91-2216 ORIGINAI -_ �
�� � Council File # ���� '�
--�'" Green Sheet # 17657
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
1
Presented By
Referred To Committee: Date
RESOLVED: That application (ID #A-01991) for a State Class A Gambling
Premise Permit by East 1�ains Babe Ruth League at 1494 N. Dale
Street, be and the same is hereby approved.
Yeas Navs Absent Requested by Department of:
imon �-
oswi z �
on � License & Permit Division
acca ee
e man �- � �
une / BY:
Adopted by Council: Date n�_5 19g� Form Approved by City Attorney
Adoption C 'fie by Counci�� Se retary � �
� sY: /0-3/•9i
By: �, ;'� •
� ��: � A roved b Ma or for Submission to
Approved by M or: Date �'��- � 1991 Council Y y
�J •- --
,
gy; %�1.�/-��,Ct--E��� B
Y=
11�ll��lEQ DEC 14'91
i
C/� � '
������
DEP RTMENT/OFFICE/COUNCIL DATE INITIATED
� Finance/License GREEN SHEET N° 17657
CONTACT PERSON&PHONE INITIAL/DATE INITIAUDATE
�DEPARTMENT DIRECTOR �C�TY COUNCIL
Christine Rozek/298-5056 nssicN �CITYATTORNEY �CITYCLERK
MUST BE ON COUNCIL AOENDA BY(DATE) NUMBER FOR gUDCaET DIRECTOR FIN.8 MCiT.SERVICES DIR.
City Cler ROUTING � �
ORDER MAYOR(OR ASSISTANT)
Hearin / By/ Il �j ❑ 0 Crn�n�;1 g
TOTAL#OF SIGN URE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Approval of an application for a State Class A Gambling Premise Permit.
Notification/ Hearin / � �
RECOMMENDATIONS:Approve(A)w ReJect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING GUESTIONS:
_PLANNING COMMISSION _CIVIL SERVICE COMMISSION �• Has this person/firm ever wo►ked under a contract for this department?
_CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a city employee?
_STAFF
— YES NO
_ DISTRICT COURT _ 3. Does this personlfirm possess a skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVET YES NO
Explain all yea answers on separate sheet and attaoh to green sheet
INITIATINO PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where,Why):
Margaret St. Sauver on behalf of East Twins Babe Ruth League requests Council
approval of their application for a State Class A Gambling Premise Permit at
1494 N. Dale Street. Gambling sessions will be held on Thursdays between the
hours of 1:00 - 5:00 PM. Proceeds from the gambling session will be used for
youth athletics.
ADVANTAQES IF APPROVED:
If Council approval is given, East Twins Babe Ruth League will conduct a
gambling session at 1494 N. Dale Street. RECEIVED
Nov 2 21991
CITY CLE
DISADVANTAGES IF APPROVED:
DISAOVANTAGES IF NOT APPROVED:
`.'�CMt�?°.�;y,..?>:. �"A
Co����,� �..�.. .�:� �,a��er
NOU � 1 1991
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETEp(CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN)
�vV
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL �
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO. 298-4225).
ROUTING ORDER:
Below are correct routings for the five most frequent rypes of documents:
CONTRACTS(assumes authorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept.Grants)
1. Outside Agency 1. Department Director
2. Department Director 2. City Attorney
3. City Attorney 3. Budget Director
4. Mayor(for contracts over$15,000) 4. Mayor/Assistant
5. Human Rights(for contracts over$50,000) 5. City Council
6. Finance and Management Services Director 6. Chief Accountant, Finance and Management Services
7. Finance Accounting
ADMINISTRATIVE ORDERS(Budget Revision) COUNCIL RESOLUTION (all others,and Ordinances)
1. Activity Manager 1. Department Director
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor Assistant
4. Budget Director 4. City Council
5. City Clerk
6. Chiet Accountant, Finance and Management Services
ADMINISTRATIVE ORDERS(all others)
1. Department Director
2. City Attorney
3. Finance and Management Services Director
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and paperclip or flag
each of these pages.
ACTION REQUESTED
Describe what the projecUrequest seeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the issue in question has been presented before any body, public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objective(s)your project/request supports by listing
the key word(s) (HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
PERSONAL SERVICE CONTRACTS:
This information will be used to determine the ciry's liability for workers compensation claims,taxes and proper civil service hiring rules.
INITIATING PROBLEM, ISSUE, OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is simply an annual budget procedure required by law/
charter or whether there are specific ways in which the City of Saint Paul
and its citizens will benefit from this projecUaction.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past processes might
this project/request produce if it is passed (e.g.,traffic delays, noise,
tax increases or assessments)?To Whom?When?For how long?
DISADVANTAGES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved? Inability to deliver service?Continued high traffic, noise,
accident rate?Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addressing, in general you must answer two questions: How much is it
gofng to cost?Who is going to pay?
e��i_aa��
. � ,�
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE fj o'L. /
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
C Lic E f Au
4�f �� - ' �er�'C�.m -1�1g r•�
Applicant Home Address �/ � ,CQ��~� _.��'?j'/��
Business Name ������ �. � ���ome Phone '"J�f�— �rp�s
Business Address �f� /�, . ,,� S-� Type of License(s)�'�-� �Q$S" �
.
Business Phone rf��, — d2.��,� � �J �'�� l��l.t�'
Public Hearing Date �� License I.D. � ,��* 0���� �/ �'
at 9:00 a.m. in the Counc Ch bers,
3rd floor City Hall and Courthouse State Tax I.D. �� A//�
Date Notice Sent; Dealer � ��/�}-
to Applicant
Federal Firearms �1� /(��/�
Public Hearing �� C�" " " /' � �
DATE INSPECTION
REVIEW VERFIED (COMPUTER) COrIlKENTS
A roved Not A roved
Bldg I & D �
�( �
Health Divn. �
�,��. I
Fire Dept. �
��%I' �
Police Dept. !: „ _1 I f�/�0 Jq I
3-�� �
�( � ��
License Divn. (
�� (al�i� � Q�L�
City Attorney �
�� �� y�� a�.
Date Received:
Site Plan G' /s
To Council Research u� zf>'"�`3/
Lease or Letter Date
from Landlord I � S� �]
�9�-�i�
! � FOR BOARD USE ONLY /
� LG214 BASE# ���
P��!
PP#
FEE
. M{nnesota Lawful Gambliny CHECK
Premises Permit Application - Part 1 of 2 INITIALS
DATE
�o�oF?�x. :{�.,.!tt;m�,., ..+x�,r;>y,{r:{;»s.:xv.�.y :.we axt:;K;%>, >3??r:Y.k� x . sk`,t; .�-•`•.�'..,^;.2;. .,`�r+.'d"'. ';.y .�}.;•;�: '�.,y .
�... • .,h••' �,+:+:Y:.v3 ��t•:••f::::�n+ !��''A"'�%:{ ':k•.,, .:�e'`.3::>.:... �.'��i,�°i?0•�'<:`•'::x:r. .:�•:•c..�::. .:�:... ..��'::Ki`�'f":::.Y;. Wc ••a..:.;.., .o.:�
:• .
..+1'�. ?' ;:5. :;,: .. >. ... ..•::::.;.: '•�?"�•%%"k. ..,c;� t;.::'k. ,. <
..��„� :..Y.,+..,,. •.:?,• �:.��c<.,f;,y!i 'Kyr, rFy,/r..;}r.;,•;.�;c:,:•..�?,:�};:..`•{f::.;•. t ..;av:�9:�n:•f Y .:y:8 ,><, .'•:x2;}{!•x,•a; '::3�" ���;,:.`;�',t[�',+.,�""�'t�:
:Y� 'a�' �� }JO S �Il� t+..�r:}. .t...,�•�,f:ti.%�,.+�:::;.+ +k r�:��� r{yl :t'(?' '�t� 4 }v ry:} .
l Zt+;::�If Y�7,�.�}�{.}r., }:'%:•:ii,+;3:' •::�'�'��:i�;'�::%?:.. .�..%/� .Cfi .�+�''n��,:. {.'•��:y�,..�..f{i:'::::;y:}':;<:;<S?ir7'<�+'
...e..:::;o;::A :i�ca�tc�rn.�....�....�':,•'!�i�•::+,..:s<:.�:.s:>s:...t.•ii:..{::'•?:i<... . �.. ,<.... . ,.#' t7.a..t•�: �.< r.:... .+u•.{�
:. ;., .
..:.x... .... ....... .: .......................................�..:t.........................t.�......,>,...::::t..:.::,:...�..,.::?�:#?:�:�i.�:.:::.<..:s�.,..+j,..;..,.i1{.,..:t:5,.;•}.;'�:��o::::...,�:�•:....•`.`:�::?•Y�e•.t•t�?;.,+{a...:;..;•`..•`.•;;:x;•+:::••f,
CI8S5 Of pf6R1159S P6R11K
QRenewal (chsck one)
Orpanizatan base license number,8 'd 19 4/ (�' A(�400) Pull-tabs,6pboards,paddiewheels,raffles,bingo
Premiaes pertriit number � B(5250) Pull-tabs,tipboards,paddlewheeis,ra}fles
� ❑ NeN► ❑ C(5200) &npo onty
❑ D(5150) Rafflet ony
YN... .., � ..¢�Y,.}'lwNN,.,Ki�S�H.^:Kt;v, s,;s•.,t, .•:f.,... .,u,.n�,,., .yn:;pwc;:t �.xx�.<:: ,�..:;t<+•;. :Na�,: ;;v.,.y..,..;�,yM..,;� ,ri.
. ,.. l....: . �•�..:• :... •• ,�{°•�"":::::.:.::.:.r>.,;.... ;;;•x;<•:.aC,..•. :C:�:;,,� ..';:2::`� ..."..."�..�:::... ..�R':•`::�� ....5�"y.'/,••,,,,.wse,.,• by'••:. 5.. :r:�. .,r,,.ttt^"s.
y�}��.�j�yj �y �/f� /�� �•�.>:,v�;,�i�;;�::;;f:?:::•::..,..... ..:.>:..::;{`'•:�;;,.;... .:;t;,.. . ';::t`.:<•a: �.�9}..tt>.•:.Y,C.k•.:,��J,.�,.s:�f.>.•,•ti.57rt.� ;o:::�
. , ..;:.. . •::.; :::. .. ., :. .:.;k..+n�;•::�R#•,'::Y::..:•::..�t�....{i•.+,e.<.:r. Y r..:.-R; ,;?>... ,.�..e.;,-. .;;p..
:'t;:- .:<r..s,n.:L:>..a:•.•.,>},j•f:.:;;,;:,'.;r... :•.•r..,u•.;,;..;... ••:.FL..�. ra:�.�.,:'5��.y�:;'•::a••...Y�'••'iYsi:t•,'•:•:i,-•, .>:ri';•'.V..,.�;.t.�•xjz:>,...
. ��M��.:�ekfi.4b�L.���..�.��;.V..�K�4//.4:...; ...k::;o.;+.:.,••.•:::::.�:5�#:':`���':�i.`••'••f�..,o...;... ✓,... . o .,.< ,.,$...:z. a.,,f�'...;c,�.{y,f: �.0 ,.f.
.,.,
:y�.. ...�...
....�v: . . .. �.::::: r:: n.M1 4.:r.......!/v:.{x.�..l...C.:4:. .+•':�':::?:r.� J ...4� ;r
....... ....•::�. .:.:�::::.�:::.�::::.::..•..,Y,•:::::c•::::,t?f,�:c:;•:'.:t��::.>:::a>:<:.:::.�.....t......:::...�..>::..r:,:`.o��•:.�':•...;,icF'::.:.�:m:�.',.fi,^.,'$.v;....,`ts,.•;:';::;:::Y:' .,�::•x:;rr�•J;�:•`.#Y`:�.+�r?Yic�•:..
N8m@ Of Orpanizebon
f'a�s f Tr��n c �a.bP ,P .�h c�c:� �n�.
gusinesa Address of Oryanizaoon-Street or P.O Box{Do not use address of your pamblir�manayer)
n . io _
Ciy State T.�p Code Couny Daytime phone number
/�, i0 Co /Cn e (l�� ) �7 - �
Name of chief exeeutive offic�er(cannot be your yambGnp manaper) Tide , Daytlme phone number
I�)M�1Qe�l ��at-� l�r`eS/ c�er17�' (1ol.�Z)o�9/- e'15/.�
Bia�o Occasions
If applying for a class A or C pennit. flll in days and beginning&ending hours of bingo occasions:
No mon than seven bingo occasions may be conducted by your o�anization per week.
'. Day ` . Beglnning/Ending Hours Day Begt�u�ing/Ending Hours Day' Beginning/Ending Hours
�� 1 �� �o�_ t,o to
� to to
� . to If bin�o�vill not be conducted.cbeck here �
�"' •:�}.•. •: •. • � ..• :. �'�9.¢;'J..�E?N't�s`e�ax?'?^y.� •°V%'s{S:;e <.ys#.. {r,a:$ x.*rrF :�A, •::w4<� i�>,. ,as� .4y7re:� a:
' '�'�4�� . y��y �:i. ' � ' • �,,�''r�y�f','f�2�`"��4''''Yu,'��.'�,.�c�,�'�` .:: •��,;r�:�' S::� �_. .:k?"�.$v�%�, "$�<:%�:. .��'p�f�..'.'��..�C'.l'.�rt
.:. . . . z
. "' � v .r a��,;. „�::•i.,>.•.:••���Yi.<•• ,i� ,.>�,a '••'�%:r �r�:•:;„�#sf•.
•;.;:...�:::::��::. �:. '�?',a„�.�'�a}1,'�M�...�t!rT..��.:::.�.�::,�,�,.;.�...�.�xi;.:, � .s:`.;v:.::s..,..a.:t,< Sf� • :`'�9. �`�'��,•. .P.��ia�..r •;�:`r.�t:?r.,• .,•:.a. • •:::�rr.��.:::`:..:{?;gc,,;k;.;.
.. .o:n.. '�^L:.�e��,A'.... ;.t'+k.�e. 4
....::.:::...:.....•;.>�. .. .... ....::::... a��• ,. ,.....�.�'... ... .:. , ...;���.;......;.;;.;..:::•>.:,;.�.:..::•:.:::::..:::..:.:..:,
.:..:.. ..::.........:. ..;. ::v..,
ame o eata is ent re pam inp nn con treet A ess not use a post o �ce box num j
����.� �-�,1� � 5/9y � , ai
Is the promi=es bcated within aty Amits? Q Yes O No Ii no,i�township 0 oryanized � unorpanized p unincorporated
Ciy and County where�ambfinD premises is located OR Township and Counry where pamblinp premises is bcated if outside oi city limits
5-�.P��/ �r�rn.�r .o �
Name and addres:�lepal er of premisec City , State Zip Code
�sbs�h i e,rknr�,�h ��7'�a /�ar�a. �- l� c,rJ /'Y�n ��ioc�
Does your panization own the buil�np where the pamblinp will be oonducted� p YES �NO
ii no,attach the iollowinD:
• a copy o(the lease(form LG202)with terms ior at least one year.
• a copy of a sketch oi the floor placrWith dmensiona,showinp what por�on is being leased.
A lease and sketch are not rec�i d for Class D appGcations.
..i��ir' .k;M:�{i:ti:rK..'�i'A�k$:ii'?}:'%4i '•'Y°�iC� ..'4'r ra:C'?:N.4:i4:•{{+.qy{:.•�w.
•:'� .x.t.. . .4'.�1.?•. v:K.{T...w:• w:x: . .v.•:.vv
•:'?t3.`?fi;. ,.:#� .) :.�c'tY:..::o..; :Y. .::>. ..5......�.....:'•^' ..3''? �....::�t:n:ts•:>;:,.;yr..>x: :•:u:,.;.,.,. :;.:aa.;:;a.>r:>:.:�.;X.,.:.:o
:...:. .: ...,:..... ....:`.�E". '£'? "3.. �� <��^..:•..::•>.. .,•::.::.:.{•............... .:wi . �;t,:^^.^z.,.
.: . .?.,.;:•..�c.'.... :.�:.:.•.;c?'•.;,.<.:: :?�...�6.��.^�.........:...::...:.... :•::...:.:r?"''�•:;>+;.::...........,.o..t.. .. ........�:' .. . ..t. ::::.;:.�..:�.:::::;:.��c"'a''i•':'%:�v<`:^�i:..::::..r.
. . ... . . •.:< . .;. ...•::,•:.::•.;.:... .R`.p....c�:::,.a;{,,<.,..,..,..: .;{,J.;:•..;,.:k#;i���:•::^:•i:}<•,:�:::2�:�i:i;:<;'':;:n;::;.
..... :.:.......... .:::. v.....r.
dx:��s� df s�o �::::s ace:±nf.� am :: -�:�r;�g��e��X��;f;;�.....$::v::n>;:::<�:<�::>:<>::<,:;:�:v:r::::.,r
� ... . ... _ _. .e. ui men�
_ :__ _ _ ..._ .... :.::.:........ ,..:.:::,,.,:.
..>. .
Addres: Ciy� , State Zap
;A,k�r;
_�'�Cq__Yrme:? C��� �:_�_P�c�.// °�`r�l�?C?�- -- _�us(_C.�l�
�
� ._.� -
. . M�nnesota Law,fut carr���n9 (U'`���a�•�/�/
� � Premise Permit Application - Part 2 of 2 �
.. �.v:�tiv. w..vw+wv.vnv.v>iirr��•::r.v -ro.vr ... .y.i.�.w wC: '.,w„•;N.?... .v,w, x„ .w. v.v:,n.y::::yn•:. ••y•
...� ::........:a�.......................�s:....eM!.......t+sr.!: .{_ ... ... . .4 # 'Y - �.r,,:�':`.:,s,:i::•.'•:.••..:•:x•:,.•r y.o. ..;:...:;:•Y..•,'...•.,•:::::::::::::::,r,F ��}s^�•t.. .ys<•+.::.:::r,
�„�."?eFiy:�"'."v.. ........... ......... ....................n....�...�3�".. "'.. ^"t'i::..�°•°�'..:.::•i:�?i•.�r...:vn... ...:f.......:::.�:v��.�::.............Sn..c....:.:..:::.:�•.�::::::::::::R•.. .Iv.<:i�:X??i'•::•::••.':<?:,:!<.:i•
..,..;:,.>. . .,.:..:...:. :....... ::•::.:.,-.,,�.,,..:,:.,..,_ :.. ,.,.. :?^�`,....:.,. ..:...:... .::.:•:>:•.�, .:::::::::.::::::_•::._::s:::::..:,:,::,:•.:::>::•:.:...:..:,•::::•.:........,. ,..::..•::::::.,..•:.::::,::::
:a>•.;>:::...:..o :•>:a:.>::.�;••:•>•;•.;;:>::•::•;�•:;;:•::•,:;i.c. ,,;r•;::;>.;;:;::>:5::.. o.:x.>:•>:;.;:••.•.:•<.�• ;:.:s
:.:.'f.•:'•• :::5::::::.:�::::::>:.::.�.�:::y?��:``•:'v':.`;?#;',':t->%;o.::::::>::.,::Y:,.+2�'��•:::
GatmbI:nQ'Bank:>Accoun�-:1' �,,..<.:::;.:�... .,:.:�:
r r�f"or.mah�n..:<:>:.,:::�:,:::.:,4.......:�..... ......:...:.:... :.::.:,.<.:::.::.:.:..:.:. ..................,;<::::::::::::?..-:::..
.........
Bank Name Bank Account Number
�rs-�' ,C�an k ,c�s-�- �s-�o�a��o�
�����SS . �ti �� p
1 �a�n p /�t� _, S-�. Aa.c�.l �n . _ �s��
. . ' ` - x/. n.W.tif??:^.:. :.......4y.,...... •:».v.v1w"' ... � 'YlNMV.4i• v:4'xr�•1.Rw• ��.�LJ�; M.,
♦•;v. . .... .. v�!� tr��v:.:ti• v,�,:��<5;
,�,"}:....:.:::::.:.::: ;BdCX!@SS��.0�... :gIJ�lGRZB�:�C`:` .�S'.��fJS�fB �!i`:i8��7�iN!B�S: 4
�. • .., .. �t7
�":�:'�'•::.<�:.^.::....8�s.... �..... .:........: ....,�.:�...,.;.... .s'�; i,v�<o.;
. . :�>.::::.r?''-:"���'��� ........... . • .�.`..�5...:.,.... S:i�'�., .;; •. •.::• .;,.t.. ;�i:`.�:'�:o•:•::.,.
...
' •:J ..xv::A:i:::::.�:::::w:::.v:::.:!:•.�r:::.v�:•J+ii.:::^�i:L:. .]....nI nvv:.w.......p?J.ntin.. .{.SK:...".�.i::u..?'n):;:.,....5'i.�{:�:??i::i{'.4:i:i� Y3.��: A .:fi:.:+'�
}C�i::m::::::::::::::::r.!w:{:r:::;. ;ty,,ri�p �. v.......v.... +p ..}....... s.......:v. _ � • . ..r..ti�:}'.. ;, .}i ?. S>..�i+.i v
: • :J�., ...v f X r,�i".Y:. �}....�y;. .. . .:}.��y�:: — {, ..,..��yS;,,�'SSi�:�.,.Y.^�..Y:}yrf,'}�'�:n ,�•+^�'','•: �.i}i}'.�L,�•
....Yv{�C}4}'ii> :`:::''.�::.'�':�.:...;:�y::.:,'{.}.w::YT.'..:.v::i��aL�i'���1� v�Q�•7iMiJIV.' �/l7L7� :lW![]51 i,.;� } +FS{,S} i..tv.... .:O.Jni:{.....:..
. � ,r � .........::.::..�. ............. ::.�.. •� . . .
�..
ame ss Ti e
. ��' �, �ar��' �f. Sac.cucr /I�o� n� Pl� Sf P� c,�,/. l'rin. C'.lrl�.r.
.
� � l'���ha � �Sna rn > > ^14v C���a�P, �f.P�l f�1�. Pres��en�
,;,.• r5�^;K$:".;:"i�'YGt,.,'t;;;'..�"^y:Y.•.'•s:`;;t;;.^;^'a�.,•.:.;.,,;.;. r x. �..yt` n".,- .` '�t�' : �t�•"•.;.•:x•;.;. •:;�';:•'.�^;^.,�!4?a"J:'�};:•`.:`:eq:;i.y,}„;;!' .y..+�;" •.::»���:�i
��a� f,:,,:.vn.,i:.;:.5•.'•,<r,"tt <W a>L �e .�,x,��.'Y�k�f :x����. ' 3' 2:���'i`�� t.c 2% .:i:
. � �,+.;i?v Y;rh{ %.}.i, ...{,3.�.+�i'tJl•.�:�.�, :.:��..5:.� , a` ,..�i�:..x,•::%. : .G�..3..}..{y. �}SS�cr �i�f�..�f :..
��inL:'r;�u.�?.:.;slu,�... .»:;k,� �9L'.� •��;,. ../.:.,. ;v.. ti:Gv.;•�;`.,.,rr�,',.r,.;::;t..�.� ;e..r.:r:�...,F,;,.;.::.'':
AckaowYe� � em...... :::.v�:::>,.::::.�:,�.:.,.:..�.��.� �..:,v..: <......>. ..... ...��..:«..::.. .,;�:.�:::.�.>:�-.:;.::._.�:»:..s :::..�f::.::::;>;::::
....:......:�::::::::::.:::::::.�::. ..................................................,.c.....>}�?�.Y.��.�.,,�c.::::,v.,....,"�•� .. .:.........:..,},..,.::�,:.:.::,.:f:;.w:.:..,;';^`;:
� :.... ;;.;::.;.
.
.................................... ......................................................................... ..........f........... . ...........................................:..............,,..:.
Gam g S te Au o on •i am the chief executive officer of the organization;
I he�eby consent that local law enforcement o�cers,the •�assume fuil responsbility for the fair and lav�(u!opera-
board or agents ot tha board,or the commissioner of tion of all activities to be oonduded;
revenue or public safety,or agents of the commissioners, .I w�l familiari2e myself with the laws of Minnesota
may enter the premises to enforce the faw. go�ming lawful gambiing and rules of the board and
Baak ReCOrds Informstioa agn��if�iconsad.to abida by thosa Iaws and rulea.
Tha board is authorized to insped the bank records oi the induding amendments to them;
gambling accouM whenever necessary to fu�ill .�y��9es in appiication information will be submitted
requirements of current gambling rules and law. ���ard and bcal unit oi govemment within 10 days
Oath oi the change;and
I dedare that: •I understand that faiiure to provide required i�ormation
•I have read this application and all iniortnation submitted or providing false or misleading iniormation may result in
to the board is true,axurate and complete; the denial or revocation oi the I'�cense.
•aA other required information has been fuly disdosed; �
Signature of chief executive officer Oate
.. . .: ..::.:.:::...:::..::::.::::....::....�:.:...y..�..::.::::.::::.;..r.:: :.....:..:...;..:.:.�...� �p.v.....:.:
9- � r -
......� ��},, ...u..,..:...} -�:�.<A.>::.::.:::<:.:::.>;:.>::::..:::�:�.:.� ::.><:::>.:>:�>:::>v>:.��:
. � {�. . ..<.:.:::.,.�:w.::.>..:............ ..{..�..:,..:..... .. ,:�..,..v.,,.. { ..... ...<.... .........:...::.
.:.. . . .e^::.. ..........<... .......... .. .. .. ... ,� ,.�.::..�:a. . . .... , ,......,......<, ,::.::,;.::::.:�:,;. ..<.. :� .:.:;•:.::::;.:•
. . . ..�..fin....�...n..v.rT..;.n....}}i. .4.., n;y.+.,�,.2 ,{.;., ;Y]! ;gwjr.;,}.;;r;.h.:{:..4"'" . . . .•M1:;J.;��i,{••v;:.�.;n+:?i'+f.� v:• 'tiy.v:bi:"v'ri:,r lrii%>{:j::Y�y'.hri};::i::>.��:
. . .....�.. . ................ . .. k., :: . . . : .. . �y���h.,�.�.. . . . W
.s�,'.•.;;:�••;�••..:?�:;�.'%:.�•`:•;�"�^!�o-i.. ' ..5.;.•�'y' : �
'i�::t{.�.3` ''fi3c•.;t�v"��2:6:v'{�%•i:i�::}nf:�'r'`•::;4::i:`:��':{�:j•i:<�:::i�t:::i{iii:.�.r �}:�'i:;y?;,�.,-,w.:x.;�r:�::;:
���ai�'GovemmentAAckno�vt�edgemert�....
::.. ....... .: .•::......... . ._..:.. _...::. ..:::.,....:.,:....�sx.:,,.<:.,,..... :a:::.:..f.«f: �'�` !::'• > .:;�r .,c: .
1. Tha city'must sign this ap�ion if the gambGng prem- 4. A co�v of the local unit oi aovernmerit's resoh�tion ao-
ises is bcated within aty limtts. ��this ao�l'�cation must be attached to this an�lication.
2. The cour�ty'•AND township••must sign this appl'�cation if 5. If this appl'�cation is denied by the loca!unit ot govemment;
tha gambling prertri�es is bcated within a township. �should not be submitted to the Gambling ConVd Board.
3. The bcai unit governme�t(city or county)must pass a Tovmshlp: By signature bebw,the township acknowledges
resolution specifically approving o�denying this application. that tha organization is appiying ior a premises permit within
township limits.
C!t • or Count " Townsht ••
City or Counry Name Township Name
� �� � �\ . ��
Si naWre q�pe►s n receivi app6 tion � Signawre of person receivin0 application
,
Title �,yrGa_J/ - D � 'ved Tide I Date Reeeived
. • .
..�.� . L /0 �.5" 9
Reter to ene instivcbons tor reqWred attach„erm.
Mail to: Gombllnp Control Bo�rd
Ros�wood Plaza South,3rd Floor
1T11 W.Counry Ro�d B
Roswllls,MN 55113 LG214(Pan�
�a.r�r�>>