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98-442Council File # � � "�1 �a' Green 5heet # � C) 8��-5 RESOLl1TiON SAINT PAUL, MINNESOTA Presented Committee Date Refecred To 1 RESOLVED, That applicarion, ID#19980000424, for a Bingo Hall License by T.S.T. Ideai Aall {Stacy Mulson, 2 Antonio Moran and Steven Ahlquist, Co-owners) DBA Ideal Hali, 1494 Dale Street North, be and the same is 3 hereby approved. Requested by Department of: Benanav Blakey Bostrom Coleman Hazris Lantry Reiter iopted by Council; Date �2� lopti Certified by Council Secretary '. 9 \ �. �- � lr-�-iAv-„�x� � . By, � — . !�t' � Form Approved by-City Attomey By: �/ Approved by,Mayor for Submission to Council By: ( �roved by Mayor: �,,�,�,a,� __ ___ - ---- _ .__ __.__ ��y�z sizsi9a GREEN SHEET No fi0895 Gerry Strathman oorr.Artt�rt p�crue ctrvcoun. � TOTAL # OF SIGNATURE PAGES a Ml'ATTOMEY ❑ 41YGEIK _ ❑ wuwcutttcav�cFSOU�. ❑ wuucw.mm�eeta ❑ r�voxiwe�itmsrrNry ❑ (CUP ALl IOCATIONS FOR SIGNATURE) Approving application for a Bingo Ha11 License by T.S.T. Ideal Hall (Stacy Mulson, Antonio Moran, and Steven Ahlquist, co-owners) dba Ideal Hall, 1494 Dale Street North. (ID I119980000424) PLANNING CAMM�SSION CIB COMMRTEE CIVIL SERVICE COMMISSION [l'P��1��/T-'.''1 Ffas+nis aersonRrm ever wakea m,aer a awn,acc rw utis depanmem4 YES NO F�s tlxa D��Mrtn erer hem a cdY emObYee? YES NO Does this PerwNfi�m Possess a siuN not namaM'P�sessed bY a�Y �� 1' IN�P�oYee7 YES NO Is this pxsorofirtn a tazgeted vendoR YES NO L AMOUNT OF TRANSAC710N i CO3TIREYENUE BUD6ETED (CiRCLE ON� YES NO INQ SOURCE �y i �Ir� (: CTli !=I�3 w, iHFORwnnoN tezvwp �3'�5�5�� Minnesota Lawfu{ Gambling Bingo Hai1 License Apptication - LG30U A bingo hall license is requirad for any premises where more than one organizatio� conducts bingo. Hall lnformation Name of Bingo Ha1t ..�DC'A � N Street Address ot Bingo Hati I I q V 9f1��' S? Phane Numbes (6��z ) � K' 6`'�1 MaOing Atldress (if different from abave) Type af Business (checkone box) Sole Proprieforship Partnership Liability Co. Tennsssen Waraing: The informatian requested on th+s form (including any attacbments} witi be used by the Gambling Controi Soard (8oard} to determine your qualifications to be invokved in lawful gambling activities in Minnesota, and io assist the Board in co�ducting e background investigation of yon. You have the rigtrt to retuse ta supply the informaiion requested; however, if you refuse to suppiy this information, the Board may not be a41e ro determine your quatificaGans an�Y, as a consaque�ce, may refuse to issue you a license If you supply the irtformation requested, the Board witl be abfe to process your application. If the Board does not fssue you a license, ail information provided in Me process of apptying tor a license remains pcivate, with She exceRtion of your name and address which witi remain public. �age 1 of 2 {198 f•T7"11 Frm Fes Date ! t Chk. initials License No. BH Privake data about you is available oniy to the foilowirtg: Board members, staH of the Board whose work assignment requires that they have access to the information; the Department of Public Safety; the Attorney Generai; the Commissioners ofAdministratiofl, Firrance, and Revenue; the legislative Auditor, natlonaf and internationat gambling regufatory sgencies; anyooe pursuantto court order; other individuais and agencies thatmay be specifrcatty authorized by state or fcx{era4 faw to have access to such infarmation; individua�s and agencies for whicfi law or legal order authorizes a new use or sharing of the intormatioo after this notice is given; you: and ar.yone wRh your written wtt«ent. Questions on this form ShouM he directed to the Gambling Conirot 8oatd at (@12j 639-4000. Hearing �mpaired individuals using a T7Y may call the Minr.esota Relay Service at 1-8Q�-6273529 and ask to place a cafl to (612) 639-4000. 4h+s pub6cation wi11 be made available in altematrve format (i e. large print, Brailte) upon request ivumber { Minnesota Sales and Use 7ax ID Number {if none, write "None'�: � ��'=�Iy2 Bingo Hail License Application -1.G300 Aage 2;�8 Loca! 11n+t of Goverflment Acknowfedgment tf the gambling premtses is within cEty iimits, the city must stgn this appilcatlon. On behatf of the city, 1 acknowledge that this aqpiication wiii be fonvarded to the appropriate city. officiafs, the city must pass a resolutia� specificaily approving or denying this application, and a copy of the resolution wiii Be forwarded tfl the appiying Of9dt1lZ0fipR. Print name of city: {Signature af city personnel teceiving � �<� /%'oC1/'� % Title /1'/ �iy, i-a_ P�` gambfing prsmises is located in a tovimshtp;`�bofh #he county and township must sign this apppcatlon. F�,r the townshio: On behalf of the township, 1 acknowledge, by this signature, awareness oF this appfication and that the township has no authority to deny or approve an appfication. �or the countv� On behaif of the counry, i acknowlecfge that this application wiil be forwarded to the appropriate county officiafs, the county must pass a resolution spec�calty approving or denying this application, and a copy of the resolution wiff be forvrarded to the applying organ'szation. Print name of tow�ship: (Signatura of township Title Date / Print name of county: of county Oath apptiication) • t declare that this application is correct and com- plete to the best of my kncwiedge and belief. • i wi11 #amiiiarize myself with the laws of the state of MinnesoYa and ruies of the Board regarding gamb- ling and agree, if licensed, to abide by those taws and rules, inciuding amendments to them. � i declare that I am qualified under the terms of Minnesota Rules, part 7862.0010, subpart 3, to be licensed as a bir�go hall and wili abide by the restrictions seY forth in Minnesota Rules, part 7882.0090, subpart 4. _ i declare that any lease agreements between the bingo hati liceasee and iawful gambling organizations wifl specificalfy identify any goods or services that the organization is required ±o purchase from the lessor or a thfrd parky vendor, and khat all goods and services furnished as Qart of the lease agreement wifl be vaiued at their fair market value. • Ghanges in the information submi8ed in this appiication wiii be submitted in wriiing to the Board and tocal unit of government within Yen days after the change occurs. Signature of CEO of the Lesso `r / �� t �'� Date Attach the Foltowing and Mail � LG30Q, Singo HaII License Applicatiort; ti� L�302, Bingo HaA Occasion List; �i LG315, Bingo Hali Personnel Information; J Proof of ownership {warranty deed, contraci for deed, property tax statement, or other); J Locat unft of government approval resolu6an {for c'rry or county}; and v Gheck for 52,5001icense fee payable fo "State of Minnesota" (fees are consi@ered eamed artd afe not prorated or transferrable}. Maii application and attachments to: Gambling Control Soard Suite 300 South 1771 WesY County Road B Roseviile, MN 5511a 98-� Minnesota Lawful Gamblin,g Bingo Hall Occasion List - LG302 Bingo Halt Name � n Fn � t �� ` Address `'V ,Z—N 1T l� Rotafing Schedule: Yes (If yes, sutmd a calendar with the name of the No t' Scheduie rr9s conducting bingo on each day.) I Name of Organizalion Organization's Premises Permit or Hours of Conduding Binga Occasions Exempiion Permit Number or Singo , EuGuded Authorization Bingo Date Occasions Sunday { Monday � a G �^F«M%NF �� Tuesday 1 �' firr � - Wednesday Thursday Friday `� t r/'�/ut SaYurday � No more than 21 bingo occasions are permitted at each hall perweek. � ff the organization dces not yet have a number, write "permii (or exemp- tion} appiied for." 3 Enter fhe starting and ending times for each occasion (for exampie, 7-9 p.m., 3:30-& p.m.). A bingo occasion must be at least 90 minutes and no more than four hoursiong. Ghanges in the above information mustbe submifted in writing to the Hoard within ten days. A change occurs itan erganization canducts bingo on a day and time ather t6an that reflected ore the 8ingo Ha11 Occasio� list, or'rf an organlzation is added or deleted on the schedule. Mai1 this form to: Gambfing Controi Board Suite 3A0 South 1711 W. GounEy Road B Roseville, MN 55113 Questions on this form should be directed to the Gambling Controf Board at (612) 639-4000.1f you use a TTY, you can call us by using the Minnesota Refay Service at 1-800-627-3528 and ask to place a caii to (612j 639-4060.7his form wiil be made availabfe in alternative format (i.e. large print, Braille) oport request. The information requested on this form will became publ+c in{ormation when received 6y the Board, and wiN Be used to determine your CamplianCe with Minnesota statutes and rules governing {awful gambiing activities. 9 � �y� �:��z.�:y� Date: May 12, 1998 Tune: 6:00 p.m. Place: Room 330 City Hall 15 West Keliogg Boulevazd LEGISLATIVE HEARING Gerry Strathmau L.egislative Hearing Officer Ideal Hall,1494 Dale Street North The Legislarive Hearing O�cer recommends granting the license. 98-�� --- MINU'I'ES OF Tf� LEGISLAT`IVE HEARING FOR IDEAL HAI.L, 1494 NQRTH DALE STREET May 12, 1998 Room 33Q City Hall Gerry Strathman, L.egislative Hearing Officer STA�F PRESENT: Christine Rozek, Office of License, Inspections and Environmental Protection (LIEP). Note: This matter will be considered at the May 20 City Council meeting. Getry Strathman called the meeting ta order at 6:00 p.m. Gerry Suathman reported this is a legislative heazing to deal with objections that have been raised to the issuance of a bingo hali license for ldeal Hali at 1494 Dale Street North. Antonio Moran, applicant, and 7oe Perkovich, previous owner, appeazed. Christine Rozek reported the new applicant is T.S.T. Ideai Hall. The principals of that corporation are Stacy Mulso, Antonio Moran, and Steven Ahlquist. There are seven requirements all of which have been met: all state forms have been received, City Workers ComplTa�c ID Form has been received, the license fee has been paid, the police record check has been done and is okay, the zoning has been approved, a current certificate of occupancy from the Fire Department has been done, and the bingo hall is located at least two miles from another bingo hall. The bingo occasions are on Monday, Tuesday, and Fridays, 1:00 to 5:00 p.m. There are cunenfly conditians on the license of no more than nine bingo occasions a week. The District 6 Planning Council has approved tlus application. The LIEP office recommends appmval. Gerry Strathman asked were there any present or pending adverse actions against this license. Christine Rozek answered no. Steve Battisto and Marion Battisto, both of 1500 North Dale Street North, appeared. Mr. Battisto stated his primary concern is the loud music on the weekends when the haii is rented. On several occasions, Mr. Battisto has cleaned up vomit around his building. There is excess tra�c and his driveway is blocked at times. He picks up pull tabs constanfly, although this is minor. The doors are sometimes open an the bingo ha11. Ms. Battisto stated she picks up debris sometimes. There are fights occasionally. Gerry STrathman asked were they concerned about events other than the bingo. Steve BattisYo responded the bingo is tolerable. Marion Battisto responded she gets stale cigarette smoke coming in one window. The exhaust system may not be high enough. The smoke can be so overwhelming she has to leave the room. Gerry Strathman stated he received a call from someone who identified herself as from the neighborhood. This person did not identify any cunent problems. The Craffic in the alley has gone away, and she has no probiems with the bingo. Mr. Strathman read a letter received from Ron and Debra Carlson, 601 Arlington Avenue West, who writes they aze against the business 9�� Yyz _— LEGISLATIVE HEARING FOR IDEAL HALL, 5-12-98 Page 2 of 3 getting a Class C liquor license, but a liquor license is not being applied for. Christine Rozek stated she tried calling the Carlsons but could not reach them. Antonio Moran stated people are out of the buiiding at 12:3Q a.m. when thcre aze weddings. A police officer is hired and checks to make sure people leava. Mr. Moran is cleaning unti12:30 a.m. At that time, there is no one in the parking lot and the cazs are gone. Mr. Moran stated he has only been there a month and a half and this is tus experience. Steve Battisto stated it is not noisy all the time. Marion Battisto stated she can hear muslc sometimes in her hause. Antonio Moran suggested the Battistos ca11 the hall so the music can be turned down. Joe Perkovich stated he let the Battisto's customers park in his lot. Also, Steve Battisto will not prune his trees that hang into the street. Marion Battisto stated she received a death notice on her answering machine from Joe Perkovich and he pazks his truck in the alley day after day. The police had to be called to get him from doing that. Gerry SCrathman stated these personal issues do not belong at this meeting; the only issue is if there is a basis to denp this license. Gerry Strathman asked are there any accommodations that can make the operations less objectionable to the neighbors. Antonio Moran responded if there is loud music, the Battistos should ca11 him. He does not have a lot of money so the bingo heips him pay the rent. Steve BatCisto felt that some sort of sound proofing can be done to deaden the noise. The noise may be a nuisance to a new tenant. The tenant that lives in the front works at night. Gerry 5trathman responded the City can measure the noise with a sound measuring device if it is ongoing. Arrangements can be made ahead of time if loud noise is expected. Antonio Moran stated he is wiiling to turn the music down and does not want to be an enemy. 7oe Perkovich stated the ceiling is dropped down and does not know why anyone can hear the noise. Gerry Strathman hoped the applicant heazd the concerns here and will do something about it. However, these concerns do not rise to the level of denying the license. Until the City has estahlished that the police have been called repeatedly or the binga hall is constanfly breaking the noise ordinance, there is not much that can be done. There is no record of violations. Steve Battisto stated a record could have been established along the way. Antonio Moran stated at the district meeting a few weeks, one neighbor said he liked the hall. Steve Battisto asked was he notified of that meeting. 7ae Perkovich responded everyone in the neighborhood received letters. Gerry Strathman stated the district council organized that meeting and he was not sure if Mr. Battisto was notified. Antonio Moran gave Marion Battisto his phone number and told her to call him if there ate any noise problems. Gerry Strathman recommended this bingo hall license be granted. Tl�e meeting was adjourned at 6:28 p.m. 9 �'-yyZ Minnesafa Lawfui Gambling Binga Hali Fersonnet information - lG315 Compfete this form if you are lisfed under "Owner tnformation" on the 1G3�� 8ingo Hati �icense Application. Singo Hail lnformation Name a.' Bingo Nali Licer,se Numbei �nc�r L/411 BH r'l(? i Address � 3. Home Address �IG� 4. Home Telepho (��2 ) 7 5. Full Name at: Gcense Number Name CRyJStatefLip BitthPiace (city. 51ate, and proveicet �ates or serv:ce Yes L1 No 6. Chec3c all that aAP�Y with Bingo Hali: a.} k pwner 6)_SOIe Propnetor5hip c.) X Persort or Eatity with a direct or indirect flnaociat mterest of fiva percent or more d.},Partner e.)�Corporate Officer fJ�Director 4.)�Manager hJ_Supervisor Bingo HaSt Duties: Z Emp4oyment record for tfle past ten years. Wst the most current first, incfuding dates of unemployment or educalion (list schooi and address). if you owned a business in Minnesota, include the Minnesota 3aies Tax and Use ID Number. Use additional sheets i1 necessary. Emptoyert5chool Address Position held Dates Type of Business MN Saies CurrenC �Jtf: •Pe52: Tetephone �G12 � y Page 1 of 2 ,�ae Fuii Middle Name i U /?'l.4 /`iG e Social Security Number y�s- �u 53�t �. � 8. Place ot residence for #he past ten years (use addifional sheets if necessaryJ: Address CitylStatelZip cuaenr 1 t63 %7 5� N. D�/'OAC.c /hN SS 1 Pesr �,'/� f1A5f% }� U. Nc�..� Par� Dates ef Residenoe i _ <i'� _ A�� z �K � 9. Criminal history statement (except petry m.isdemeanors). Inctude the date you were charged, the cityJstate where the charges were filed, and tfie disposition of the case. 4f none, write "none." {ysi t4�E ssame, addtess, aad license or exemption percrit nomtrer of any exciuded organization yau belong to which conducis Iawful gambiing in Of F_YemOtron Permrt NumbO! .S' �/Z QltSo� CA�rr% i and na^+e antl adGress ot any If none, write "none." Tue 7Me ' T�ne (w�tinued a� ��lY x g��YyZ Bingo Hail Personnei fnformation - LG315 License No. � Name of 8mgo Hall Personrtel Name Page 2 of 2 1/98 �ath and Consent t t have never been convicted af a fetar,y. 2. f have never been convicted of a crime involving gambling, 3. i have neve� been convided oI assault. a criminal viotation invofving fne use of a firearm, or making tertoristic threats. 4. I am not current�y ot have never been engaged in a connected wAh an iNegal business. 5. I do not owe $500 or more in delinquent tazes to the state of Mirrtesota. 6. I have nat had a sales and use tax permit ravoked by the commissioner cf revenue within the last two years. 7. I have fited, after demand, tax returns required by the commissioner of revertue. 8. I am not a ficensed distributor or affiliate of a disinbutor urtder Mina Stat. sec. 3d9.161. 9. f am not a ticensed manufacturer or aKliate o£ a manufacturer under Minn. Stat. sec. 348.163. 10.1 witi not 6e an officer, director, paid employee, or volunteer of a licensed, exempt, or excluded organization in its conduet of lawtui gambiing, or represenk a licensed, exempt, or exciuded organization in the purchase of, ar influence the purohase of, lawful gambfing equepment t i. I am not a whoiesale disVibutor or an affiliate or an employee of a wholesale distributor of aicaholic treverages. 12. I wilt not provide any staif to conduct or assist in the conduct of bingo ar any other form of lawFul gambling on the premises. 13.1 will not acquire gambiing equiRment or provide inventory control fior any arganization that conducts IawFul gamDiing on the premises. 14.1 will not prepare or assist in the preparaGon of any reports raquired by Minn. Rules, part 7861.0120, subp. 3, for an otganization canducting IawfW gambiing on the premises. 15. t wilt not ptaviCe accounTing services to any ar9anization conducNng fawfW gambling on the premises. t6. ( wiii not solicit, suggest, encourage, ormake any expenditures ot an organizafion's gross receipts from lawful gamhling, t7. I will not chatge any fee to a person without which the person could not play bingo or participate in another form of lawful gambling on the premises. 78. � wilt noF provide assistance or parficipate in Yhe conduct of law£ul gambiing on the premises. 19. t wiil not percnit more than Zt bingo occasions to be conducted on the pcem+ses in any week. 20. I will not recruit a person to become a gambling manager or assisant gam6ling manager or identily to an organizatian a person as a candidate to become a gambling manager oc assistant gambling manager. 21. I wiii noi be involved in the procurement of, or irtiluencing tne procurement of, IawfW gambl'sng equipment for an organ¢ation which conducYS lawful gam6ling on the iicensee's premises. 22. t wi0 not provide or permit an a�liate or persort acting on behaff of the bingo hait ticensee ta provide any compensation. 9iR, gratuity, Premium, contribution, or thing of valus to a Gambling Controf Baard empbyee or member of the Gambling Controi Boartl. 23. i wi11 not directly or mdirectly give gifts, trips, prizes, toans of money, premiums, or other gratuiSes to 9ambling organiza8ons, or their empbyees, other than nominal gifts not to exceed a value of $25 per o�ganization in a calendar year. i� addition, 1 understand, a9ree, and hereby irrevocably consent that suits and actions relating to the su6ject matter of ffie bingo haii license appiication, or acts or omissions arsing fran such apptication, may be commenced against me in a�y court of campetsnt jurisdiction in Minnesota by service on the MinnesoW Secretary of State of a�y summons, process, or pieading authotized by thz laws of Minnesota. By signature of this document, the undersigoed authorizes the Department of Publia Safety to conduct a background investigation porsuant to Minnesota Rules, paR 7862.0010, subpart 10. 6URTHER AFFIANT SAYE'fH N,T , pt that this Oath and Conserrt Statement are sup rt of the appticaGOn for a bingo hal '. �_rf .��.fbiing C trol Board. �`C �;'� MY �° �..�— �/ � /771AD" GTZfiG��, � . _.,-a5;2✓�� ( 1 of� I �� (Signature of Binga NaA Personnei Applicant) .� / ; (Date Signad} fi�scribed and swom to befor jq�e this �� day of I_ 7 �CZLc� J , 19 �� ( r 3 / i� (COmmission expiradoN Attach and Mai! Attach all LG375 forms to the LG300 Singo Hal{ License Apptication fortn, ar submit when information chaoges, and send to: Gambling Control Board Suita 90o South 1711 West County Roed B Rosevllle, MN 55113 Tennessen War�ing: 7he informatian �equested on this form (inUudiog any atcachments} wiii be used by the Gambiing Control Board (8oard} to detertnine your qua4ifications to be involved in 'awful gambiing aCtivities in Minnesota, and to assi5t the 9oarci ia ;onducting a tradcground investigation of you You have the right to �efuse to suppiy the information requested; hawever, if you refuse o supply this intormaicon, the Hoard may not 6e able to determine our qualifi;ztions and. as a cansequence, may refusa to issue you ilc2nse if you supply the mformaUOn requested, the Soard wNl he 51e to process yaur application If the Board does not issue you a :ense, aft informaUOn provided m the process of app�ying for a ense remains prtvate, with the exceplion of your name and atldress vch wdl remain pub6c. Disctosu�e of Sociat Security Namber You are required to provide your Social Security number on ihis form. Your Sociai Security number wiii be used to determine your compliance with the tax faws of Minnesafa. Authorization for requiring yaur Sociai Security number is 4ound at U.S.C. 405{c)Si). Private data a6aut you is avaiiabte oniy to the foifowing: Soartl mem- 6e�s, staff of the Board whose work assignmeot reqwres that they have access ta the inEormation; the DepaKment of Pubttc Satety; fhe Attorney General; the Commissioners ofAdmin'wtraticn, Finance. and Revenue, the l.egisla:ive Auditor, national and intemationai gam- b4ing regulatory agencies; anyone pursuant to court order; other indiwduals and agencies that may be specificaliy authorized by state ar fedesal law to have access to such inEormation; indiv�duals and agencres for which taw or lega! orde� authorizes a new use ot shar- ing of the mformation afte� this notice is givea, you; and anyaee wrth your written consent This form wdl 6e made avai4able in aiter- native formaf (i.e large pnnt, Braitle) upon request � 98-�/�{� Mirrnesota Lawfu! Gambting Bingo Hall Persannei information - LG315 Comptete this form if you are Iisted under "Owner Intormation" on the LG300 Bingo Hatl License Application. Bingo Hall Information Name of Bingo Hail License Number (i i D��-� H-R�-�. sH c�oa Address CitylStatelZip TefeRhone i � � y y� .il I•� �� S � S t � g � �.�.� Ssif 7(�a )< Personnei information 1. Lasf Name First Name Full Middle iVame A tF t-C� v j s r' S±£��,� /y/ i c�fA-F t.. �2. Maiden Name Previous Name Social Securitv Numb 3. Home Address CirylStata�p fa 7� (� oo �B �6E S i_ S� - 4. Home Telephone No. Drivers License Number State of (G,1.�)�/�7_�s/r19 d_i./�� - �7�-��z_A7� Page 1 of 2 1/98 r•� //� ' CPlA ^ /a' 7 ✓ Msv. SS�l7 of Birth Birthplace (caty, state, and province} �j3�.�3 S � PP�V L !�?Al , Dates of Service U.S. Citizen? Yes l� No 6. Check all that appry with Bingo Hall: aJ_�Owner b.)_SOIe Proprietorship cJ � Person or Entity with a direct or in�lirect financiai interest of five percent or more d.)_Padner e.)_ CZCorporate Officer fJ_Directar g.) � Manager h.)_Supervisor Bingo Hatl Duties: 7. Empfoyment record for the past ten years. List the most current first, including dates of unemployment or education {Iist schooi and address). Ifi you owned a b�siness in Minnesota, include the Minnesota Saies Tax and Use ID Number. Use additional sheets if necessary. EmployerfSchool _ Address _ �,� ,� Position beld Dates Type of Business MN Sales E:� CurrentTST CQfAt�.c6 Cft�eR�N� e ° �£�64 I T3 �� Past: /rliqwccT /'�✓r7 . Sroox Fa�.�s sv t��...,-�..,cf "1'a ¢.Tll[,A- G�a1r 5 � �RPlF✓a+D p�„L S J„E••�-*SCK� f�nR � �,�,.� Ca'��< b P{ace of residence for the past ten years (use additional sheets if necessary): Address CityfStatelZip Current: Past: ^ TaXNO. ��G— v� '�l. 1812;/� ✓-9S .Ss+coNs - 9Y s<T.w�.,r JG4�6 97 - 9i �i.a-� Dates of esidence SSn 7 9j/ 7� - i�P£.tE.� 9. Criminal history statement (except petty misdemeanors). Incfude the date you were charged, the citylstate where the charges were fiied, and the disposition of the case. If none, write "none ° 0. List the name, address, and Iicense or exemption permit number of any organization and name antl address ot any excluded organization you belong to which condu�rts tawfuf gambling in Mi�nesota. If none, write "none" .� . .. .. . . _ , � � (continued on 0 98-yvz Bingo Hall Personnel Information - LG315 License No. Name of Bingo Hall BSi ! t7F�t� {i�4�C_ Oath and Co _ . _ Page 2 of 2 1/98 Personnel Name STErf� ��-QU�S) 1. I have never 6een convicted of a felony. 2. I have never been convictetl of a cnme involving gambling. 3. I have never been convicted of assault, a criminal vio�ation invoWing the use of a firearm, or making terroristic tfireats. 4. 1 am not currently or have never been engaged in or connected wfth an iliegal business. 5. 1 do not owe $500 or more in delinquent taxes to the state of Minnesota. 6. 1 have not had a sales and use tax permit revoked by tfie commissioner af revenue within the last two years. 7. i have fited, afYer demand, tax retums required by the commissioner of revenue. 8. 1 am not a licensed distributor or a�liate of a distributor under Minn. Stat. sec. 349.161. 9. I am not a licensed manufacturer or a�liate of a manufacturer under Minn. Stat. sec. 349.163. 10.1 will not be an officer, director, paid employee, or votunteer of a licensed, exempt, or excluded organization in its conduct of IawFui gambling, or represent a Iicensed, exempt, or exciuded organization in the purchase of, or inFluence the purchase of, lawfuf gambling equipment. 11. I am not a whofesa{e distributor or an affiliate or an employee of a wholesale distributor of alcoholic beverages. 12. I will not provide any staff to conduct or assist in the conduct of bingo or any other form of lawful gambling on the premises. 13.1 wiii not acquire gambiing equipment or provide inventory control for any organization that conducts lawful gambling on the premises. 74. 1 wiil not prepare or assist in the preparation of any raports required by Minn. Rules, part 7861.0720, subp. 3, for an organization conducting lawfui gambling on the premises. 15. I will not provide accounting services to any organization conducting lawful gambl+ng on the premises. 16. I will not soiicit, suggest, encourage, or make any expenditures of ao organization's gross receipts from lawfu! gambling. 17.1 wiil not charge any fee to a person without which the perso could not play bingo or participate in another form of gambiing on the premises. . , � � ..�� ,..a��.� k1t and sworn to before me this��! day of Attach and Mail Attach all LG315 fortns to the LG300 Bingo Hail License Application form, or submit when information changes, and send to: Gambiing Contro! Boartl Suite 300 South 1711 West County Road B Roseville, MN 55113 'ennessen Warrting: The information requested on this form �nctuding any attacbments) wiil be used by the Gambling Control oard jBoard) to determine your qualifications to be invotved in wfuf gambiing activities in Minnesota, and to assist tfie Board in mducting a background investigation of you. You have the tight to fuse to supply the information requested; however, if you refuse supply this informatwq the Board may not be abie to determine ur qualificaNOns and, as a consequence, may refuse to issue you cense. If you suppiy ihe information requested, the Board will he e to process your application. If the Board does not issue you a nse, all �nformation provided �n the process of applying for a ase remains prrvate, wdh the excephon o( your name and address ;h wdl remain public 18. 1 wiit not provide assistance or partic+pate in the conduct of lawfui gambiing on the premises. 19. I will not pertnit more than 21 bingo occasions to be wnducted on the premises in any week. 20. I wifl not recruif a person to bewme a gambling manager or assistant gambling manager or identlty to an organization a person as a candidate to become a gambling manager or assistant gambling manager. 21, I witl not be involved in the procurement of, ar influencing the procurement of, lawFul gambting equipment for an organization which conducts Iawful gambling on the licensee's premises. 22.1 wiU not provide or perznit an affiliate or person acting on behaif of the bingo hail licensee to provide any compensation, gift, gratuity, premium, contribution, or thing of value to a C�ambling Control Soartl employee or member of the Gambting Control Board. 23. f wiil not directly or indirectly give gifts, trips, prizes, loans of money, premiums, or other gratuities to gambling organizations, or thei� employees, other than nominal gifts not to exceed e value of $25 per organization in a calendar year. In addition, I understand, agree, and hereby ircevocably consent that suits and actions relating to the subject matter of the bingo hall license application, or acts or omissions arising from such apppcation, may be commenced against me in any court of competent jurisdiction in Minnesota by service on the Minnesota Secretary of State of any summons, process, orpleading authorized by the laws ot Minnesota. By signature of this document, the undersigned autfiorizes the Departme�t of PublicSafety to co�duct a hackgrou�d investigation pursuant to Minnesota Rufes, part 7862.0010, subpart 10. FURTHER AFFIANT SAYE7N N07, ezcept that this Oath and Consent Statement are s� d N support of the application for a bin o � � ambl ag Control Board. rr�enuS1RA J. G1E ._' ,.,� � i 20�9 r; �-",.. g/ , '� l o�� 1 / d (f7ate Signed) , is 9�' � r�L� aCOd (Commission expiration) Disciosure of Social Security Number You are required to provide your Social5ecurity number on this form. Your Social Security number will be used to determine your compfiance with the tax laws of Minnesota. Authorization for requiring your Social Security number is found at U.S.C. 405(c){i). Private data about you is availabte only to the following: Board mem- bers, staff of the Board whose work assignment requires that they have access to the information; the Department of Pubtic Safety; theAttorney Generat, the Commissioners ofAdministretion, Finance, and Revenue; the legislativeAUditor, national and intemational9am- bling regulatory agencies; anyone pursuant to court order, other individuais and age�cies that may be specificaily authorized by state or federal law to have access to such information; individuais and agencies for which law or fegal o�der authorizes a new use or shar- ing of the information after this notice is given; you; and anyone with your written consent. This form wiN be made available in alter- native format (i,e. large pnnt, Braille) upon request y �- yy� Minnesota Lawful Gambitng st�sres Bingo Ha11 Personnel Information Page 1 of 2 Compiete this fortn ff you are listed under "Owner Information" on the LG300 Bingo Hat! License Application, or within ten davs after a change in i�formation. Incomptete, faise, or misteading applicaUon information may resuit in denial of a license. Home Addrass State Zip Gode M N 551`2 s�rtnPtace c�ry a�a sraa City Fuli Middfe Nai ,d none, wrtte "no �� -f�J �tary Service Oates af Senice � US. Cflizen: - If no, enter regi: � t � N� J�Yes p No / wfth Bingo Hafl (chedc one): �Sole Proprietarship � Managet O Supervfsor � Partner O Corporate Officer (� Director ient RecorU for the past ten years tuse separace sneei, n i(school, address, dates). if you owned a business i� M Empioyer Atldress Posttion Held of Residence for the past ten years (use separate sheet, if necessary). Atldress City State 21p Cade Name Social Sewdty P Q�a'-�8-� Homa Phone � ��/!'7��X..�� Dates of Residence � — �� 21�, _ S.JG Criminal History Statement (except petty mistlemeanors). �nauae me aa[e you were cnargea, me ci[ps�a�e wue�a u�c u�a�y�� .._,_ filed, and the disposition of the qse. If none, write "none" (Use separate sheet, ff necesSary.) ►JON� iinnesata, or name and address of any excluded oi Organizatbn �e� OrganizaQOn Adtlress Address Licenae )rganizatlon Addres! Lkense w ). Indude periods of unempioyment (dates) or iclude the Minnesota Sales Tax and Use ID Number. Dates 7ype of Bustness MN Sales Tau # = v. P. 51q2- �r�nt ca:te� - i8�2� •rr nni.�. �Ican , .�iocor� nlrir.c �1 you belong to which contlucts iawru� ga�� of titfe: Member.) If none, write "none." License or Exempt Pertn@ Number � nne Tiqe Nvmbar TNe Numbar Tide (conUnued on back) 1 Personnet information � Hall Personnel Informatioa Oath and Consent Statement t. I have never been convicted of a felony. 2. t have never been convided of a crime invofving gambting. 3. I have never been convicted of assault, a uimi�al violation in- valving the use of a firearm, or making terroristic threats. 4. I am not currenUy or have never 6een engaged in or conneGed with an illegat business. 5. 1 do not owe $500 or more in deiinquent taxes to the state of Minnesota. 6. f have not had a sales and use tax permit revoked by the com- missioner of revenue within the last two years. 7. f have filed, after demand, tax retums required by the commis- sioner of revenue. 8. t am not a licensed distributor or a�liate of a distributor under Minn. Stat. sec. 3d9.161. 9. f am nat a iicensed manufadurer or afhliate of a manufacturer under Minn. Stat. sec. 349.163. 10.1 wilt not be an officer, director, paid employee, or volunteer oE a licensed, exempt, or excluded organization in its conducf of tawful gambling, or represent a iicensed, exempt, or exduded organization in the purchase of, or influence the purchase of, IawFul gambling equipment. t t, l am not a wholesate distributor or an affiliate or an emplayee of a wholesale distributor of atcohotic beverages. 12. t wiii not provide any staff to conduct or assist in the conduct of bingo or any other form of lawfut gamhling on the premises. 13. � wiA �ot acquire gambling equipment or provide inventory con- tro! for any organization that conducts tawful gambiing on the premises. 74. i will not prepare or assist in the preparation of any reports required by Minn. Rules, paR 786M1.0120, subp. 3, for an orga- nization conducting lawfui gambiing on the premises. 15.1 wiil not provide accounting services to any organization con- ducting lawful gambling on the premises. f6. I wiil not solicit, suggest, encourage, ormake any expenditures af aa organization's gross receipts fran lawful gamblirtg. � 17. I wili not charge any fee to a person withaut which the person cou(d not pfay bingo or participate in another fortn of IawEui , gambling on the premises. � swom to before me this .—��O{ day of Public) S 8-�i4� LG315— 8i18t98 'a9e 2 of 2 18. I will not provide assistance or participate in the condud of tawfut gambling on the premises. " 19. I wiil not pertnit more than 27 bingo occasians to be rAnducted on the premises in any vreek 20. t will not recruit a person to become a gambling manager or assistant gambting manager or identify to an organization a person as a candidate to become a gambiing manager or assistant gambling ma�ager. 21.1 will not be invoived in the procurement of, or influencing the procurement af, lawfut gambting equipmerrt for an organization which conducts fawFul gambling on the licensee's premises. 22. I wili not provide or pertnit an afifiliate er person acting on be- half of the hingo hall iicensae to provide any compensation, gift, gratuity, premium, conV7butian, orthing ofvalueto a Gam- bling CanVCt Boazd employee or member ofthe Gambling Con- trol Board. 23. ! will not directiy or indirectly give gifls, Vips, prizes, loans of money, ptemiums, or other gratuities to gambling oiyanizations, or the±r employees, other than nominal gifls not to exceed a value of $25 per organization in a calendar year. In addition, 1 understand, agree, and hereby irrevocabiy consent that suits and actions relating to the subject matter of the bingo hall license application, or acts ar omissions arising ftom such ap- piication, may 6e commenced against me in any court of compe- tent iurisdidion in Minnesota by service an the Minnesota Secre- tary of State ef any summons, process, or pieading authorized by the laws of Minnesota. By signature of this document, the undersigned author¢es the Depariment of Public Safety to conduct a background investiga- tion pursuant to Minnesota Rules, part 7862.0010, subpa�t t0. FURTHER AFFIANT SAYETH NOT, except that this Oath and Consent Statement are submitted in support of the application for a bingo hail license from the Gambiing Control8oard. 'ennessen Waming: The information requested on this form (inGuding any ttachments) will be used �y the Caam6ling ConUOI Board (Board) to deter- iine your quaiifications to be involved in lawful 9ambiing activiUes in Min- �sota, and to assist the Board in conducGng a baUcground imesUgation of �u. You have the rigM to refuse fo supply fhe information requested; how- �er, if you refuse to supply this infortnation, the Board may not be abfe to dermine your quali8cations and, as a consequenca, may retuse to issue u a ficense. if you suppiy the inkrtnation requested, the Hoard will be able process your appticaGoa It the Board does nW issue you a license, all xmation provided tn the process otapplying Tor a ttcense remains priwate, i the ezceptioo of yuur name and atldress which will remain publ(c. �ate data about you is available only W the foibwing: Boartl members, f of the Board w�osa work assignment requires thet they have acceu tn information: the Departmenf ot Pu611c Safety: Ne Atiomey Generai; the �missianers of ACminisVatlon, Finance, and Revenue; the LegfslaGve tor, national anA infemational gambling regutatory agencies; anyone uant to court ordar, other individuats and agen t hat may be specificaity authodzed by state ortecferai iaw m nave ac��o w�� - maGon; inditiduats antl agencies fur whFch iaw or legal order authosizes a rtew use or sharing of the iMormation after tfiis notice is given; you; antl anyone with your written conunt. This tortn will be made available in alter- naUve fartnat (i.e. iarge print, Braille) upon request. DhGosure of Soclal Secudty Numbec You are required to provide your Soda� Sewrity number on this form. Your Sx1al Security number wip be used to determine your compitance with the taz laws of Minnesota. Autha rization for requiri� your5ociai Security numberis fou� at u.S.C.405(c)(i). Attach and Mail Attach al1 LG315 forms to the LG300 Bingo Hall License Appiica- tion fartn, or submit when infortnation cha�es, and send ta: Gambling Control Board Sufte 300 South 171� West County Road B Rosevflle, MN b6113 _ Council File # � � "�1 �a' Green 5heet # � C) 8��-5 RESOLl1TiON SAINT PAUL, MINNESOTA Presented Committee Date Refecred To 1 RESOLVED, That applicarion, ID#19980000424, for a Bingo Hall License by T.S.T. Ideai Aall {Stacy Mulson, 2 Antonio Moran and Steven Ahlquist, Co-owners) DBA Ideal Hali, 1494 Dale Street North, be and the same is 3 hereby approved. Requested by Department of: Benanav Blakey Bostrom Coleman Hazris Lantry Reiter iopted by Council; Date �2� lopti Certified by Council Secretary '. 9 \ �. �- � lr-�-iAv-„�x� � . By, � — . !�t' � Form Approved by-City Attomey By: �/ Approved by,Mayor for Submission to Council By: ( �roved by Mayor: �,,�,�,a,� __ ___ - ---- _ .__ __.__ ��y�z sizsi9a GREEN SHEET No fi0895 Gerry Strathman oorr.Artt�rt p�crue ctrvcoun. � TOTAL # OF SIGNATURE PAGES a Ml'ATTOMEY ❑ 41YGEIK _ ❑ wuwcutttcav�cFSOU�. ❑ wuucw.mm�eeta ❑ r�voxiwe�itmsrrNry ❑ (CUP ALl IOCATIONS FOR SIGNATURE) Approving application for a Bingo Ha11 License by T.S.T. Ideal Hall (Stacy Mulson, Antonio Moran, and Steven Ahlquist, co-owners) dba Ideal Hall, 1494 Dale Street North. (ID I119980000424) PLANNING CAMM�SSION CIB COMMRTEE CIVIL SERVICE COMMISSION [l'P��1��/T-'.''1 Ffas+nis aersonRrm ever wakea m,aer a awn,acc rw utis depanmem4 YES NO F�s tlxa D��Mrtn erer hem a cdY emObYee? YES NO Does this PerwNfi�m Possess a siuN not namaM'P�sessed bY a�Y �� 1' IN�P�oYee7 YES NO Is this pxsorofirtn a tazgeted vendoR YES NO L AMOUNT OF TRANSAC710N i CO3TIREYENUE BUD6ETED (CiRCLE ON� YES NO INQ SOURCE �y i �Ir� (: CTli !=I�3 w, iHFORwnnoN tezvwp �3'�5�5�� Minnesota Lawfu{ Gambling Bingo Hai1 License Apptication - LG30U A bingo hall license is requirad for any premises where more than one organizatio� conducts bingo. Hall lnformation Name of Bingo Ha1t ..�DC'A � N Street Address ot Bingo Hati I I q V 9f1��' S? Phane Numbes (6��z ) � K' 6`'�1 MaOing Atldress (if different from abave) Type af Business (checkone box) Sole Proprieforship Partnership Liability Co. Tennsssen Waraing: The informatian requested on th+s form (including any attacbments} witi be used by the Gambling Controi Soard (8oard} to determine your qualifications to be invokved in lawful gambling activities in Minnesota, and io assist the Board in co�ducting e background investigation of yon. You have the rigtrt to retuse ta supply the informaiion requested; however, if you refuse to suppiy this information, the Board may not be a41e ro determine your quatificaGans an�Y, as a consaque�ce, may refuse to issue you a license If you supply the irtformation requested, the Board witl be abfe to process your application. If the Board does not fssue you a license, ail information provided in Me process of apptying tor a license remains pcivate, with She exceRtion of your name and address which witi remain public. �age 1 of 2 {198 f•T7"11 Frm Fes Date ! t Chk. initials License No. BH Privake data about you is available oniy to the foilowirtg: Board members, staH of the Board whose work assignment requires that they have access to the information; the Department of Public Safety; the Attorney Generai; the Commissioners ofAdministratiofl, Firrance, and Revenue; the legislative Auditor, natlonaf and internationat gambling regufatory sgencies; anyooe pursuantto court order; other individuais and agencies thatmay be specifrcatty authorized by state or fcx{era4 faw to have access to such infarmation; individua�s and agencies for whicfi law or legal order authorizes a new use or sharing of the intormatioo after this notice is given; you: and ar.yone wRh your written wtt«ent. Questions on this form ShouM he directed to the Gambling Conirot 8oatd at (@12j 639-4000. Hearing �mpaired individuals using a T7Y may call the Minr.esota Relay Service at 1-8Q�-6273529 and ask to place a cafl to (612) 639-4000. 4h+s pub6cation wi11 be made available in altematrve format (i e. large print, Brailte) upon request ivumber { Minnesota Sales and Use 7ax ID Number {if none, write "None'�: � ��'=�Iy2 Bingo Hail License Application -1.G300 Aage 2;�8 Loca! 11n+t of Goverflment Acknowfedgment tf the gambling premtses is within cEty iimits, the city must stgn this appilcatlon. On behatf of the city, 1 acknowledge that this aqpiication wiii be fonvarded to the appropriate city. officiafs, the city must pass a resolutia� specificaily approving or denying this application, and a copy of the resolution wiii Be forwarded tfl the appiying Of9dt1lZ0fipR. Print name of city: {Signature af city personnel teceiving � �<� /%'oC1/'� % Title /1'/ �iy, i-a_ P�` gambfing prsmises is located in a tovimshtp;`�bofh #he county and township must sign this apppcatlon. F�,r the townshio: On behalf of the township, 1 acknowledge, by this signature, awareness oF this appfication and that the township has no authority to deny or approve an appfication. �or the countv� On behaif of the counry, i acknowlecfge that this application wiil be forwarded to the appropriate county officiafs, the county must pass a resolution spec�calty approving or denying this application, and a copy of the resolution wiff be forvrarded to the applying organ'szation. Print name of tow�ship: (Signatura of township Title Date / Print name of county: of county Oath apptiication) • t declare that this application is correct and com- plete to the best of my kncwiedge and belief. • i wi11 #amiiiarize myself with the laws of the state of MinnesoYa and ruies of the Board regarding gamb- ling and agree, if licensed, to abide by those taws and rules, inciuding amendments to them. � i declare that I am qualified under the terms of Minnesota Rules, part 7862.0010, subpart 3, to be licensed as a bir�go hall and wili abide by the restrictions seY forth in Minnesota Rules, part 7882.0090, subpart 4. _ i declare that any lease agreements between the bingo hati liceasee and iawful gambling organizations wifl specificalfy identify any goods or services that the organization is required ±o purchase from the lessor or a thfrd parky vendor, and khat all goods and services furnished as Qart of the lease agreement wifl be vaiued at their fair market value. • Ghanges in the information submi8ed in this appiication wiii be submitted in wriiing to the Board and tocal unit of government within Yen days after the change occurs. Signature of CEO of the Lesso `r / �� t �'� Date Attach the Foltowing and Mail � LG30Q, Singo HaII License Applicatiort; ti� L�302, Bingo HaA Occasion List; �i LG315, Bingo Hali Personnel Information; J Proof of ownership {warranty deed, contraci for deed, property tax statement, or other); J Locat unft of government approval resolu6an {for c'rry or county}; and v Gheck for 52,5001icense fee payable fo "State of Minnesota" (fees are consi@ered eamed artd afe not prorated or transferrable}. Maii application and attachments to: Gambling Control Soard Suite 300 South 1771 WesY County Road B Roseviile, MN 5511a 98-� Minnesota Lawful Gamblin,g Bingo Hall Occasion List - LG302 Bingo Halt Name � n Fn � t �� ` Address `'V ,Z—N 1T l� Rotafing Schedule: Yes (If yes, sutmd a calendar with the name of the No t' Scheduie rr9s conducting bingo on each day.) I Name of Organizalion Organization's Premises Permit or Hours of Conduding Binga Occasions Exempiion Permit Number or Singo , EuGuded Authorization Bingo Date Occasions Sunday { Monday � a G �^F«M%NF �� Tuesday 1 �' firr � - Wednesday Thursday Friday `� t r/'�/ut SaYurday � No more than 21 bingo occasions are permitted at each hall perweek. � ff the organization dces not yet have a number, write "permii (or exemp- tion} appiied for." 3 Enter fhe starting and ending times for each occasion (for exampie, 7-9 p.m., 3:30-& p.m.). A bingo occasion must be at least 90 minutes and no more than four hoursiong. Ghanges in the above information mustbe submifted in writing to the Hoard within ten days. A change occurs itan erganization canducts bingo on a day and time ather t6an that reflected ore the 8ingo Ha11 Occasio� list, or'rf an organlzation is added or deleted on the schedule. Mai1 this form to: Gambfing Controi Board Suite 3A0 South 1711 W. GounEy Road B Roseville, MN 55113 Questions on this form should be directed to the Gambling Controf Board at (612) 639-4000.1f you use a TTY, you can call us by using the Minnesota Refay Service at 1-800-627-3528 and ask to place a caii to (612j 639-4060.7his form wiil be made availabfe in alternative format (i.e. large print, Braille) oport request. The information requested on this form will became publ+c in{ormation when received 6y the Board, and wiN Be used to determine your CamplianCe with Minnesota statutes and rules governing {awful gambiing activities. 9 � �y� �:��z.�:y� Date: May 12, 1998 Tune: 6:00 p.m. Place: Room 330 City Hall 15 West Keliogg Boulevazd LEGISLATIVE HEARING Gerry Strathmau L.egislative Hearing Officer Ideal Hall,1494 Dale Street North The Legislarive Hearing O�cer recommends granting the license. 98-�� --- MINU'I'ES OF Tf� LEGISLAT`IVE HEARING FOR IDEAL HAI.L, 1494 NQRTH DALE STREET May 12, 1998 Room 33Q City Hall Gerry Strathman, L.egislative Hearing Officer STA�F PRESENT: Christine Rozek, Office of License, Inspections and Environmental Protection (LIEP). Note: This matter will be considered at the May 20 City Council meeting. Getry Strathman called the meeting ta order at 6:00 p.m. Gerry Suathman reported this is a legislative heazing to deal with objections that have been raised to the issuance of a bingo hali license for ldeal Hali at 1494 Dale Street North. Antonio Moran, applicant, and 7oe Perkovich, previous owner, appeazed. Christine Rozek reported the new applicant is T.S.T. Ideai Hall. The principals of that corporation are Stacy Mulso, Antonio Moran, and Steven Ahlquist. There are seven requirements all of which have been met: all state forms have been received, City Workers ComplTa�c ID Form has been received, the license fee has been paid, the police record check has been done and is okay, the zoning has been approved, a current certificate of occupancy from the Fire Department has been done, and the bingo hall is located at least two miles from another bingo hall. The bingo occasions are on Monday, Tuesday, and Fridays, 1:00 to 5:00 p.m. There are cunenfly conditians on the license of no more than nine bingo occasions a week. The District 6 Planning Council has approved tlus application. The LIEP office recommends appmval. Gerry Strathman asked were there any present or pending adverse actions against this license. Christine Rozek answered no. Steve Battisto and Marion Battisto, both of 1500 North Dale Street North, appeared. Mr. Battisto stated his primary concern is the loud music on the weekends when the haii is rented. On several occasions, Mr. Battisto has cleaned up vomit around his building. There is excess tra�c and his driveway is blocked at times. He picks up pull tabs constanfly, although this is minor. The doors are sometimes open an the bingo ha11. Ms. Battisto stated she picks up debris sometimes. There are fights occasionally. Gerry STrathman asked were they concerned about events other than the bingo. Steve BattisYo responded the bingo is tolerable. Marion Battisto responded she gets stale cigarette smoke coming in one window. The exhaust system may not be high enough. The smoke can be so overwhelming she has to leave the room. Gerry Strathman stated he received a call from someone who identified herself as from the neighborhood. This person did not identify any cunent problems. The Craffic in the alley has gone away, and she has no probiems with the bingo. Mr. Strathman read a letter received from Ron and Debra Carlson, 601 Arlington Avenue West, who writes they aze against the business 9�� Yyz _— LEGISLATIVE HEARING FOR IDEAL HALL, 5-12-98 Page 2 of 3 getting a Class C liquor license, but a liquor license is not being applied for. Christine Rozek stated she tried calling the Carlsons but could not reach them. Antonio Moran stated people are out of the buiiding at 12:3Q a.m. when thcre aze weddings. A police officer is hired and checks to make sure people leava. Mr. Moran is cleaning unti12:30 a.m. At that time, there is no one in the parking lot and the cazs are gone. Mr. Moran stated he has only been there a month and a half and this is tus experience. Steve Battisto stated it is not noisy all the time. Marion Battisto stated she can hear muslc sometimes in her hause. Antonio Moran suggested the Battistos ca11 the hall so the music can be turned down. Joe Perkovich stated he let the Battisto's customers park in his lot. Also, Steve Battisto will not prune his trees that hang into the street. Marion Battisto stated she received a death notice on her answering machine from Joe Perkovich and he pazks his truck in the alley day after day. The police had to be called to get him from doing that. Gerry SCrathman stated these personal issues do not belong at this meeting; the only issue is if there is a basis to denp this license. Gerry Strathman asked are there any accommodations that can make the operations less objectionable to the neighbors. Antonio Moran responded if there is loud music, the Battistos should ca11 him. He does not have a lot of money so the bingo heips him pay the rent. Steve BatCisto felt that some sort of sound proofing can be done to deaden the noise. The noise may be a nuisance to a new tenant. The tenant that lives in the front works at night. Gerry 5trathman responded the City can measure the noise with a sound measuring device if it is ongoing. Arrangements can be made ahead of time if loud noise is expected. Antonio Moran stated he is wiiling to turn the music down and does not want to be an enemy. 7oe Perkovich stated the ceiling is dropped down and does not know why anyone can hear the noise. Gerry Strathman hoped the applicant heazd the concerns here and will do something about it. However, these concerns do not rise to the level of denying the license. Until the City has estahlished that the police have been called repeatedly or the binga hall is constanfly breaking the noise ordinance, there is not much that can be done. There is no record of violations. Steve Battisto stated a record could have been established along the way. Antonio Moran stated at the district meeting a few weeks, one neighbor said he liked the hall. Steve Battisto asked was he notified of that meeting. 7ae Perkovich responded everyone in the neighborhood received letters. Gerry Strathman stated the district council organized that meeting and he was not sure if Mr. Battisto was notified. Antonio Moran gave Marion Battisto his phone number and told her to call him if there ate any noise problems. Gerry Strathman recommended this bingo hall license be granted. Tl�e meeting was adjourned at 6:28 p.m. 9 �'-yyZ Minnesafa Lawfui Gambling Binga Hali Fersonnet information - lG315 Compfete this form if you are lisfed under "Owner tnformation" on the 1G3�� 8ingo Hati �icense Application. Singo Hail lnformation Name a.' Bingo Nali Licer,se Numbei �nc�r L/411 BH r'l(? i Address � 3. Home Address �IG� 4. Home Telepho (��2 ) 7 5. Full Name at: Gcense Number Name CRyJStatefLip BitthPiace (city. 51ate, and proveicet �ates or serv:ce Yes L1 No 6. Chec3c all that aAP�Y with Bingo Hali: a.} k pwner 6)_SOIe Propnetor5hip c.) X Persort or Eatity with a direct or indirect flnaociat mterest of fiva percent or more d.},Partner e.)�Corporate Officer fJ�Director 4.)�Manager hJ_Supervisor Bingo HaSt Duties: Z Emp4oyment record for tfle past ten years. Wst the most current first, incfuding dates of unemployment or educalion (list schooi and address). if you owned a business in Minnesota, include the Minnesota 3aies Tax and Use ID Number. Use additional sheets i1 necessary. Emptoyert5chool Address Position held Dates Type of Business MN Saies CurrenC �Jtf: •Pe52: Tetephone �G12 � y Page 1 of 2 ,�ae Fuii Middle Name i U /?'l.4 /`iG e Social Security Number y�s- �u 53�t �. � 8. Place ot residence for #he past ten years (use addifional sheets if necessaryJ: Address CitylStatelZip cuaenr 1 t63 %7 5� N. D�/'OAC.c /hN SS 1 Pesr �,'/� f1A5f% }� U. Nc�..� Par� Dates ef Residenoe i _ <i'� _ A�� z �K � 9. Criminal history statement (except petry m.isdemeanors). Inctude the date you were charged, the cityJstate where the charges were filed, and tfie disposition of the case. 4f none, write "none." {ysi t4�E ssame, addtess, aad license or exemption percrit nomtrer of any exciuded organization yau belong to which conducis Iawful gambiing in Of F_YemOtron Permrt NumbO! .S' �/Z QltSo� CA�rr% i and na^+e antl adGress ot any If none, write "none." Tue 7Me ' T�ne (w�tinued a� ��lY x g��YyZ Bingo Hail Personnei fnformation - LG315 License No. � Name of 8mgo Hall Personrtel Name Page 2 of 2 1/98 �ath and Consent t t have never been convicted af a fetar,y. 2. f have never been convicted of a crime involving gambling, 3. i have neve� been convided oI assault. a criminal viotation invofving fne use of a firearm, or making tertoristic threats. 4. I am not current�y ot have never been engaged in a connected wAh an iNegal business. 5. I do not owe $500 or more in delinquent tazes to the state of Mirrtesota. 6. I have nat had a sales and use tax permit ravoked by the commissioner cf revenue within the last two years. 7. I have fited, after demand, tax returns required by the commissioner of revertue. 8. I am not a ficensed distributor or affiliate of a disinbutor urtder Mina Stat. sec. 3d9.161. 9. f am not a ticensed manufacturer or aKliate o£ a manufacturer under Minn. Stat. sec. 348.163. 10.1 witi not 6e an officer, director, paid employee, or volunteer of a licensed, exempt, or excluded organization in its conduet of lawtui gambiing, or represenk a licensed, exempt, or exciuded organization in the purchase of, ar influence the purohase of, lawful gambfing equepment t i. I am not a whoiesale disVibutor or an affiliate or an employee of a wholesale distributor of aicaholic treverages. 12. I wilt not provide any staif to conduct or assist in the conduct of bingo ar any other form of lawFul gambling on the premises. 13.1 will not acquire gambiing equiRment or provide inventory control fior any arganization that conducts IawFul gamDiing on the premises. 14.1 will not prepare or assist in the preparaGon of any reports raquired by Minn. Rules, part 7861.0120, subp. 3, for an otganization canducting IawfW gambiing on the premises. 15. t wilt not ptaviCe accounTing services to any ar9anization conducNng fawfW gambling on the premises. t6. ( wiii not solicit, suggest, encourage, ormake any expenditures ot an organizafion's gross receipts from lawful gamhling, t7. I will not chatge any fee to a person without which the person could not play bingo or participate in another form of lawful gambling on the premises. 78. � wilt noF provide assistance or parficipate in Yhe conduct of law£ul gambiing on the premises. 19. t wiil not percnit more than Zt bingo occasions to be conducted on the pcem+ses in any week. 20. I will not recruit a person to become a gambling manager or assisant gam6ling manager or identily to an organizatian a person as a candidate to become a gambling manager oc assistant gambling manager. 21. I wiii noi be involved in the procurement of, or irtiluencing tne procurement of, IawfW gambl'sng equipment for an organ¢ation which conducYS lawful gam6ling on the iicensee's premises. 22. t wi0 not provide or permit an a�liate or persort acting on behaff of the bingo hait ticensee ta provide any compensation. 9iR, gratuity, Premium, contribution, or thing of valus to a Gambling Controf Baard empbyee or member of the Gambling Controi Boartl. 23. i wi11 not directly or mdirectly give gifts, trips, prizes, toans of money, premiums, or other gratuiSes to 9ambling organiza8ons, or their empbyees, other than nominal gifts not to exceed a value of $25 per o�ganization in a calendar year. i� addition, 1 understand, a9ree, and hereby irrevocably consent that suits and actions relating to the su6ject matter of ffie bingo haii license appiication, or acts or omissions arsing fran such apptication, may be commenced against me in a�y court of campetsnt jurisdiction in Minnesota by service on the MinnesoW Secretary of State of a�y summons, process, or pieading authotized by thz laws of Minnesota. By signature of this document, the undersigoed authorizes the Department of Publia Safety to conduct a background investigation porsuant to Minnesota Rules, paR 7862.0010, subpart 10. 6URTHER AFFIANT SAYE'fH N,T , pt that this Oath and Conserrt Statement are sup rt of the appticaGOn for a bingo hal '. �_rf .��.fbiing C trol Board. �`C �;'� MY �° �..�— �/ � /771AD" GTZfiG��, � . _.,-a5;2✓�� ( 1 of� I �� (Signature of Binga NaA Personnei Applicant) .� / ; (Date Signad} fi�scribed and swom to befor jq�e this �� day of I_ 7 �CZLc� J , 19 �� ( r 3 / i� (COmmission expiradoN Attach and Mai! Attach all LG375 forms to the LG300 Singo Hal{ License Apptication fortn, ar submit when information chaoges, and send to: Gambling Control Board Suita 90o South 1711 West County Roed B Rosevllle, MN 55113 Tennessen War�ing: 7he informatian �equested on this form (inUudiog any atcachments} wiii be used by the Gambiing Control Board (8oard} to detertnine your qua4ifications to be involved in 'awful gambiing aCtivities in Minnesota, and to assi5t the 9oarci ia ;onducting a tradcground investigation of you You have the right to �efuse to suppiy the information requested; hawever, if you refuse o supply this intormaicon, the Hoard may not 6e able to determine our qualifi;ztions and. as a cansequence, may refusa to issue you ilc2nse if you supply the mformaUOn requested, the Soard wNl he 51e to process yaur application If the Board does not issue you a :ense, aft informaUOn provided m the process of app�ying for a ense remains prtvate, with the exceplion of your name and atldress vch wdl remain pub6c. Disctosu�e of Sociat Security Namber You are required to provide your Social Security number on ihis form. Your Sociai Security number wiii be used to determine your compliance with the tax faws of Minnesafa. Authorization for requiring yaur Sociai Security number is 4ound at U.S.C. 405{c)Si). Private data a6aut you is avaiiabte oniy to the foifowing: Soartl mem- 6e�s, staff of the Board whose work assignmeot reqwres that they have access ta the inEormation; the DepaKment of Pubttc Satety; fhe Attorney General; the Commissioners ofAdmin'wtraticn, Finance. and Revenue, the l.egisla:ive Auditor, national and intemationai gam- b4ing regulatory agencies; anyone pursuant to court order; other indiwduals and agencies that may be specificaliy authorized by state ar fedesal law to have access to such inEormation; indiv�duals and agencres for which taw or lega! orde� authorizes a new use ot shar- ing of the mformation afte� this notice is givea, you; and anyaee wrth your written consent This form wdl 6e made avai4able in aiter- native formaf (i.e large pnnt, Braitle) upon request � 98-�/�{� Mirrnesota Lawfu! Gambting Bingo Hall Persannei information - LG315 Comptete this form if you are Iisted under "Owner Intormation" on the LG300 Bingo Hatl License Application. Bingo Hall Information Name of Bingo Hail License Number (i i D��-� H-R�-�. sH c�oa Address CitylStatelZip TefeRhone i � � y y� .il I•� �� S � S t � g � �.�.� Ssif 7(�a )< Personnei information 1. Lasf Name First Name Full Middle iVame A tF t-C� v j s r' S±£��,� /y/ i c�fA-F t.. �2. Maiden Name Previous Name Social Securitv Numb 3. Home Address CirylStata�p fa 7� (� oo �B �6E S i_ S� - 4. Home Telephone No. Drivers License Number State of (G,1.�)�/�7_�s/r19 d_i./�� - �7�-��z_A7� Page 1 of 2 1/98 r•� //� ' CPlA ^ /a' 7 ✓ Msv. SS�l7 of Birth Birthplace (caty, state, and province} �j3�.�3 S � PP�V L !�?Al , Dates of Service U.S. Citizen? Yes l� No 6. Check all that appry with Bingo Hall: aJ_�Owner b.)_SOIe Proprietorship cJ � Person or Entity with a direct or in�lirect financiai interest of five percent or more d.)_Padner e.)_ CZCorporate Officer fJ_Directar g.) � Manager h.)_Supervisor Bingo Hatl Duties: 7. Empfoyment record for the past ten years. List the most current first, including dates of unemployment or education {Iist schooi and address). Ifi you owned a b�siness in Minnesota, include the Minnesota Saies Tax and Use ID Number. Use additional sheets if necessary. EmployerfSchool _ Address _ �,� ,� Position beld Dates Type of Business MN Sales E:� CurrentTST CQfAt�.c6 Cft�eR�N� e ° �£�64 I T3 �� Past: /rliqwccT /'�✓r7 . Sroox Fa�.�s sv t��...,-�..,cf "1'a ¢.Tll[,A- G�a1r 5 � �RPlF✓a+D p�„L S J„E••�-*SCK� f�nR � �,�,.� Ca'��< b P{ace of residence for the past ten years (use additional sheets if necessary): Address CityfStatelZip Current: Past: ^ TaXNO. ��G— v� '�l. 1812;/� ✓-9S .Ss+coNs - 9Y s<T.w�.,r JG4�6 97 - 9i �i.a-� Dates of esidence SSn 7 9j/ 7� - i�P£.tE.� 9. Criminal history statement (except petty misdemeanors). Incfude the date you were charged, the citylstate where the charges were fiied, and the disposition of the case. If none, write "none ° 0. List the name, address, and Iicense or exemption permit number of any organization and name antl address ot any excluded organization you belong to which condu�rts tawfuf gambling in Mi�nesota. If none, write "none" .� . .. .. . . _ , � � (continued on 0 98-yvz Bingo Hall Personnel Information - LG315 License No. Name of Bingo Hall BSi ! t7F�t� {i�4�C_ Oath and Co _ . _ Page 2 of 2 1/98 Personnel Name STErf� ��-QU�S) 1. I have never 6een convicted of a felony. 2. I have never been convictetl of a cnme involving gambling. 3. I have never been convicted of assault, a criminal vio�ation invoWing the use of a firearm, or making terroristic tfireats. 4. 1 am not currently or have never been engaged in or connected wfth an iliegal business. 5. 1 do not owe $500 or more in delinquent taxes to the state of Minnesota. 6. 1 have not had a sales and use tax permit revoked by tfie commissioner af revenue within the last two years. 7. i have fited, afYer demand, tax retums required by the commissioner of revenue. 8. 1 am not a licensed distributor or a�liate of a distributor under Minn. Stat. sec. 349.161. 9. I am not a licensed manufacturer or a�liate of a manufacturer under Minn. Stat. sec. 349.163. 10.1 will not be an officer, director, paid employee, or votunteer of a licensed, exempt, or excluded organization in its conduct of IawFui gambling, or represent a Iicensed, exempt, or exciuded organization in the purchase of, or inFluence the purchase of, lawfuf gambling equipment. 11. I am not a whofesa{e distributor or an affiliate or an employee of a wholesale distributor of alcoholic beverages. 12. I will not provide any staff to conduct or assist in the conduct of bingo or any other form of lawful gambling on the premises. 13.1 wiii not acquire gambiing equipment or provide inventory control for any organization that conducts lawful gambling on the premises. 74. 1 wiil not prepare or assist in the preparation of any raports required by Minn. Rules, part 7861.0720, subp. 3, for an organization conducting lawfui gambling on the premises. 15. I will not provide accounting services to any organization conducting lawful gambl+ng on the premises. 16. I will not soiicit, suggest, encourage, or make any expenditures of ao organization's gross receipts from lawfu! gambling. 17.1 wiil not charge any fee to a person without which the perso could not play bingo or participate in another form of gambiing on the premises. . , � � ..�� ,..a��.� k1t and sworn to before me this��! day of Attach and Mail Attach all LG315 fortns to the LG300 Bingo Hail License Application form, or submit when information changes, and send to: Gambiing Contro! Boartl Suite 300 South 1711 West County Road B Roseville, MN 55113 'ennessen Warrting: The information requested on this form �nctuding any attacbments) wiil be used by the Gambling Control oard jBoard) to determine your qualifications to be invotved in wfuf gambiing activities in Minnesota, and to assist tfie Board in mducting a background investigation of you. You have the tight to fuse to supply the information requested; however, if you refuse supply this informatwq the Board may not be abie to determine ur qualificaNOns and, as a consequence, may refuse to issue you cense. If you suppiy ihe information requested, the Board will he e to process your application. If the Board does not issue you a nse, all �nformation provided �n the process of applying for a ase remains prrvate, wdh the excephon o( your name and address ;h wdl remain public 18. 1 wiit not provide assistance or partic+pate in the conduct of lawfui gambiing on the premises. 19. I will not pertnit more than 21 bingo occasions to be wnducted on the premises in any week. 20. I wifl not recruif a person to bewme a gambling manager or assistant gambling manager or identlty to an organization a person as a candidate to become a gambling manager or assistant gambling manager. 21, I witl not be involved in the procurement of, ar influencing the procurement of, lawFul gambting equipment for an organization which conducts Iawful gambling on the licensee's premises. 22.1 wiU not provide or perznit an affiliate or person acting on behaif of the bingo hail licensee to provide any compensation, gift, gratuity, premium, contribution, or thing of value to a C�ambling Control Soartl employee or member of the Gambting Control Board. 23. f wiil not directly or indirectly give gifts, trips, prizes, loans of money, premiums, or other gratuities to gambling organizations, or thei� employees, other than nominal gifts not to exceed e value of $25 per organization in a calendar year. In addition, I understand, agree, and hereby ircevocably consent that suits and actions relating to the subject matter of the bingo hall license application, or acts or omissions arising from such apppcation, may be commenced against me in any court of competent jurisdiction in Minnesota by service on the Minnesota Secretary of State of any summons, process, orpleading authorized by the laws ot Minnesota. By signature of this document, the undersigned autfiorizes the Departme�t of PublicSafety to co�duct a hackgrou�d investigation pursuant to Minnesota Rufes, part 7862.0010, subpart 10. FURTHER AFFIANT SAYE7N N07, ezcept that this Oath and Consent Statement are s� d N support of the application for a bin o � � ambl ag Control Board. rr�enuS1RA J. G1E ._' ,.,� � i 20�9 r; �-",.. g/ , '� l o�� 1 / d (f7ate Signed) , is 9�' � r�L� aCOd (Commission expiration) Disciosure of Social Security Number You are required to provide your Social5ecurity number on this form. Your Social Security number will be used to determine your compfiance with the tax laws of Minnesota. Authorization for requiring your Social Security number is found at U.S.C. 405(c){i). Private data about you is availabte only to the following: Board mem- bers, staff of the Board whose work assignment requires that they have access to the information; the Department of Pubtic Safety; theAttorney Generat, the Commissioners ofAdministretion, Finance, and Revenue; the legislativeAUditor, national and intemational9am- bling regulatory agencies; anyone pursuant to court order, other individuais and age�cies that may be specificaily authorized by state or federal law to have access to such information; individuais and agencies for which law or fegal o�der authorizes a new use or shar- ing of the information after this notice is given; you; and anyone with your written consent. This form wiN be made available in alter- native format (i,e. large pnnt, Braille) upon request y �- yy� Minnesota Lawful Gambitng st�sres Bingo Ha11 Personnel Information Page 1 of 2 Compiete this fortn ff you are listed under "Owner Information" on the LG300 Bingo Hat! License Application, or within ten davs after a change in i�formation. Incomptete, faise, or misteading applicaUon information may resuit in denial of a license. Home Addrass State Zip Gode M N 551`2 s�rtnPtace c�ry a�a sraa City Fuli Middfe Nai ,d none, wrtte "no �� -f�J �tary Service Oates af Senice � US. Cflizen: - If no, enter regi: � t � N� J�Yes p No / wfth Bingo Hafl (chedc one): �Sole Proprietarship � Managet O Supervfsor � Partner O Corporate Officer (� Director ient RecorU for the past ten years tuse separace sneei, n i(school, address, dates). if you owned a business i� M Empioyer Atldress Posttion Held of Residence for the past ten years (use separate sheet, if necessary). Atldress City State 21p Cade Name Social Sewdty P Q�a'-�8-� Homa Phone � ��/!'7��X..�� Dates of Residence � — �� 21�, _ S.JG Criminal History Statement (except petty mistlemeanors). �nauae me aa[e you were cnargea, me ci[ps�a�e wue�a u�c u�a�y�� .._,_ filed, and the disposition of the qse. If none, write "none" (Use separate sheet, ff necesSary.) ►JON� iinnesata, or name and address of any excluded oi Organizatbn �e� OrganizaQOn Adtlress Address Licenae )rganizatlon Addres! Lkense w ). Indude periods of unempioyment (dates) or iclude the Minnesota Sales Tax and Use ID Number. Dates 7ype of Bustness MN Sales Tau # = v. P. 51q2- �r�nt ca:te� - i8�2� •rr nni.�. �Ican , .�iocor� nlrir.c �1 you belong to which contlucts iawru� ga�� of titfe: Member.) If none, write "none." License or Exempt Pertn@ Number � nne Tiqe Nvmbar TNe Numbar Tide (conUnued on back) 1 Personnet information � Hall Personnel Informatioa Oath and Consent Statement t. I have never been convicted of a felony. 2. t have never been convided of a crime invofving gambting. 3. I have never been convicted of assault, a uimi�al violation in- valving the use of a firearm, or making terroristic threats. 4. I am not currenUy or have never 6een engaged in or conneGed with an illegat business. 5. 1 do not owe $500 or more in deiinquent taxes to the state of Minnesota. 6. f have not had a sales and use tax permit revoked by the com- missioner of revenue within the last two years. 7. f have filed, after demand, tax retums required by the commis- sioner of revenue. 8. t am not a licensed distributor or a�liate of a distributor under Minn. Stat. sec. 3d9.161. 9. f am nat a iicensed manufadurer or afhliate of a manufacturer under Minn. Stat. sec. 349.163. 10.1 wilt not be an officer, director, paid employee, or volunteer oE a licensed, exempt, or excluded organization in its conducf of tawful gambling, or represent a iicensed, exempt, or exduded organization in the purchase of, or influence the purchase of, IawFul gambling equipment. t t, l am not a wholesate distributor or an affiliate or an emplayee of a wholesale distributor of atcohotic beverages. 12. t wiii not provide any staff to conduct or assist in the conduct of bingo or any other form of lawfut gamhling on the premises. 13. � wiA �ot acquire gambling equipment or provide inventory con- tro! for any organization that conducts tawful gambiing on the premises. 74. i will not prepare or assist in the preparation of any reports required by Minn. Rules, paR 786M1.0120, subp. 3, for an orga- nization conducting lawfui gambiing on the premises. 15.1 wiil not provide accounting services to any organization con- ducting lawful gambling on the premises. f6. I wiil not solicit, suggest, encourage, ormake any expenditures af aa organization's gross receipts fran lawful gamblirtg. � 17. I wili not charge any fee to a person withaut which the person cou(d not pfay bingo or participate in another fortn of IawEui , gambling on the premises. � swom to before me this .—��O{ day of Public) S 8-�i4� LG315— 8i18t98 'a9e 2 of 2 18. I will not provide assistance or participate in the condud of tawfut gambling on the premises. " 19. I wiil not pertnit more than 27 bingo occasians to be rAnducted on the premises in any vreek 20. t will not recruit a person to become a gambling manager or assistant gambting manager or identify to an organization a person as a candidate to become a gambiing manager or assistant gambling ma�ager. 21.1 will not be invoived in the procurement of, or influencing the procurement af, lawfut gambting equipmerrt for an organization which conducts fawFul gambling on the licensee's premises. 22. I wili not provide or pertnit an afifiliate er person acting on be- half of the hingo hall iicensae to provide any compensation, gift, gratuity, premium, conV7butian, orthing ofvalueto a Gam- bling CanVCt Boazd employee or member ofthe Gambling Con- trol Board. 23. ! will not directiy or indirectly give gifls, Vips, prizes, loans of money, ptemiums, or other gratuities to gambling oiyanizations, or the±r employees, other than nominal gifls not to exceed a value of $25 per organization in a calendar year. In addition, 1 understand, agree, and hereby irrevocabiy consent that suits and actions relating to the subject matter of the bingo hall license application, or acts ar omissions arising ftom such ap- piication, may 6e commenced against me in any court of compe- tent iurisdidion in Minnesota by service an the Minnesota Secre- tary of State ef any summons, process, or pieading authorized by the laws of Minnesota. By signature of this document, the undersigned author¢es the Depariment of Public Safety to conduct a background investiga- tion pursuant to Minnesota Rules, part 7862.0010, subpa�t t0. FURTHER AFFIANT SAYETH NOT, except that this Oath and Consent Statement are submitted in support of the application for a bingo hail license from the Gambiing Control8oard. 'ennessen Waming: The information requested on this form (inGuding any ttachments) will be used �y the Caam6ling ConUOI Board (Board) to deter- iine your quaiifications to be involved in lawful 9ambiing activiUes in Min- �sota, and to assist the Board in conducGng a baUcground imesUgation of �u. You have the rigM to refuse fo supply fhe information requested; how- �er, if you refuse to supply this infortnation, the Board may not be abfe to dermine your quali8cations and, as a consequenca, may retuse to issue u a ficense. if you suppiy the inkrtnation requested, the Hoard will be able process your appticaGoa It the Board does nW issue you a license, all xmation provided tn the process otapplying Tor a ttcense remains priwate, i the ezceptioo of yuur name and atldress which will remain publ(c. �ate data about you is available only W the foibwing: Boartl members, f of the Board w�osa work assignment requires thet they have acceu tn information: the Departmenf ot Pu611c Safety: Ne Atiomey Generai; the �missianers of ACminisVatlon, Finance, and Revenue; the LegfslaGve tor, national anA infemational gambling regutatory agencies; anyone uant to court ordar, other individuats and agen t hat may be specificaity authodzed by state ortecferai iaw m nave ac��o w�� - maGon; inditiduats antl agencies fur whFch iaw or legal order authosizes a rtew use or sharing of the iMormation after tfiis notice is given; you; antl anyone with your written conunt. This tortn will be made available in alter- naUve fartnat (i.e. iarge print, Braille) upon request. DhGosure of Soclal Secudty Numbec You are required to provide your Soda� Sewrity number on this form. Your Sx1al Security number wip be used to determine your compitance with the taz laws of Minnesota. Autha rization for requiri� your5ociai Security numberis fou� at u.S.C.405(c)(i). Attach and Mail Attach al1 LG315 forms to the LG300 Bingo Hall License Appiica- tion fartn, or submit when infortnation cha�es, and send ta: Gambling Control Board Sufte 300 South 171� West County Road B Rosevflle, MN b6113 _ Council File # � � "�1 �a' Green 5heet # � C) 8��-5 RESOLl1TiON SAINT PAUL, MINNESOTA Presented Committee Date Refecred To 1 RESOLVED, That applicarion, ID#19980000424, for a Bingo Hall License by T.S.T. Ideai Aall {Stacy Mulson, 2 Antonio Moran and Steven Ahlquist, Co-owners) DBA Ideal Hali, 1494 Dale Street North, be and the same is 3 hereby approved. Requested by Department of: Benanav Blakey Bostrom Coleman Hazris Lantry Reiter iopted by Council; Date �2� lopti Certified by Council Secretary '. 9 \ �. �- � lr-�-iAv-„�x� � . By, � — . !�t' � Form Approved by-City Attomey By: �/ Approved by,Mayor for Submission to Council By: ( �roved by Mayor: �,,�,�,a,� __ ___ - ---- _ .__ __.__ ��y�z sizsi9a GREEN SHEET No fi0895 Gerry Strathman oorr.Artt�rt p�crue ctrvcoun. � TOTAL # OF SIGNATURE PAGES a Ml'ATTOMEY ❑ 41YGEIK _ ❑ wuwcutttcav�cFSOU�. ❑ wuucw.mm�eeta ❑ r�voxiwe�itmsrrNry ❑ (CUP ALl IOCATIONS FOR SIGNATURE) Approving application for a Bingo Ha11 License by T.S.T. Ideal Hall (Stacy Mulson, Antonio Moran, and Steven Ahlquist, co-owners) dba Ideal Hall, 1494 Dale Street North. (ID I119980000424) PLANNING CAMM�SSION CIB COMMRTEE CIVIL SERVICE COMMISSION [l'P��1��/T-'.''1 Ffas+nis aersonRrm ever wakea m,aer a awn,acc rw utis depanmem4 YES NO F�s tlxa D��Mrtn erer hem a cdY emObYee? YES NO Does this PerwNfi�m Possess a siuN not namaM'P�sessed bY a�Y �� 1' IN�P�oYee7 YES NO Is this pxsorofirtn a tazgeted vendoR YES NO L AMOUNT OF TRANSAC710N i CO3TIREYENUE BUD6ETED (CiRCLE ON� YES NO INQ SOURCE �y i �Ir� (: CTli !=I�3 w, iHFORwnnoN tezvwp �3'�5�5�� Minnesota Lawfu{ Gambling Bingo Hai1 License Apptication - LG30U A bingo hall license is requirad for any premises where more than one organizatio� conducts bingo. Hall lnformation Name of Bingo Ha1t ..�DC'A � N Street Address ot Bingo Hati I I q V 9f1��' S? Phane Numbes (6��z ) � K' 6`'�1 MaOing Atldress (if different from abave) Type af Business (checkone box) Sole Proprieforship Partnership Liability Co. Tennsssen Waraing: The informatian requested on th+s form (including any attacbments} witi be used by the Gambling Controi Soard (8oard} to determine your qualifications to be invokved in lawful gambling activities in Minnesota, and io assist the Board in co�ducting e background investigation of yon. You have the rigtrt to retuse ta supply the informaiion requested; however, if you refuse to suppiy this information, the Board may not be a41e ro determine your quatificaGans an�Y, as a consaque�ce, may refuse to issue you a license If you supply the irtformation requested, the Board witl be abfe to process your application. If the Board does not fssue you a license, ail information provided in Me process of apptying tor a license remains pcivate, with She exceRtion of your name and address which witi remain public. �age 1 of 2 {198 f•T7"11 Frm Fes Date ! t Chk. initials License No. BH Privake data about you is available oniy to the foilowirtg: Board members, staH of the Board whose work assignment requires that they have access to the information; the Department of Public Safety; the Attorney Generai; the Commissioners ofAdministratiofl, Firrance, and Revenue; the legislative Auditor, natlonaf and internationat gambling regufatory sgencies; anyooe pursuantto court order; other individuais and agencies thatmay be specifrcatty authorized by state or fcx{era4 faw to have access to such infarmation; individua�s and agencies for whicfi law or legal order authorizes a new use or sharing of the intormatioo after this notice is given; you: and ar.yone wRh your written wtt«ent. Questions on this form ShouM he directed to the Gambling Conirot 8oatd at (@12j 639-4000. Hearing �mpaired individuals using a T7Y may call the Minr.esota Relay Service at 1-8Q�-6273529 and ask to place a cafl to (612) 639-4000. 4h+s pub6cation wi11 be made available in altematrve format (i e. large print, Brailte) upon request ivumber { Minnesota Sales and Use 7ax ID Number {if none, write "None'�: � ��'=�Iy2 Bingo Hail License Application -1.G300 Aage 2;�8 Loca! 11n+t of Goverflment Acknowfedgment tf the gambling premtses is within cEty iimits, the city must stgn this appilcatlon. On behatf of the city, 1 acknowledge that this aqpiication wiii be fonvarded to the appropriate city. officiafs, the city must pass a resolutia� specificaily approving or denying this application, and a copy of the resolution wiii Be forwarded tfl the appiying Of9dt1lZ0fipR. Print name of city: {Signature af city personnel teceiving � �<� /%'oC1/'� % Title /1'/ �iy, i-a_ P�` gambfing prsmises is located in a tovimshtp;`�bofh #he county and township must sign this apppcatlon. F�,r the townshio: On behalf of the township, 1 acknowledge, by this signature, awareness oF this appfication and that the township has no authority to deny or approve an appfication. �or the countv� On behaif of the counry, i acknowlecfge that this application wiil be forwarded to the appropriate county officiafs, the county must pass a resolution spec�calty approving or denying this application, and a copy of the resolution wiff be forvrarded to the applying organ'szation. Print name of tow�ship: (Signatura of township Title Date / Print name of county: of county Oath apptiication) • t declare that this application is correct and com- plete to the best of my kncwiedge and belief. • i wi11 #amiiiarize myself with the laws of the state of MinnesoYa and ruies of the Board regarding gamb- ling and agree, if licensed, to abide by those taws and rules, inciuding amendments to them. � i declare that I am qualified under the terms of Minnesota Rules, part 7862.0010, subpart 3, to be licensed as a bir�go hall and wili abide by the restrictions seY forth in Minnesota Rules, part 7882.0090, subpart 4. _ i declare that any lease agreements between the bingo hati liceasee and iawful gambling organizations wifl specificalfy identify any goods or services that the organization is required ±o purchase from the lessor or a thfrd parky vendor, and khat all goods and services furnished as Qart of the lease agreement wifl be vaiued at their fair market value. • Ghanges in the information submi8ed in this appiication wiii be submitted in wriiing to the Board and tocal unit of government within Yen days after the change occurs. Signature of CEO of the Lesso `r / �� t �'� Date Attach the Foltowing and Mail � LG30Q, Singo HaII License Applicatiort; ti� L�302, Bingo HaA Occasion List; �i LG315, Bingo Hali Personnel Information; J Proof of ownership {warranty deed, contraci for deed, property tax statement, or other); J Locat unft of government approval resolu6an {for c'rry or county}; and v Gheck for 52,5001icense fee payable fo "State of Minnesota" (fees are consi@ered eamed artd afe not prorated or transferrable}. Maii application and attachments to: Gambling Control Soard Suite 300 South 1771 WesY County Road B Roseviile, MN 5511a 98-� Minnesota Lawful Gamblin,g Bingo Hall Occasion List - LG302 Bingo Halt Name � n Fn � t �� ` Address `'V ,Z—N 1T l� Rotafing Schedule: Yes (If yes, sutmd a calendar with the name of the No t' Scheduie rr9s conducting bingo on each day.) I Name of Organizalion Organization's Premises Permit or Hours of Conduding Binga Occasions Exempiion Permit Number or Singo , EuGuded Authorization Bingo Date Occasions Sunday { Monday � a G �^F«M%NF �� Tuesday 1 �' firr � - Wednesday Thursday Friday `� t r/'�/ut SaYurday � No more than 21 bingo occasions are permitted at each hall perweek. � ff the organization dces not yet have a number, write "permii (or exemp- tion} appiied for." 3 Enter fhe starting and ending times for each occasion (for exampie, 7-9 p.m., 3:30-& p.m.). A bingo occasion must be at least 90 minutes and no more than four hoursiong. Ghanges in the above information mustbe submifted in writing to the Hoard within ten days. A change occurs itan erganization canducts bingo on a day and time ather t6an that reflected ore the 8ingo Ha11 Occasio� list, or'rf an organlzation is added or deleted on the schedule. Mai1 this form to: Gambfing Controi Board Suite 3A0 South 1711 W. GounEy Road B Roseville, MN 55113 Questions on this form should be directed to the Gambling Controf Board at (612) 639-4000.1f you use a TTY, you can call us by using the Minnesota Refay Service at 1-800-627-3528 and ask to place a caii to (612j 639-4060.7his form wiil be made availabfe in alternative format (i.e. large print, Braille) oport request. The information requested on this form will became publ+c in{ormation when received 6y the Board, and wiN Be used to determine your CamplianCe with Minnesota statutes and rules governing {awful gambiing activities. 9 � �y� �:��z.�:y� Date: May 12, 1998 Tune: 6:00 p.m. Place: Room 330 City Hall 15 West Keliogg Boulevazd LEGISLATIVE HEARING Gerry Strathmau L.egislative Hearing Officer Ideal Hall,1494 Dale Street North The Legislarive Hearing O�cer recommends granting the license. 98-�� --- MINU'I'ES OF Tf� LEGISLAT`IVE HEARING FOR IDEAL HAI.L, 1494 NQRTH DALE STREET May 12, 1998 Room 33Q City Hall Gerry Strathman, L.egislative Hearing Officer STA�F PRESENT: Christine Rozek, Office of License, Inspections and Environmental Protection (LIEP). Note: This matter will be considered at the May 20 City Council meeting. Getry Strathman called the meeting ta order at 6:00 p.m. Gerry Suathman reported this is a legislative heazing to deal with objections that have been raised to the issuance of a bingo hali license for ldeal Hali at 1494 Dale Street North. Antonio Moran, applicant, and 7oe Perkovich, previous owner, appeazed. Christine Rozek reported the new applicant is T.S.T. Ideai Hall. The principals of that corporation are Stacy Mulso, Antonio Moran, and Steven Ahlquist. There are seven requirements all of which have been met: all state forms have been received, City Workers ComplTa�c ID Form has been received, the license fee has been paid, the police record check has been done and is okay, the zoning has been approved, a current certificate of occupancy from the Fire Department has been done, and the bingo hall is located at least two miles from another bingo hall. The bingo occasions are on Monday, Tuesday, and Fridays, 1:00 to 5:00 p.m. There are cunenfly conditians on the license of no more than nine bingo occasions a week. The District 6 Planning Council has approved tlus application. The LIEP office recommends appmval. Gerry Strathman asked were there any present or pending adverse actions against this license. Christine Rozek answered no. Steve Battisto and Marion Battisto, both of 1500 North Dale Street North, appeared. Mr. Battisto stated his primary concern is the loud music on the weekends when the haii is rented. On several occasions, Mr. Battisto has cleaned up vomit around his building. There is excess tra�c and his driveway is blocked at times. He picks up pull tabs constanfly, although this is minor. The doors are sometimes open an the bingo ha11. Ms. Battisto stated she picks up debris sometimes. There are fights occasionally. Gerry STrathman asked were they concerned about events other than the bingo. Steve BattisYo responded the bingo is tolerable. Marion Battisto responded she gets stale cigarette smoke coming in one window. The exhaust system may not be high enough. The smoke can be so overwhelming she has to leave the room. Gerry Strathman stated he received a call from someone who identified herself as from the neighborhood. This person did not identify any cunent problems. The Craffic in the alley has gone away, and she has no probiems with the bingo. Mr. Strathman read a letter received from Ron and Debra Carlson, 601 Arlington Avenue West, who writes they aze against the business 9�� Yyz _— LEGISLATIVE HEARING FOR IDEAL HALL, 5-12-98 Page 2 of 3 getting a Class C liquor license, but a liquor license is not being applied for. Christine Rozek stated she tried calling the Carlsons but could not reach them. Antonio Moran stated people are out of the buiiding at 12:3Q a.m. when thcre aze weddings. A police officer is hired and checks to make sure people leava. Mr. Moran is cleaning unti12:30 a.m. At that time, there is no one in the parking lot and the cazs are gone. Mr. Moran stated he has only been there a month and a half and this is tus experience. Steve Battisto stated it is not noisy all the time. Marion Battisto stated she can hear muslc sometimes in her hause. Antonio Moran suggested the Battistos ca11 the hall so the music can be turned down. Joe Perkovich stated he let the Battisto's customers park in his lot. Also, Steve Battisto will not prune his trees that hang into the street. Marion Battisto stated she received a death notice on her answering machine from Joe Perkovich and he pazks his truck in the alley day after day. The police had to be called to get him from doing that. Gerry SCrathman stated these personal issues do not belong at this meeting; the only issue is if there is a basis to denp this license. Gerry Strathman asked are there any accommodations that can make the operations less objectionable to the neighbors. Antonio Moran responded if there is loud music, the Battistos should ca11 him. He does not have a lot of money so the bingo heips him pay the rent. Steve BatCisto felt that some sort of sound proofing can be done to deaden the noise. The noise may be a nuisance to a new tenant. The tenant that lives in the front works at night. Gerry 5trathman responded the City can measure the noise with a sound measuring device if it is ongoing. Arrangements can be made ahead of time if loud noise is expected. Antonio Moran stated he is wiiling to turn the music down and does not want to be an enemy. 7oe Perkovich stated the ceiling is dropped down and does not know why anyone can hear the noise. Gerry Strathman hoped the applicant heazd the concerns here and will do something about it. However, these concerns do not rise to the level of denying the license. Until the City has estahlished that the police have been called repeatedly or the binga hall is constanfly breaking the noise ordinance, there is not much that can be done. There is no record of violations. Steve Battisto stated a record could have been established along the way. Antonio Moran stated at the district meeting a few weeks, one neighbor said he liked the hall. Steve Battisto asked was he notified of that meeting. 7ae Perkovich responded everyone in the neighborhood received letters. Gerry Strathman stated the district council organized that meeting and he was not sure if Mr. Battisto was notified. Antonio Moran gave Marion Battisto his phone number and told her to call him if there ate any noise problems. Gerry Strathman recommended this bingo hall license be granted. Tl�e meeting was adjourned at 6:28 p.m. 9 �'-yyZ Minnesafa Lawfui Gambling Binga Hali Fersonnet information - lG315 Compfete this form if you are lisfed under "Owner tnformation" on the 1G3�� 8ingo Hati �icense Application. Singo Hail lnformation Name a.' Bingo Nali Licer,se Numbei �nc�r L/411 BH r'l(? i Address � 3. Home Address �IG� 4. Home Telepho (��2 ) 7 5. Full Name at: Gcense Number Name CRyJStatefLip BitthPiace (city. 51ate, and proveicet �ates or serv:ce Yes L1 No 6. Chec3c all that aAP�Y with Bingo Hali: a.} k pwner 6)_SOIe Propnetor5hip c.) X Persort or Eatity with a direct or indirect flnaociat mterest of fiva percent or more d.},Partner e.)�Corporate Officer fJ�Director 4.)�Manager hJ_Supervisor Bingo HaSt Duties: Z Emp4oyment record for tfle past ten years. Wst the most current first, incfuding dates of unemployment or educalion (list schooi and address). if you owned a business in Minnesota, include the Minnesota 3aies Tax and Use ID Number. Use additional sheets i1 necessary. Emptoyert5chool Address Position held Dates Type of Business MN Saies CurrenC �Jtf: •Pe52: Tetephone �G12 � y Page 1 of 2 ,�ae Fuii Middle Name i U /?'l.4 /`iG e Social Security Number y�s- �u 53�t �. � 8. Place ot residence for #he past ten years (use addifional sheets if necessaryJ: Address CitylStatelZip cuaenr 1 t63 %7 5� N. D�/'OAC.c /hN SS 1 Pesr �,'/� f1A5f% }� U. Nc�..� Par� Dates ef Residenoe i _ <i'� _ A�� z �K � 9. Criminal history statement (except petry m.isdemeanors). Inctude the date you were charged, the cityJstate where the charges were filed, and tfie disposition of the case. 4f none, write "none." {ysi t4�E ssame, addtess, aad license or exemption percrit nomtrer of any exciuded organization yau belong to which conducis Iawful gambiing in Of F_YemOtron Permrt NumbO! .S' �/Z QltSo� CA�rr% i and na^+e antl adGress ot any If none, write "none." Tue 7Me ' T�ne (w�tinued a� ��lY x g��YyZ Bingo Hail Personnei fnformation - LG315 License No. � Name of 8mgo Hall Personrtel Name Page 2 of 2 1/98 �ath and Consent t t have never been convicted af a fetar,y. 2. f have never been convicted of a crime involving gambling, 3. i have neve� been convided oI assault. a criminal viotation invofving fne use of a firearm, or making tertoristic threats. 4. I am not current�y ot have never been engaged in a connected wAh an iNegal business. 5. I do not owe $500 or more in delinquent tazes to the state of Mirrtesota. 6. I have nat had a sales and use tax permit ravoked by the commissioner cf revenue within the last two years. 7. I have fited, after demand, tax returns required by the commissioner of revertue. 8. I am not a ficensed distributor or affiliate of a disinbutor urtder Mina Stat. sec. 3d9.161. 9. f am not a ticensed manufacturer or aKliate o£ a manufacturer under Minn. Stat. sec. 348.163. 10.1 witi not 6e an officer, director, paid employee, or volunteer of a licensed, exempt, or excluded organization in its conduet of lawtui gambiing, or represenk a licensed, exempt, or exciuded organization in the purchase of, ar influence the purohase of, lawful gambfing equepment t i. I am not a whoiesale disVibutor or an affiliate or an employee of a wholesale distributor of aicaholic treverages. 12. I wilt not provide any staif to conduct or assist in the conduct of bingo ar any other form of lawFul gambling on the premises. 13.1 will not acquire gambiing equiRment or provide inventory control fior any arganization that conducts IawFul gamDiing on the premises. 14.1 will not prepare or assist in the preparaGon of any reports raquired by Minn. Rules, part 7861.0120, subp. 3, for an otganization canducting IawfW gambiing on the premises. 15. t wilt not ptaviCe accounTing services to any ar9anization conducNng fawfW gambling on the premises. t6. ( wiii not solicit, suggest, encourage, ormake any expenditures ot an organizafion's gross receipts from lawful gamhling, t7. I will not chatge any fee to a person without which the person could not play bingo or participate in another form of lawful gambling on the premises. 78. � wilt noF provide assistance or parficipate in Yhe conduct of law£ul gambiing on the premises. 19. t wiil not percnit more than Zt bingo occasions to be conducted on the pcem+ses in any week. 20. I will not recruit a person to become a gambling manager or assisant gam6ling manager or identily to an organizatian a person as a candidate to become a gambling manager oc assistant gambling manager. 21. I wiii noi be involved in the procurement of, or irtiluencing tne procurement of, IawfW gambl'sng equipment for an organ¢ation which conducYS lawful gam6ling on the iicensee's premises. 22. t wi0 not provide or permit an a�liate or persort acting on behaff of the bingo hait ticensee ta provide any compensation. 9iR, gratuity, Premium, contribution, or thing of valus to a Gambling Controf Baard empbyee or member of the Gambling Controi Boartl. 23. i wi11 not directly or mdirectly give gifts, trips, prizes, toans of money, premiums, or other gratuiSes to 9ambling organiza8ons, or their empbyees, other than nominal gifts not to exceed a value of $25 per o�ganization in a calendar year. i� addition, 1 understand, a9ree, and hereby irrevocably consent that suits and actions relating to the su6ject matter of ffie bingo haii license appiication, or acts or omissions arsing fran such apptication, may be commenced against me in a�y court of campetsnt jurisdiction in Minnesota by service on the MinnesoW Secretary of State of a�y summons, process, or pieading authotized by thz laws of Minnesota. By signature of this document, the undersigoed authorizes the Department of Publia Safety to conduct a background investigation porsuant to Minnesota Rules, paR 7862.0010, subpart 10. 6URTHER AFFIANT SAYE'fH N,T , pt that this Oath and Conserrt Statement are sup rt of the appticaGOn for a bingo hal '. �_rf .��.fbiing C trol Board. �`C �;'� MY �° �..�— �/ � /771AD" GTZfiG��, � . _.,-a5;2✓�� ( 1 of� I �� (Signature of Binga NaA Personnei Applicant) .� / ; (Date Signad} fi�scribed and swom to befor jq�e this �� day of I_ 7 �CZLc� J , 19 �� ( r 3 / i� (COmmission expiradoN Attach and Mai! Attach all LG375 forms to the LG300 Singo Hal{ License Apptication fortn, ar submit when information chaoges, and send to: Gambling Control Board Suita 90o South 1711 West County Roed B Rosevllle, MN 55113 Tennessen War�ing: 7he informatian �equested on this form (inUudiog any atcachments} wiii be used by the Gambiing Control Board (8oard} to detertnine your qua4ifications to be involved in 'awful gambiing aCtivities in Minnesota, and to assi5t the 9oarci ia ;onducting a tradcground investigation of you You have the right to �efuse to suppiy the information requested; hawever, if you refuse o supply this intormaicon, the Hoard may not 6e able to determine our qualifi;ztions and. as a cansequence, may refusa to issue you ilc2nse if you supply the mformaUOn requested, the Soard wNl he 51e to process yaur application If the Board does not issue you a :ense, aft informaUOn provided m the process of app�ying for a ense remains prtvate, with the exceplion of your name and atldress vch wdl remain pub6c. Disctosu�e of Sociat Security Namber You are required to provide your Social Security number on ihis form. Your Sociai Security number wiii be used to determine your compliance with the tax faws of Minnesafa. Authorization for requiring yaur Sociai Security number is 4ound at U.S.C. 405{c)Si). Private data a6aut you is avaiiabte oniy to the foifowing: Soartl mem- 6e�s, staff of the Board whose work assignmeot reqwres that they have access ta the inEormation; the DepaKment of Pubttc Satety; fhe Attorney General; the Commissioners ofAdmin'wtraticn, Finance. and Revenue, the l.egisla:ive Auditor, national and intemationai gam- b4ing regulatory agencies; anyone pursuant to court order; other indiwduals and agencies that may be specificaliy authorized by state ar fedesal law to have access to such inEormation; indiv�duals and agencres for which taw or lega! orde� authorizes a new use ot shar- ing of the mformation afte� this notice is givea, you; and anyaee wrth your written consent This form wdl 6e made avai4able in aiter- native formaf (i.e large pnnt, Braitle) upon request � 98-�/�{� Mirrnesota Lawfu! Gambting Bingo Hall Persannei information - LG315 Comptete this form if you are Iisted under "Owner Intormation" on the LG300 Bingo Hatl License Application. Bingo Hall Information Name of Bingo Hail License Number (i i D��-� H-R�-�. sH c�oa Address CitylStatelZip TefeRhone i � � y y� .il I•� �� S � S t � g � �.�.� Ssif 7(�a )< Personnei information 1. Lasf Name First Name Full Middle iVame A tF t-C� v j s r' S±£��,� /y/ i c�fA-F t.. �2. Maiden Name Previous Name Social Securitv Numb 3. Home Address CirylStata�p fa 7� (� oo �B �6E S i_ S� - 4. Home Telephone No. Drivers License Number State of (G,1.�)�/�7_�s/r19 d_i./�� - �7�-��z_A7� Page 1 of 2 1/98 r•� //� ' CPlA ^ /a' 7 ✓ Msv. SS�l7 of Birth Birthplace (caty, state, and province} �j3�.�3 S � PP�V L !�?Al , Dates of Service U.S. Citizen? Yes l� No 6. Check all that appry with Bingo Hall: aJ_�Owner b.)_SOIe Proprietorship cJ � Person or Entity with a direct or in�lirect financiai interest of five percent or more d.)_Padner e.)_ CZCorporate Officer fJ_Directar g.) � Manager h.)_Supervisor Bingo Hatl Duties: 7. Empfoyment record for the past ten years. List the most current first, including dates of unemployment or education {Iist schooi and address). Ifi you owned a b�siness in Minnesota, include the Minnesota Saies Tax and Use ID Number. Use additional sheets if necessary. EmployerfSchool _ Address _ �,� ,� Position beld Dates Type of Business MN Sales E:� CurrentTST CQfAt�.c6 Cft�eR�N� e ° �£�64 I T3 �� Past: /rliqwccT /'�✓r7 . Sroox Fa�.�s sv t��...,-�..,cf "1'a ¢.Tll[,A- G�a1r 5 � �RPlF✓a+D p�„L S J„E••�-*SCK� f�nR � �,�,.� Ca'��< b P{ace of residence for the past ten years (use additional sheets if necessary): Address CityfStatelZip Current: Past: ^ TaXNO. ��G— v� '�l. 1812;/� ✓-9S .Ss+coNs - 9Y s<T.w�.,r JG4�6 97 - 9i �i.a-� Dates of esidence SSn 7 9j/ 7� - i�P£.tE.� 9. Criminal history statement (except petty misdemeanors). Incfude the date you were charged, the citylstate where the charges were fiied, and the disposition of the case. If none, write "none ° 0. List the name, address, and Iicense or exemption permit number of any organization and name antl address ot any excluded organization you belong to which condu�rts tawfuf gambling in Mi�nesota. If none, write "none" .� . .. .. . . _ , � � (continued on 0 98-yvz Bingo Hall Personnel Information - LG315 License No. Name of Bingo Hall BSi ! t7F�t� {i�4�C_ Oath and Co _ . _ Page 2 of 2 1/98 Personnel Name STErf� ��-QU�S) 1. I have never 6een convicted of a felony. 2. I have never been convictetl of a cnme involving gambling. 3. I have never been convicted of assault, a criminal vio�ation invoWing the use of a firearm, or making terroristic tfireats. 4. 1 am not currently or have never been engaged in or connected wfth an iliegal business. 5. 1 do not owe $500 or more in delinquent taxes to the state of Minnesota. 6. 1 have not had a sales and use tax permit revoked by tfie commissioner af revenue within the last two years. 7. i have fited, afYer demand, tax retums required by the commissioner of revenue. 8. 1 am not a licensed distributor or a�liate of a distributor under Minn. Stat. sec. 349.161. 9. I am not a licensed manufacturer or a�liate of a manufacturer under Minn. Stat. sec. 349.163. 10.1 will not be an officer, director, paid employee, or votunteer of a licensed, exempt, or excluded organization in its conduct of IawFui gambling, or represent a Iicensed, exempt, or exciuded organization in the purchase of, or inFluence the purchase of, lawfuf gambling equipment. 11. I am not a whofesa{e distributor or an affiliate or an employee of a wholesale distributor of alcoholic beverages. 12. I will not provide any staff to conduct or assist in the conduct of bingo or any other form of lawful gambling on the premises. 13.1 wiii not acquire gambiing equipment or provide inventory control for any organization that conducts lawful gambling on the premises. 74. 1 wiil not prepare or assist in the preparation of any raports required by Minn. Rules, part 7861.0720, subp. 3, for an organization conducting lawfui gambling on the premises. 15. I will not provide accounting services to any organization conducting lawful gambl+ng on the premises. 16. I will not soiicit, suggest, encourage, or make any expenditures of ao organization's gross receipts from lawfu! gambling. 17.1 wiil not charge any fee to a person without which the perso could not play bingo or participate in another form of gambiing on the premises. . , � � ..�� ,..a��.� k1t and sworn to before me this��! day of Attach and Mail Attach all LG315 fortns to the LG300 Bingo Hail License Application form, or submit when information changes, and send to: Gambiing Contro! Boartl Suite 300 South 1711 West County Road B Roseville, MN 55113 'ennessen Warrting: The information requested on this form �nctuding any attacbments) wiil be used by the Gambling Control oard jBoard) to determine your qualifications to be invotved in wfuf gambiing activities in Minnesota, and to assist tfie Board in mducting a background investigation of you. You have the tight to fuse to supply the information requested; however, if you refuse supply this informatwq the Board may not be abie to determine ur qualificaNOns and, as a consequence, may refuse to issue you cense. If you suppiy ihe information requested, the Board will he e to process your application. If the Board does not issue you a nse, all �nformation provided �n the process of applying for a ase remains prrvate, wdh the excephon o( your name and address ;h wdl remain public 18. 1 wiit not provide assistance or partic+pate in the conduct of lawfui gambiing on the premises. 19. I will not pertnit more than 21 bingo occasions to be wnducted on the premises in any week. 20. I wifl not recruif a person to bewme a gambling manager or assistant gambling manager or identlty to an organization a person as a candidate to become a gambling manager or assistant gambling manager. 21, I witl not be involved in the procurement of, ar influencing the procurement of, lawFul gambting equipment for an organization which conducts Iawful gambling on the licensee's premises. 22.1 wiU not provide or perznit an affiliate or person acting on behaif of the bingo hail licensee to provide any compensation, gift, gratuity, premium, contribution, or thing of value to a C�ambling Control Soartl employee or member of the Gambting Control Board. 23. f wiil not directly or indirectly give gifts, trips, prizes, loans of money, premiums, or other gratuities to gambling organizations, or thei� employees, other than nominal gifts not to exceed e value of $25 per organization in a calendar year. In addition, I understand, agree, and hereby ircevocably consent that suits and actions relating to the subject matter of the bingo hall license application, or acts or omissions arising from such apppcation, may be commenced against me in any court of competent jurisdiction in Minnesota by service on the Minnesota Secretary of State of any summons, process, orpleading authorized by the laws ot Minnesota. By signature of this document, the undersigned autfiorizes the Departme�t of PublicSafety to co�duct a hackgrou�d investigation pursuant to Minnesota Rufes, part 7862.0010, subpart 10. FURTHER AFFIANT SAYE7N N07, ezcept that this Oath and Consent Statement are s� d N support of the application for a bin o � � ambl ag Control Board. rr�enuS1RA J. G1E ._' ,.,� � i 20�9 r; �-",.. g/ , '� l o�� 1 / d (f7ate Signed) , is 9�' � r�L� aCOd (Commission expiration) Disciosure of Social Security Number You are required to provide your Social5ecurity number on this form. Your Social Security number will be used to determine your compfiance with the tax laws of Minnesota. Authorization for requiring your Social Security number is found at U.S.C. 405(c){i). Private data about you is availabte only to the following: Board mem- bers, staff of the Board whose work assignment requires that they have access to the information; the Department of Pubtic Safety; theAttorney Generat, the Commissioners ofAdministretion, Finance, and Revenue; the legislativeAUditor, national and intemational9am- bling regulatory agencies; anyone pursuant to court order, other individuais and age�cies that may be specificaily authorized by state or federal law to have access to such information; individuais and agencies for which law or fegal o�der authorizes a new use or shar- ing of the information after this notice is given; you; and anyone with your written consent. This form wiN be made available in alter- native format (i,e. large pnnt, Braille) upon request y �- yy� Minnesota Lawful Gambitng st�sres Bingo Ha11 Personnel Information Page 1 of 2 Compiete this fortn ff you are listed under "Owner Information" on the LG300 Bingo Hat! License Application, or within ten davs after a change in i�formation. Incomptete, faise, or misteading applicaUon information may resuit in denial of a license. Home Addrass State Zip Gode M N 551`2 s�rtnPtace c�ry a�a sraa City Fuli Middfe Nai ,d none, wrtte "no �� -f�J �tary Service Oates af Senice � US. Cflizen: - If no, enter regi: � t � N� J�Yes p No / wfth Bingo Hafl (chedc one): �Sole Proprietarship � Managet O Supervfsor � Partner O Corporate Officer (� Director ient RecorU for the past ten years tuse separace sneei, n i(school, address, dates). if you owned a business i� M Empioyer Atldress Posttion Held of Residence for the past ten years (use separate sheet, if necessary). Atldress City State 21p Cade Name Social Sewdty P Q�a'-�8-� Homa Phone � ��/!'7��X..�� Dates of Residence � — �� 21�, _ S.JG Criminal History Statement (except petty mistlemeanors). �nauae me aa[e you were cnargea, me ci[ps�a�e wue�a u�c u�a�y�� .._,_ filed, and the disposition of the qse. If none, write "none" (Use separate sheet, ff necesSary.) ►JON� iinnesata, or name and address of any excluded oi Organizatbn �e� OrganizaQOn Adtlress Address Licenae )rganizatlon Addres! Lkense w ). Indude periods of unempioyment (dates) or iclude the Minnesota Sales Tax and Use ID Number. Dates 7ype of Bustness MN Sales Tau # = v. P. 51q2- �r�nt ca:te� - i8�2� •rr nni.�. �Ican , .�iocor� nlrir.c �1 you belong to which contlucts iawru� ga�� of titfe: Member.) If none, write "none." License or Exempt Pertn@ Number � nne Tiqe Nvmbar TNe Numbar Tide (conUnued on back) 1 Personnet information � Hall Personnel Informatioa Oath and Consent Statement t. I have never been convicted of a felony. 2. t have never been convided of a crime invofving gambting. 3. I have never been convicted of assault, a uimi�al violation in- valving the use of a firearm, or making terroristic threats. 4. I am not currenUy or have never 6een engaged in or conneGed with an illegat business. 5. 1 do not owe $500 or more in deiinquent taxes to the state of Minnesota. 6. f have not had a sales and use tax permit revoked by the com- missioner of revenue within the last two years. 7. f have filed, after demand, tax retums required by the commis- sioner of revenue. 8. t am not a licensed distributor or a�liate of a distributor under Minn. Stat. sec. 3d9.161. 9. f am nat a iicensed manufadurer or afhliate of a manufacturer under Minn. Stat. sec. 349.163. 10.1 wilt not be an officer, director, paid employee, or volunteer oE a licensed, exempt, or excluded organization in its conducf of tawful gambling, or represent a iicensed, exempt, or exduded organization in the purchase of, or influence the purchase of, IawFul gambling equipment. t t, l am not a wholesate distributor or an affiliate or an emplayee of a wholesale distributor of atcohotic beverages. 12. t wiii not provide any staff to conduct or assist in the conduct of bingo or any other form of lawfut gamhling on the premises. 13. � wiA �ot acquire gambling equipment or provide inventory con- tro! for any organization that conducts tawful gambiing on the premises. 74. i will not prepare or assist in the preparation of any reports required by Minn. Rules, paR 786M1.0120, subp. 3, for an orga- nization conducting lawfui gambiing on the premises. 15.1 wiil not provide accounting services to any organization con- ducting lawful gambling on the premises. f6. I wiil not solicit, suggest, encourage, ormake any expenditures af aa organization's gross receipts fran lawful gamblirtg. � 17. I wili not charge any fee to a person withaut which the person cou(d not pfay bingo or participate in another fortn of IawEui , gambling on the premises. � swom to before me this .—��O{ day of Public) S 8-�i4� LG315— 8i18t98 'a9e 2 of 2 18. I will not provide assistance or participate in the condud of tawfut gambling on the premises. " 19. I wiil not pertnit more than 27 bingo occasians to be rAnducted on the premises in any vreek 20. t will not recruit a person to become a gambling manager or assistant gambting manager or identify to an organization a person as a candidate to become a gambiing manager or assistant gambling ma�ager. 21.1 will not be invoived in the procurement of, or influencing the procurement af, lawfut gambting equipmerrt for an organization which conducts fawFul gambling on the licensee's premises. 22. I wili not provide or pertnit an afifiliate er person acting on be- half of the hingo hall iicensae to provide any compensation, gift, gratuity, premium, conV7butian, orthing ofvalueto a Gam- bling CanVCt Boazd employee or member ofthe Gambling Con- trol Board. 23. ! will not directiy or indirectly give gifls, Vips, prizes, loans of money, ptemiums, or other gratuities to gambling oiyanizations, or the±r employees, other than nominal gifls not to exceed a value of $25 per organization in a calendar year. In addition, 1 understand, agree, and hereby irrevocabiy consent that suits and actions relating to the subject matter of the bingo hall license application, or acts ar omissions arising ftom such ap- piication, may 6e commenced against me in any court of compe- tent iurisdidion in Minnesota by service an the Minnesota Secre- tary of State ef any summons, process, or pieading authorized by the laws of Minnesota. By signature of this document, the undersigned author¢es the Depariment of Public Safety to conduct a background investiga- tion pursuant to Minnesota Rules, part 7862.0010, subpa�t t0. FURTHER AFFIANT SAYETH NOT, except that this Oath and Consent Statement are submitted in support of the application for a bingo hail license from the Gambiing Control8oard. 'ennessen Waming: The information requested on this form (inGuding any ttachments) will be used �y the Caam6ling ConUOI Board (Board) to deter- iine your quaiifications to be involved in lawful 9ambiing activiUes in Min- �sota, and to assist the Board in conducGng a baUcground imesUgation of �u. You have the rigM to refuse fo supply fhe information requested; how- �er, if you refuse to supply this infortnation, the Board may not be abfe to dermine your quali8cations and, as a consequenca, may retuse to issue u a ficense. if you suppiy the inkrtnation requested, the Hoard will be able process your appticaGoa It the Board does nW issue you a license, all xmation provided tn the process otapplying Tor a ttcense remains priwate, i the ezceptioo of yuur name and atldress which will remain publ(c. �ate data about you is available only W the foibwing: Boartl members, f of the Board w�osa work assignment requires thet they have acceu tn information: the Departmenf ot Pu611c Safety: Ne Atiomey Generai; the �missianers of ACminisVatlon, Finance, and Revenue; the LegfslaGve tor, national anA infemational gambling regutatory agencies; anyone uant to court ordar, other individuats and agen t hat may be specificaity authodzed by state ortecferai iaw m nave ac��o w�� - maGon; inditiduats antl agencies fur whFch iaw or legal order authosizes a rtew use or sharing of the iMormation after tfiis notice is given; you; antl anyone with your written conunt. This tortn will be made available in alter- naUve fartnat (i.e. iarge print, Braille) upon request. DhGosure of Soclal Secudty Numbec You are required to provide your Soda� Sewrity number on this form. Your Sx1al Security number wip be used to determine your compitance with the taz laws of Minnesota. Autha rization for requiri� your5ociai Security numberis fou� at u.S.C.405(c)(i). Attach and Mail Attach al1 LG315 forms to the LG300 Bingo Hall License Appiica- tion fartn, or submit when infortnation cha�es, and send ta: Gambling Control Board Sufte 300 South 171� West County Road B Rosevflle, MN b6113 _