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98-228Council File # J O�Z ordinance # Green Sheet ;E 5�482 _ RESOLUTION 2� OF SAINT PAUL, MINNESOTA 1 Z 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 Presented Referred To � Committee: Date RSSOLVSD: That application (ID #B-04985) for a State Class B Gambling Premise Permit by St. Pau1 Festival & Heritage Foundation at sports Break, 1199 Rice Street, be and the same is hereby approved. Requeated by Department of: Certi£ied by Council Secretary By: Approved by Office of License. Insg�ctions and Bnvironmental Protection BY� /�� Form Approv by City Att rney By: ;� ��G� Approved by Mayor £or Submission to Council By: By: Adopted by Council: Date �y� m ,,,$„ �� 1 �14 �' ��_a N� �� William GunCher - 266-9132 Hearing: 3125/98 TOTAL # OF SIGNATURE PAGES 50482 9�-2z� IGREEN SHEET � pEPARTMENT DIRECTOA FON OCINATTORNE!' � BUDGET DIRECTOR � � MAYOR (OR ASSISTANT� INRIAUDATE � CITY LOUNCIL � C�TY CLERK a FIN. 8 MGT SERVICES DIR. � (CLiP ALL LOCATIONS FOR S�GNATURE) Steve Remington on behalf of St. Paul Festival & Heritage Foundation requests Council approval for a State Class B Gambling Premise Permi.t at Sports Break, 1199 Rice Street. (ID ��B-04985) __PIANNINGCOMMISSipN _C�VILSERVICE __ CIB CAMMITTEE _ _ STAFF _ _ OISiRiCTGOVFiT _ SUPPORTS WHICH COUNCIL OQIEGTIVE� INRIATING VROBLEM,iSSUE. ADYANTAGES IF APPROVEO: Whet, Wnen. PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UES710NS: t. kWS this person/firm ever workatl untler a contract for this de08rtment? YES NO 2. Has this personffirm ever been a city em0�oyee? YES NO 3. Does this personttirm possess a skiN not normafly possessed by any cmreni ciry employeeT YES NO Explain ali yea answera on separate shaet end attach to green aheet Whyp Co�rrac�! R�,ear�h ��ter ; . : � x<< DISADVANTAGES IF NOT APPROVED. OTAL AMOUNT OF TRANSACTION COSTlREYENUE BUUGETEO (CIRCIE ONE) YES NO 1NUIfdG SOURCE AC7IVITY NUMBER VANCIAL INFpR4FATIOM {E%PLAIN) �'�-2z� LG2�4 n,�„ Minnesota Lazvfut Gambting Premises Permit Application - Part 1 of 2 FOR BOAR4 USE ONLY BASE : PP � FEE CHECK INITIALS DATE c � • , TyPe of Appl�eatior� ; ❑ . . , . . . . �- Class of premises pertnit+, . .' .. ...., . ,. ,., . Renewal (cf�eck one) Organization base {"icense number a`'� �� S � A(5400] Putl-ta6s, tipboards, paddlewheeis, raf9es, biryo Premises permit number f}� B(5250) Pull-tabs, 5pboards, paddiewheeis, 2fFles I j� New � C($200) &ngo only ❑ � (5750) Raffies onty �.\c.�.l \ ry Cr.liu�c �ox iness Ad o( Organization - Street a y P . . O Boz (Do noi c use ��' fslln,n�.lnl� �\. �r.sl� �QZ� G a.t� a. iress of your 11) �.1'3 - t.� � 0 :utive officer (cannot be your 4,�..._ a.�C o ,�. �. u-a ,� �YCc �1�i�3-4700 If applying for a class A or C permit, fill in days and begiru�ing & ending hours of bingo occasions: �o more than seven bingo occasions may be cbnducted by your organization per week. Day BeglnningfEnding Hou� Day Beg�nning/Ending Houn Day � Beginning JEnding Hours to , to to If bingo will not be conducted, check here � rv e oi es�ann nmem w ` ner gam�ung rmi ne { c y onauctea �tree �ao not use a st on�ce nox numaer� ' �Oer� �cc�.K 1�a,/` + ��I ILiG� a1'• �f. .�.+� R1�J S�/a� [s the premises located wirtiin ary limits? �'j �'es C Nv If no, is township � organized � unorganized �'7 unincorporated City and County where garnbGng premises is tocated OR Township and Counry where gamb7ing premises is Iopted if outside o( ciry Iimits St. P�.�l (��...,: <� � .- Name and address of Ieg � ow j ner of premises ` y^ � City '^n State Z�p Code '� �� r r n. .,. S Y'" I( 1 l � i c t �\, t yy,� Y•• U- S S J �� Qoes your arganization own the builtLlg where the gambling will be conducted? p YES �j NO .- .. ti sw. attach the tolbwing: � � . • a wpy oE she lease (form tG202) with terms tor at leazt one year. • a mpy ot a sketch of fhe 800r pian wifh dmensions, sfiowing what poroon is being ieased. - A tease and sketch are not required fw Ctass D appiica�ons. => Address of storage space of gambIin�s"eqnipment oa �e �e a Po �x ��m�. - Address City State Tip code �:'.„_=?;;= �- ", 1 (� _ ;.. j (`) ° S2 , t.. � S t. S'E . 1'y.,i` w� N � S 1 d' �� —� �' " GambZitt�7 � Bank Name k t .. N�,.��,t '- 6ank AcMress l � - _ �GiW<f\ RE��..�> P�p� 5��-ft 1�.��A��.S. �► . ss4r7 in�.N,�« T�.� �n�r.s� (llcii �7�% �{, iV� a'�:�twa.�"« SS373 f�r��dc• Minnesofa Lau�fui Gambling Premise Permit Application - Part 2 of 2 3(� 6ank Account Number ��3b� �3�-1 y �tate Zrp Code ?�ul tr�N SS � a i IZ_Ro�a..,l vN5t1.h a l�<t� Qzi�,, Ssr�3 �11r,.bl,. r✓►SwaF<, 1 . S'{c�<. ICe-., �Ic r.. I?il �lc�<.(a.�,� t��<._!-�. 3E_ �.s•.\ Ssled �ke-��•" t hereby conseni thaf bcat !aw enfiorcemsnt oHiaers, the board or ageMS of the board, or the commissioner of revenue or pubi'ic safety, or agents of tha commissioners, may enter tha premises to enforce the law. Bank Records Informatioa T6e board is authorized to inspect the bank records of the ganbling account whenever necessary to fu�it requirements of current gambling rules and law. Oath I deciare that: -i have read this appl"�caYion and all informaiion submitFed to ihe board is true, accurate and mmpiete; •ali other required information has been ful(y disclosed; Sign ure of chief �e off+cer ,CA - ,- "�' LOCCiI t. The city •must sign this appl'wation if the gambling prem- ises is located within city lim@s. 2. The county "AND township•' must sign this application if the gambling premises is located within a township. 3. The IoczJ unii government (c'rty or county) must pass a resolutian specifically approving or denying ihis applicatiort. _ City u Ct �.� . ''` &ig:a�re TiBe � Date Received �131a .� Aeter to the instructions for required attachments. " Mail lo: Gambilnp Conlrol Bcard Rosewood P}au Souih, 3rd Floo� _� 77it W_ County Road 8 ' , Roeev�ib, MN 55713 •1 am ihe chial exeeutiva off'�cer of the organizaiion; •t assume iult responsibBity for the fair and tawfut opera- tion of aVI adivities to be condtided; -! wil! famliarize myself with the laws of Minnesota governing lawful gambling and rules of ihe board and agree, 'rf Iicensed, to abide by tFrose taws and rutes, inctuding amendments to them; •any changes in applicaiion information will be submiYtad to the board and locat unit of government within 10 days of the change; and •! undarstand that failure to provide required information or providing faise or misleading intormai+on may resuk ia the denial or revocatwn of the 1"�cense. ��98 F. 4. A coov of the local unif of 4overnmenYS resolution ao- provingthis aopl+cation must be aitac�'�ed to inis aoolipi'rort. 5. If this appC�cation is denied by the bcal unit of government, d shouid not be submitted to the Gambling Control Board. Township: 8y signature betow, ihe township acknowledges that the organization is appiying for a premises permit within township limits. Townsfiip Name Signafure of person receiving applica8on Title I Date Received [.G216(Pnrt 2y �a.r�rn�9t) 98—zZ� Name {- 4 r W <3 \ N�_ �,,�s� �3��,i� 312�, . _.._.._. ..... ._ _.__ _. _ .P��,i mN ss,a� 2.R�6�.�i�i�'s. a� � ��1,_.,«? Q< �'i�..,.l�1�� N S'��c.�e... i3t►ct�.�t,.�ar�,,�_t � Ekuw�':�„<�«��C. 2t,�,.d> P1p� 574� ��.-�A��.S. �'� �'cc St.�+nsTo•'� f1<<i 1 �� % S'�, iV • a� 1 hereby ansent that bcal law enforcement officers, ihe board or agents of the board, or ihe ccmmissioner of revenue or public satery, or agents of the cammissioners, mzy enter the premises to anforce the law. Bank Records Informatioa The board is autharized to inspect the 6ank records of the ganbiing account whenever necessary to fuHil! requirements of current gambting rules and law. Oath t dedare Ihat: -I have read tfiis appiication and afl iniormatron submffied to the board is true, accurafe and compiete; •aA other required in ha b een fuify d is c lo s e d; S , SS4�� waf"« $5371 h"1 c -w�� r zd,a�.: •i am ihe chief oxecutive otticer ct the organizatan; •1 aswme tuA responsiblity tor the tair and lawful opera- t+on ot atl activities to be conducted; �4 wi!{ familiarize myse�t with the laws ot Minnesota governing fawfut gambling and tules of the board and agree, fi licsnsed, to abide by Ihose taws and rufes, incfuding amendmenls to them; •any changes in application iniormation wiii be submittsd to the board and bcai unit ot government within 10 days of the chan9e; and •I understand th2t faiture to provide required information or providing false or misleading iniormation may resuit in the denial or revocation of the Iicense. Minnesota Lau�,ful Gambling Premise Permit Application - Part 2 of 2 Date �3/ 9$ chief ezecu2ive oNicer , ^ "�� Loca1 Goveriirrie�t Acknov 7. The city'must sign this application if ihe gambting prem- ises is Iocafed wRhin city limits. Z. The county ••AND township'• must sign this appl'wation if ;he gambling premises is located within a township, 3. The tocal unit govecnment (city or county) must pass a resolution speciticaliy approving or denying this a¢plicat+on. Cuy or Cc C Signa�ure Tine (_ � Date Reeeivec � �3�Q Refer to the instruaions tor required aaachments. Maif W: Gamb1{np Control Soard Roaewood Plass South, 3rd F1cor 1711 W. County Ro�d 8 Rosevllle, MN 551t3 , .. ._ .. - , ... .. .. _. . . ..,:::.: =:.«�., ..•:._.:..-_.::_.;,:,::: 4. A cow of the local unit of oovemmeM's Tesofution ao- Qrovingthis aDOtication must be attached to tnis ao�lication 5. if this application is denied by the bcat unit of government, it should not be submitted to ihe Gambling Control Board. Township: By signature below, the township acknowledges that the organizalion is applying for a premises permii within township limits. Townstiip Name S�gnaNre of person rerniving applkcation Title � Date Rece'sved LG21<(Part 2) �a«7rna+� � ! 1 �� `J �z..,_ Council File # J O�Z ordinance # Green Sheet ;E 5�482 _ RESOLUTION 2� OF SAINT PAUL, MINNESOTA 1 Z 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 Presented Referred To � Committee: Date RSSOLVSD: That application (ID #B-04985) for a State Class B Gambling Premise Permit by St. Pau1 Festival & Heritage Foundation at sports Break, 1199 Rice Street, be and the same is hereby approved. Requeated by Department of: Certi£ied by Council Secretary By: Approved by Office of License. Insg�ctions and Bnvironmental Protection BY� /�� Form Approv by City Att rney By: ;� ��G� Approved by Mayor £or Submission to Council By: By: Adopted by Council: Date �y� m ,,,$„ �� 1 �14 �' ��_a N� �� William GunCher - 266-9132 Hearing: 3125/98 TOTAL # OF SIGNATURE PAGES 50482 9�-2z� IGREEN SHEET � pEPARTMENT DIRECTOA FON OCINATTORNE!' � BUDGET DIRECTOR � � MAYOR (OR ASSISTANT� INRIAUDATE � CITY LOUNCIL � C�TY CLERK a FIN. 8 MGT SERVICES DIR. � (CLiP ALL LOCATIONS FOR S�GNATURE) Steve Remington on behalf of St. Paul Festival & Heritage Foundation requests Council approval for a State Class B Gambling Premise Permi.t at Sports Break, 1199 Rice Street. (ID ��B-04985) __PIANNINGCOMMISSipN _C�VILSERVICE __ CIB CAMMITTEE _ _ STAFF _ _ OISiRiCTGOVFiT _ SUPPORTS WHICH COUNCIL OQIEGTIVE� INRIATING VROBLEM,iSSUE. ADYANTAGES IF APPROVEO: Whet, Wnen. PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UES710NS: t. kWS this person/firm ever workatl untler a contract for this de08rtment? YES NO 2. Has this personffirm ever been a city em0�oyee? YES NO 3. Does this personttirm possess a skiN not normafly possessed by any cmreni ciry employeeT YES NO Explain ali yea answera on separate shaet end attach to green aheet Whyp Co�rrac�! R�,ear�h ��ter ; . : � x<< DISADVANTAGES IF NOT APPROVED. OTAL AMOUNT OF TRANSACTION COSTlREYENUE BUUGETEO (CIRCIE ONE) YES NO 1NUIfdG SOURCE AC7IVITY NUMBER VANCIAL INFpR4FATIOM {E%PLAIN) �'�-2z� LG2�4 n,�„ Minnesota Lazvfut Gambting Premises Permit Application - Part 1 of 2 FOR BOAR4 USE ONLY BASE : PP � FEE CHECK INITIALS DATE c � • , TyPe of Appl�eatior� ; ❑ . . , . . . . �- Class of premises pertnit+, . .' .. ...., . ,. ,., . Renewal (cf�eck one) Organization base {"icense number a`'� �� S � A(5400] Putl-ta6s, tipboards, paddlewheeis, raf9es, biryo Premises permit number f}� B(5250) Pull-tabs, 5pboards, paddiewheeis, 2fFles I j� New � C($200) &ngo only ❑ � (5750) Raffies onty �.\c.�.l \ ry Cr.liu�c �ox iness Ad o( Organization - Street a y P . . O Boz (Do noi c use ��' fslln,n�.lnl� �\. �r.sl� �QZ� G a.t� a. iress of your 11) �.1'3 - t.� � 0 :utive officer (cannot be your 4,�..._ a.�C o ,�. �. u-a ,� �YCc �1�i�3-4700 If applying for a class A or C permit, fill in days and begiru�ing & ending hours of bingo occasions: �o more than seven bingo occasions may be cbnducted by your organization per week. Day BeglnningfEnding Hou� Day Beg�nning/Ending Houn Day � Beginning JEnding Hours to , to to If bingo will not be conducted, check here � rv e oi es�ann nmem w ` ner gam�ung rmi ne { c y onauctea �tree �ao not use a st on�ce nox numaer� ' �Oer� �cc�.K 1�a,/` + ��I ILiG� a1'• �f. .�.+� R1�J S�/a� [s the premises located wirtiin ary limits? �'j �'es C Nv If no, is township � organized � unorganized �'7 unincorporated City and County where garnbGng premises is tocated OR Township and Counry where gamb7ing premises is Iopted if outside o( ciry Iimits St. P�.�l (��...,: <� � .- Name and address of Ieg � ow j ner of premises ` y^ � City '^n State Z�p Code '� �� r r n. .,. S Y'" I( 1 l � i c t �\, t yy,� Y•• U- S S J �� Qoes your arganization own the builtLlg where the gambling will be conducted? p YES �j NO .- .. ti sw. attach the tolbwing: � � . • a wpy oE she lease (form tG202) with terms tor at leazt one year. • a mpy ot a sketch of fhe 800r pian wifh dmensions, sfiowing what poroon is being ieased. - A tease and sketch are not required fw Ctass D appiica�ons. => Address of storage space of gambIin�s"eqnipment oa �e �e a Po �x ��m�. - Address City State Tip code �:'.„_=?;;= �- ", 1 (� _ ;.. j (`) ° S2 , t.. � S t. S'E . 1'y.,i` w� N � S 1 d' �� —� �' " GambZitt�7 � Bank Name k t .. N�,.��,t '- 6ank AcMress l � - _ �GiW<f\ RE��..�> P�p� 5��-ft 1�.��A��.S. �► . ss4r7 in�.N,�« T�.� �n�r.s� (llcii �7�% �{, iV� a'�:�twa.�"« SS373 f�r��dc• Minnesofa Lau�fui Gambling Premise Permit Application - Part 2 of 2 3(� 6ank Account Number ��3b� �3�-1 y �tate Zrp Code ?�ul tr�N SS � a i IZ_Ro�a..,l vN5t1.h a l�<t� Qzi�,, Ssr�3 �11r,.bl,. r✓►SwaF<, 1 . S'{c�<. ICe-., �Ic r.. I?il �lc�<.(a.�,� t��<._!-�. 3E_ �.s•.\ Ssled �ke-��•" t hereby conseni thaf bcat !aw enfiorcemsnt oHiaers, the board or ageMS of the board, or the commissioner of revenue or pubi'ic safety, or agents of tha commissioners, may enter tha premises to enforce the law. Bank Records Informatioa T6e board is authorized to inspect the bank records of the ganbling account whenever necessary to fu�it requirements of current gambling rules and law. Oath I deciare that: -i have read this appl"�caYion and all informaiion submitFed to ihe board is true, accurate and mmpiete; •ali other required information has been ful(y disclosed; Sign ure of chief �e off+cer ,CA - ,- "�' LOCCiI t. The city •must sign this appl'wation if the gambling prem- ises is located within city lim@s. 2. The county "AND township•' must sign this application if the gambling premises is located within a township. 3. The IoczJ unii government (c'rty or county) must pass a resolutian specifically approving or denying ihis applicatiort. _ City u Ct �.� . ''` &ig:a�re TiBe � Date Received �131a .� Aeter to the instructions for required attachments. " Mail lo: Gambilnp Conlrol Bcard Rosewood P}au Souih, 3rd Floo� _� 77it W_ County Road 8 ' , Roeev�ib, MN 55713 •1 am ihe chial exeeutiva off'�cer of the organizaiion; •t assume iult responsibBity for the fair and tawfut opera- tion of aVI adivities to be condtided; -! wil! famliarize myself with the laws of Minnesota governing lawful gambling and rules of ihe board and agree, 'rf Iicensed, to abide by tFrose taws and rutes, inctuding amendments to them; •any changes in applicaiion information will be submiYtad to the board and locat unit of government within 10 days of the change; and •! undarstand that failure to provide required information or providing faise or misleading intormai+on may resuk ia the denial or revocatwn of the 1"�cense. ��98 F. 4. A coov of the local unif of 4overnmenYS resolution ao- provingthis aopl+cation must be aitac�'�ed to inis aoolipi'rort. 5. If this appC�cation is denied by the bcal unit of government, d shouid not be submitted to the Gambling Control Board. Township: 8y signature betow, ihe township acknowledges that the organization is appiying for a premises permit within township limits. Townsfiip Name Signafure of person receiving applica8on Title I Date Received [.G216(Pnrt 2y �a.r�rn�9t) 98—zZ� Name {- 4 r W <3 \ N�_ �,,�s� �3��,i� 312�, . _.._.._. ..... ._ _.__ _. _ .P��,i mN ss,a� 2.R�6�.�i�i�'s. a� � ��1,_.,«? Q< �'i�..,.l�1�� N S'��c.�e... i3t►ct�.�t,.�ar�,,�_t � Ekuw�':�„<�«��C. 2t,�,.d> P1p� 574� ��.-�A��.S. �'� �'cc St.�+nsTo•'� f1<<i 1 �� % S'�, iV • a� 1 hereby ansent that bcal law enforcement officers, ihe board or agents of the board, or ihe ccmmissioner of revenue or public satery, or agents of the cammissioners, mzy enter the premises to anforce the law. Bank Records Informatioa The board is autharized to inspect the 6ank records of the ganbiing account whenever necessary to fuHil! requirements of current gambting rules and law. Oath t dedare Ihat: -I have read tfiis appiication and afl iniormatron submffied to the board is true, accurafe and compiete; •aA other required in ha b een fuify d is c lo s e d; S , SS4�� waf"« $5371 h"1 c -w�� r zd,a�.: •i am ihe chief oxecutive otticer ct the organizatan; •1 aswme tuA responsiblity tor the tair and lawful opera- t+on ot atl activities to be conducted; �4 wi!{ familiarize myse�t with the laws ot Minnesota governing fawfut gambling and tules of the board and agree, fi licsnsed, to abide by Ihose taws and rufes, incfuding amendmenls to them; •any changes in application iniormation wiii be submittsd to the board and bcai unit ot government within 10 days of the chan9e; and •I understand th2t faiture to provide required information or providing false or misleading iniormation may resuit in the denial or revocation of the Iicense. Minnesota Lau�,ful Gambling Premise Permit Application - Part 2 of 2 Date �3/ 9$ chief ezecu2ive oNicer , ^ "�� Loca1 Goveriirrie�t Acknov 7. The city'must sign this application if ihe gambting prem- ises is Iocafed wRhin city limits. Z. The county ••AND township'• must sign this appl'wation if ;he gambling premises is located within a township, 3. The tocal unit govecnment (city or county) must pass a resolution speciticaliy approving or denying this a¢plicat+on. Cuy or Cc C Signa�ure Tine (_ � Date Reeeivec � �3�Q Refer to the instruaions tor required aaachments. Maif W: Gamb1{np Control Soard Roaewood Plass South, 3rd F1cor 1711 W. County Ro�d 8 Rosevllle, MN 551t3 , .. ._ .. - , ... .. .. _. . . ..,:::.: =:.«�., ..•:._.:..-_.::_.;,:,::: 4. A cow of the local unit of oovemmeM's Tesofution ao- Qrovingthis aDOtication must be attached to tnis ao�lication 5. if this application is denied by the bcat unit of government, it should not be submitted to ihe Gambling Control Board. Township: By signature below, the township acknowledges that the organizalion is applying for a premises permii within township limits. Townstiip Name S�gnaNre of person rerniving applkcation Title � Date Rece'sved LG21<(Part 2) �a«7rna+� � ! 1 �� `J �z..,_ Council File # J O�Z ordinance # Green Sheet ;E 5�482 _ RESOLUTION 2� OF SAINT PAUL, MINNESOTA 1 Z 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 Presented Referred To � Committee: Date RSSOLVSD: That application (ID #B-04985) for a State Class B Gambling Premise Permit by St. Pau1 Festival & Heritage Foundation at sports Break, 1199 Rice Street, be and the same is hereby approved. Requeated by Department of: Certi£ied by Council Secretary By: Approved by Office of License. Insg�ctions and Bnvironmental Protection BY� /�� Form Approv by City Att rney By: ;� ��G� Approved by Mayor £or Submission to Council By: By: Adopted by Council: Date �y� m ,,,$„ �� 1 �14 �' ��_a N� �� William GunCher - 266-9132 Hearing: 3125/98 TOTAL # OF SIGNATURE PAGES 50482 9�-2z� IGREEN SHEET � pEPARTMENT DIRECTOA FON OCINATTORNE!' � BUDGET DIRECTOR � � MAYOR (OR ASSISTANT� INRIAUDATE � CITY LOUNCIL � C�TY CLERK a FIN. 8 MGT SERVICES DIR. � (CLiP ALL LOCATIONS FOR S�GNATURE) Steve Remington on behalf of St. Paul Festival & Heritage Foundation requests Council approval for a State Class B Gambling Premise Permi.t at Sports Break, 1199 Rice Street. (ID ��B-04985) __PIANNINGCOMMISSipN _C�VILSERVICE __ CIB CAMMITTEE _ _ STAFF _ _ OISiRiCTGOVFiT _ SUPPORTS WHICH COUNCIL OQIEGTIVE� INRIATING VROBLEM,iSSUE. ADYANTAGES IF APPROVEO: Whet, Wnen. PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UES710NS: t. kWS this person/firm ever workatl untler a contract for this de08rtment? YES NO 2. Has this personffirm ever been a city em0�oyee? YES NO 3. Does this personttirm possess a skiN not normafly possessed by any cmreni ciry employeeT YES NO Explain ali yea answera on separate shaet end attach to green aheet Whyp Co�rrac�! R�,ear�h ��ter ; . : � x<< DISADVANTAGES IF NOT APPROVED. OTAL AMOUNT OF TRANSACTION COSTlREYENUE BUUGETEO (CIRCIE ONE) YES NO 1NUIfdG SOURCE AC7IVITY NUMBER VANCIAL INFpR4FATIOM {E%PLAIN) �'�-2z� LG2�4 n,�„ Minnesota Lazvfut Gambting Premises Permit Application - Part 1 of 2 FOR BOAR4 USE ONLY BASE : PP � FEE CHECK INITIALS DATE c � • , TyPe of Appl�eatior� ; ❑ . . , . . . . �- Class of premises pertnit+, . .' .. ...., . ,. ,., . Renewal (cf�eck one) Organization base {"icense number a`'� �� S � A(5400] Putl-ta6s, tipboards, paddlewheeis, raf9es, biryo Premises permit number f}� B(5250) Pull-tabs, 5pboards, paddiewheeis, 2fFles I j� New � C($200) &ngo only ❑ � (5750) Raffies onty �.\c.�.l \ ry Cr.liu�c �ox iness Ad o( Organization - Street a y P . . O Boz (Do noi c use ��' fslln,n�.lnl� �\. �r.sl� �QZ� G a.t� a. iress of your 11) �.1'3 - t.� � 0 :utive officer (cannot be your 4,�..._ a.�C o ,�. �. u-a ,� �YCc �1�i�3-4700 If applying for a class A or C permit, fill in days and begiru�ing & ending hours of bingo occasions: �o more than seven bingo occasions may be cbnducted by your organization per week. Day BeglnningfEnding Hou� Day Beg�nning/Ending Houn Day � Beginning JEnding Hours to , to to If bingo will not be conducted, check here � rv e oi es�ann nmem w ` ner gam�ung rmi ne { c y onauctea �tree �ao not use a st on�ce nox numaer� ' �Oer� �cc�.K 1�a,/` + ��I ILiG� a1'• �f. .�.+� R1�J S�/a� [s the premises located wirtiin ary limits? �'j �'es C Nv If no, is township � organized � unorganized �'7 unincorporated City and County where garnbGng premises is tocated OR Township and Counry where gamb7ing premises is Iopted if outside o( ciry Iimits St. P�.�l (��...,: <� � .- Name and address of Ieg � ow j ner of premises ` y^ � City '^n State Z�p Code '� �� r r n. .,. S Y'" I( 1 l � i c t �\, t yy,� Y•• U- S S J �� Qoes your arganization own the builtLlg where the gambling will be conducted? p YES �j NO .- .. ti sw. attach the tolbwing: � � . • a wpy oE she lease (form tG202) with terms tor at leazt one year. • a mpy ot a sketch of fhe 800r pian wifh dmensions, sfiowing what poroon is being ieased. - A tease and sketch are not required fw Ctass D appiica�ons. => Address of storage space of gambIin�s"eqnipment oa �e �e a Po �x ��m�. - Address City State Tip code �:'.„_=?;;= �- ", 1 (� _ ;.. j (`) ° S2 , t.. � S t. S'E . 1'y.,i` w� N � S 1 d' �� —� �' " GambZitt�7 � Bank Name k t .. N�,.��,t '- 6ank AcMress l � - _ �GiW<f\ RE��..�> P�p� 5��-ft 1�.��A��.S. �► . ss4r7 in�.N,�« T�.� �n�r.s� (llcii �7�% �{, iV� a'�:�twa.�"« SS373 f�r��dc• Minnesofa Lau�fui Gambling Premise Permit Application - Part 2 of 2 3(� 6ank Account Number ��3b� �3�-1 y �tate Zrp Code ?�ul tr�N SS � a i IZ_Ro�a..,l vN5t1.h a l�<t� Qzi�,, Ssr�3 �11r,.bl,. r✓►SwaF<, 1 . S'{c�<. ICe-., �Ic r.. I?il �lc�<.(a.�,� t��<._!-�. 3E_ �.s•.\ Ssled �ke-��•" t hereby conseni thaf bcat !aw enfiorcemsnt oHiaers, the board or ageMS of the board, or the commissioner of revenue or pubi'ic safety, or agents of tha commissioners, may enter tha premises to enforce the law. Bank Records Informatioa T6e board is authorized to inspect the bank records of the ganbling account whenever necessary to fu�it requirements of current gambling rules and law. Oath I deciare that: -i have read this appl"�caYion and all informaiion submitFed to ihe board is true, accurate and mmpiete; •ali other required information has been ful(y disclosed; Sign ure of chief �e off+cer ,CA - ,- "�' LOCCiI t. The city •must sign this appl'wation if the gambling prem- ises is located within city lim@s. 2. The county "AND township•' must sign this application if the gambling premises is located within a township. 3. The IoczJ unii government (c'rty or county) must pass a resolutian specifically approving or denying ihis applicatiort. _ City u Ct �.� . ''` &ig:a�re TiBe � Date Received �131a .� Aeter to the instructions for required attachments. " Mail lo: Gambilnp Conlrol Bcard Rosewood P}au Souih, 3rd Floo� _� 77it W_ County Road 8 ' , Roeev�ib, MN 55713 •1 am ihe chial exeeutiva off'�cer of the organizaiion; •t assume iult responsibBity for the fair and tawfut opera- tion of aVI adivities to be condtided; -! wil! famliarize myself with the laws of Minnesota governing lawful gambling and rules of ihe board and agree, 'rf Iicensed, to abide by tFrose taws and rutes, inctuding amendments to them; •any changes in applicaiion information will be submiYtad to the board and locat unit of government within 10 days of the change; and •! undarstand that failure to provide required information or providing faise or misleading intormai+on may resuk ia the denial or revocatwn of the 1"�cense. ��98 F. 4. A coov of the local unif of 4overnmenYS resolution ao- provingthis aopl+cation must be aitac�'�ed to inis aoolipi'rort. 5. If this appC�cation is denied by the bcal unit of government, d shouid not be submitted to the Gambling Control Board. Township: 8y signature betow, ihe township acknowledges that the organization is appiying for a premises permit within township limits. Townsfiip Name Signafure of person receiving applica8on Title I Date Received [.G216(Pnrt 2y �a.r�rn�9t) 98—zZ� Name {- 4 r W <3 \ N�_ �,,�s� �3��,i� 312�, . _.._.._. ..... ._ _.__ _. _ .P��,i mN ss,a� 2.R�6�.�i�i�'s. a� � ��1,_.,«? Q< �'i�..,.l�1�� N S'��c.�e... i3t►ct�.�t,.�ar�,,�_t � Ekuw�':�„<�«��C. 2t,�,.d> P1p� 574� ��.-�A��.S. �'� �'cc St.�+nsTo•'� f1<<i 1 �� % S'�, iV • a� 1 hereby ansent that bcal law enforcement officers, ihe board or agents of the board, or ihe ccmmissioner of revenue or public satery, or agents of the cammissioners, mzy enter the premises to anforce the law. Bank Records Informatioa The board is autharized to inspect the 6ank records of the ganbiing account whenever necessary to fuHil! requirements of current gambting rules and law. Oath t dedare Ihat: -I have read tfiis appiication and afl iniormatron submffied to the board is true, accurafe and compiete; •aA other required in ha b een fuify d is c lo s e d; S , SS4�� waf"« $5371 h"1 c -w�� r zd,a�.: •i am ihe chief oxecutive otticer ct the organizatan; •1 aswme tuA responsiblity tor the tair and lawful opera- t+on ot atl activities to be conducted; �4 wi!{ familiarize myse�t with the laws ot Minnesota governing fawfut gambling and tules of the board and agree, fi licsnsed, to abide by Ihose taws and rufes, incfuding amendmenls to them; •any changes in application iniormation wiii be submittsd to the board and bcai unit ot government within 10 days of the chan9e; and •I understand th2t faiture to provide required information or providing false or misleading iniormation may resuit in the denial or revocation of the Iicense. Minnesota Lau�,ful Gambling Premise Permit Application - Part 2 of 2 Date �3/ 9$ chief ezecu2ive oNicer , ^ "�� Loca1 Goveriirrie�t Acknov 7. The city'must sign this application if ihe gambting prem- ises is Iocafed wRhin city limits. Z. The county ••AND township'• must sign this appl'wation if ;he gambling premises is located within a township, 3. The tocal unit govecnment (city or county) must pass a resolution speciticaliy approving or denying this a¢plicat+on. Cuy or Cc C Signa�ure Tine (_ � Date Reeeivec � �3�Q Refer to the instruaions tor required aaachments. Maif W: Gamb1{np Control Soard Roaewood Plass South, 3rd F1cor 1711 W. County Ro�d 8 Rosevllle, MN 551t3 , .. ._ .. - , ... .. .. _. . . ..,:::.: =:.«�., ..•:._.:..-_.::_.;,:,::: 4. A cow of the local unit of oovemmeM's Tesofution ao- Qrovingthis aDOtication must be attached to tnis ao�lication 5. if this application is denied by the bcat unit of government, it should not be submitted to ihe Gambling Control Board. Township: By signature below, the township acknowledges that the organizalion is applying for a premises permii within township limits. Townstiip Name S�gnaNre of person rerniving applkcation Title � Date Rece'sved LG21<(Part 2) �a«7rna+� � ! 1 �� `J �z..,_