will be conductetl? � t'ts � nti
'"" " if no, arach Lhe foflowing: � � .
" , _ • a copy of tl�e lease {torm LG202) with terms for at least one year.
- _ • a mpy of a sketch of the floor pian with dimensions, shovring what por4on is being leased.
.. - � - - A lease and sketch are not reGuired for Class D appliracons.
- _- - ,.. _.,-.. - ��-- . .; � - , . . - � - - :. ;:
� -_ .. ......,. .....� _ . ., ... ..:..... _ ... . _. ;.;
. . .. ..,_ . . :- -�
�-� AArir.��c'�nf c+nr�di+ SnarP �{�97I1b1�II¢-�C�7.2�DIIICIIt� 4nr+ot�*<_�a PO imb>r _-.;;;(
-= ,�+,� 41�7 �Ca��t•N OQ Va�.�a'S Ht5 MN 5512-7 - —
� 'ni : a) l 1�9 F?"'� 5T� sa�,wr P«��. /hr ss l 0 6
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Business Address ot Occaniz�LOn - Street or P. O 6ox (Do nct use the aodress of your g �bt�ng manager)
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Minnesota LawfuZ Gambling
Premise Permit Application - Part 2 of 2
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i hereby consent that bcal faw an`crczment officers, 2he
bozrd or acents of the board, or the conmissioner ot
revenua or public safety, or agents of the c�mmissioners,
may enter the prenises to enforce the law.
Bank Records Information
The board is euthorized to inspect the bank records of the
gambling account whenever necessary to fuHill
requiremanu of curren[ gambti�g rules and law.
Oath
I declare that:
•I ha�ee read this application and all iniornetion subm'f.:ed
to the board is trua, accurate and c�mpiete;
•ail other required information fizs been tulty disclosed;
7. The city'nust sigri this application if the gambling prem-
ises is Yocated wGhin city iimits.
2. The county •'AND Sownship'• must sgn this zpplication 'rf
the gambling premises is located wrhin a township. .
3. The local unit govarnment (ciry or counfy) must pass a
resolution specifically approving or denying this application.
- " � Ciry or Counry Name
C �� ( � .- , Si n�tur of i
� _ . - . _ tN.�•J r
,_ TiBe n
._ --_.-,/' - � � IJ.
Date
' _ � d � •
=� Aeter to the instructions fw required aaachmenu.
; ,: Mail to:
Gambilnq Control Board
Aosewood Pleza Soufh, 3rd F�oor
1717 W. County Roid B
poaevllie, MN 55113
•I an the chief executive officer of the crganization;
-0 assune Su1f rasponsi4ility for the izir znd 4avriu{ opera-
tion of zIl adivities to be conduded;
•1 wili familiarize myself with the Izws of Minnesota
governing Ia•.v�ui gambling and rules oi the board and
agree, rf licensed, to abide by those Izws and rules,
inciuding amendments to them;
•any changes in applicziion information will be submiC_d
to the baard and local unR of government within 10 days
of the change; and �
•I unders;and thzi failure to provide required informaiion
or providing false or misieading information may result in
the denial or revocation ofi the license.
4. A coov of the local unit oi oovernmenPs resolution ao-
Qrgvino t'�is aoolicaiion must be arached to this aoolication.
5. Ii this application is denied by the locai unit of government.
it shouid not be submitted to the Gambling Control Board.
Township: By signature below, the township acknowledges
that the organization is applying tor a premises permii within
township timits.
Township Name
Signature o( person receiving apptication
Title
I Date Received
LG214(Part2)
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