Loading...
91-2326���a1NJ�. ���� qi -z32� � . . I� Council File # Green Sheet # 17762 RESOLUTION CITY OF SAINT PAUL, MINNESOTA Presented By •e� Referred To Committee: Date RESOLVED: That application (ID #B-00344) for a State Class B Gambling Premise Permit by Fraternal Order of Eagles Aerie #33, 287 Maria Avenue, 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 un e i son BY� Adopted by Council: Date D 1 9 1991 Form Approved by City Attorney Adoption Certified by Council Secretary , � sy: • //-ZS-�l' By: � ��� Approved by y . Date ,��' A �gg� Approved by Mayor for Submission to `t� Council BY; /,l�%�,��.���' By: ��������� ��„a. ;� '32 , q�-Z32b�✓ � DmPARTMENT/OFFICE/COUNCIL DATE INITIATED G R E E N S H E ET NO 17 7 6 2 Finance/License CONTACT PERSON 8 PHONE INITIAUDATE INITIAUDATE �DEPARTMENT DIRECTOR �CITY COUNCIL Christine Rozek-298-5056 AsSIGN �CITYATTORNEY �CITYCLERK MUST BE ON COUNCIL AGENDA BY(DATE) C�t C lerk NUMBER FOR �BUDGET DIRECTOR �FIN.&MOT.SERVICES DIR. �7 ROUTING ORDER �MAYOR(OR ASSISTAN� Q�� Hearin / 12-19-91 B / 12-12-91 TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: Approval of an application for a State Class B Gambling Premise Permit. Notification/ 12-6-91 Hearin / 12-19-91 RECOMMENDATIONS:Approve(A)or ReJect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING GUESTIONS: _PLANNINCi COMMISSION _ CIVIL SERVICE COMMISSION 1• Has this person/firm ever worked under a contract for this depertment? _CIB COMMITTEE _ YES NO 2. Has this person/firm ever been a city employee? _STAFF — YES NO _ DISTRICT COURT _ 3. Does this erson/firm p possess a skill not normally possessed by any current city employee? SUPPORTS WHICH COUNCIL OBJECTIVEI YES NO Explain all yes answars on separate sheet and attach to green shest INIT�ATING PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where,Why): Gerald Peterson on behalf of Fraternal Order of Eagles Aerie 4�33 requests Council approval of their application for a State Class B Gambling Premise Permit at 287 Maria Avenue. Proceeds from the pulltab sales will be used for children's activities, charities and benefits for special events. ADVANTAOES IFAPPROVED: If Council approval is given, Fraternal Order of Eagles Aerie 4�33 will operate a pulltab booth at 287 Maria Avenue. DISADVANTAGES IFAPPROVED: �ECEIVED r�EC 0 91591 CiTY CLERK OISADVANTAGES IF NOT APPROVED: �i011��^E� �?�'���'C�1 E;�f?f@P' �'�C 0 9 199i TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED(CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION:(EXPLAIN) �� � � 4 . 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. Ciry 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. Chief 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 sach of these pages. ACTtON 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 projecVrequest 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 liabiliry 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 Ciry 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 projecUrequest 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 tai�or the information you provide here to the issue you , are addressing, in general you must answer two questions:How much is it going to cost?Who is going to pay? , . C�� -�32� ,/ DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE ll �9 9� / INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by -C / O j�� L,,,_,.,_� L �fjAud ��prnQl�!'��/" f3T �aq/E�.S ��� Ttr�° � J Attlicant � `� H�se Allress �'� f�✓�Qh/� �, �%t,� ��n�c ���5' Business Name A-p��� -�3� Home Phone �'f�"j�-`j(o '�� Business Address ��� /�Qr'la= fT v�',,�f�Q�Type of License(s) ��� �Q�S' � Business Phone -- �f/1�iL'�`T6 �.3 �Cj'/ylUl/11p�{�jYJLS'L1i��2IY�yJf�"/'f e-l.C1 Public Hearing Date o2 License I.D. � � �UD��-� j��q� at 9:00 a.m. in the Council Ch ers, 3rd floor City Hall and Courthouse State Tax I.D. �� �D'�Qo2,�� Date Notice Sent; Dealer � /l�/� to Applicant /'�- �j Federal Firearms � /��A Public Hearing e��t� ,Q�- DATE INSPECTION REVIEW VERFIED (COMPUTER) COrIl�IENTS A roved Not A roved Bldg I & D ! ��� Health Divn. � �, �,1- I Fire Dept. � u�A- � Police Dept. SQ�!'� ii�a�l�� � License Divn. ( r�l���c� ( ��.. City Attorney f ►� �a��ti,� Q '� Date Received: Site Plan �I�" To Council Research �� �1 Lease or Letter �� ate from Landlord � � . 9�-z3z� � FOR BOARD USE ONLY LG214 - BASE# �`2°'°'� PP# FEE -' Minnesota Iaw,ful Gambiing CHECK : .:��`;,�., Premises Permit Application - Part 1 of 2 D�LS � � rY{?.i FF.•ny.}y:•:8:},v,�ry.:,x,{x:q•;.;..r_v;rx.si�i:f.�:?':?iiii:::i^i:•iii:ii::p";• . . r: ..: ...... .:...:... ...::..r.:•.}•:.�M'::y.wx:::x.}i:.:Y.{.iii:•}i'r.!?:^iii::•ik•i:!bi:+rihiiiiii:Y:•i\•:'.ii%{.ii}i?vn .:::::.. r .., �QQ� �y .}f{./....Y;.nv.Y/Al...v..h%}:}}x.....nn......�n:::n�:::::.................................................,...........2 •:.}:.}}iC???>2?Y..v...Y...2�......{..:...:..:.::.:.. :....x:.)n.....`..........:......:::.):::...:�i:'f }.to-.'. ....d.":...................... ......:::::.::::.s....................................... . .............................. .r.3::::::.....;. ..:-:::...3.......:::•:::..::•.:.:.:..:::,C;.:�:::::::::•.::�:::•::::::.::::::,..::....-:.. x:}}:::f.v:.............. .::1.{.;v.v:•.•. :.+.{�i:.:...�::::::::.....r. ..l....i.. , .�}}..::6:•:••n•:•::v.w:•:v.�.•::: ...�:::::::.�......................::. �v:�::::::•v._::..x....r.:i•:i:i?{.; ..... Y.•v+:::::....�:..�.•:•:v.t.;r.}• ... . r../i..nx...�..r.....�.r..............:.............:..........�::::::::n�:w:::•:...........M1.nh ...........w...:...::v.4:.:......... ♦....... ..�`�.Y. . .. . ........ .. ......... ......::...:.....r.n................r.....1...........s......f�:............r....vn.n..........r.x��:::::::r:r.:rx:::::::•:.i:•ii.::.ii:.:•iii`:i:iii: .}::�.fi... :;>..f . . r 'i}r.�irr..x. ... r...��.r. ....r..... ....... r....f. /...................... ••...r..,. ' . ..�./....... ..... .. ......... ........ . ........:::..:.v:•::::::._:•::::::::.v.....:s:::•:::.�M1 •::n•::•::�v:.....................},C•.v:::•:::: v•::••.•�::::••:•x•:•::.�::�.• •vl.•:•:.?'.;•::i:::'i:•:::'�:?:$}:::;.;}: .v'. n!C.......y.�... ...,l,r,h�.;n}:::::{�ir;{;};r•:.::.t:•i:::iCq;•}i:i:i�:>:::{�:;:!8.'�^:^::f:::f::•}5:.:::.:.{v.::.....::•i%� . .;.}:::,v,{:•.:::•:�� •::l�•:•.�:...... . •: ;. v: . . . . . .. ..:... n......v....M1.... M1:.�.....;�......r............r. >:i'J.iiiiii:S:'vii:•:::i:':t:i:i•'.�i:i:�iii'ri' ..{.. ^iY.•:iiiiii::•:rr'' x4::ii:•i::4}i:'+• ......e.?w::ni:•iiiiiiii:::v............................ ' "'" i: �i ... .. . ............. ...............................:::. :rr{i;:�:::::.r....v...... � .............:...........:................................... . .. . .. .. �. ...: . . . . . ........y....v..:............................. ...t...... ...+f'.v'....�............ {••:.+.t•i}:ti�i........:.......{tiv•:.v.{.n.?.n............i::i}}::�>i:{� . e..;:� :: 1��Qt�Ort::::::::.:::::.::.::::::::::•::::.�:::::.�:::.�:,•;;:•;;:•>:•::.:;::::::::::::.�:::.........,.:::::......,.....................:.:.>.<...�:::.�:::::..... Class of premises pertnit ,� Renewal (check one) _ , OrganizaYwn base license number �C.S Y � A($400) Pulhtabs,tipboards,paddlewheels,raffles,bingo � �F Premises permit number A3--c�o3 yy o a� �B($250) Pull-tabs,tipboards,paddlewheeis,raffles � New ❑ C($200) &ngo only 4;;,, . ❑ �($150) Raffles only ,,:,... ,:_t.:.,,<.:.,. :.,,:,{,. ::{{+•::wx{rr„ rr,!'.•X.�L:•%<it{+S•}:•. 1.?i{{{:. l.'i}%:c:S?' .v,{{{.;x.};{{.wp,v„tr:,{.v�xtiti.i};�.:•:i?•i:ti:�:?•�i.::+ii:vy:.w{;{. . � nvxr{.w..:};.•ti.,v,•:{{:{�x.i:tiry;A�.�•i.;r{i{nw;?IX{?n:.iiiY.{.,v,•:•i:•i:•i:•i:•i:ti::n;:rn:•i:•::::r,(rny,L?n;, . .. : . .. ............�...::........:r::.:...'v'�$r...............�......:.$.... ... ..}... ,. . .S$:•r::.:w..:...... .:n........1.n .:n............... ....w:....:...n........�:....:...... i�.. .......... .... .................. ..... ...............................xi::::x?.:::ii}.;..;::::..};::..;.:..:-....:..::x?:•.v:::�•;;f,1+•;;... XY...... . . .....r.,-...::.;.,-;{;y.} . . .r rs..r.i:.v. .:w::�. � .. ..... ................ .I....................................f..............:......v:.......:.:::.•.�:.. r......rv:vi.vv,n}i•{:!;y}v;J,.::::ti:i:i}i}iy. . ,�.:. ... : . . . :........ .. . ......v.......................,,v............f•:.:::.::...:.:.:.....:.........:::::...:.:::::::::•!:s:.i•:�:o::c;:.::.::a::•:::?.......:.:�..... ... r.::<•:::....:....:i'• ...?......:..:.:::::.::::..•::::::::...::.+.•.,.::•:.;•:.i•:;::�.y::::.:j;::::.:�::.5•::::::A :?O:v: . :._ . � � ::::::.�::u::::::.i':::::.;w..:rw::::::::.;v.,�, +ii{:.v:;+i:::�,..;....:L...:::::::::::• x.{. . i'.r::::� . ':Q i: .���:.'•::•.'•:�:S:�i!:;:�:�:':'�:i:':�:�i:�:�:�::;::;.:::i:r:`�:�i:�::�i:�>::;3':?;:;�:i�:i:'<:i::<:�::�::%:%:'.�::::+:•:�•.'.••`:�:�:�..:. ..f::::...,,,.::?+::.::::::::r:::r�:::+,;:ii:'.•":::.:�>::�:t%�:•`:%:q+.'•.%%'::�:::%:;. � �tr:t�z�t���r»:::�': .. .�rta.....:........:::.:�::::...................:.:..............................................................,.......::.:.,.........................�.....r................,....,..,...,: .r. .:.�.::::..:::::::::::.:.::::::.:.�:::::�.:::..�:::...:::...:........:::..:......:.::.:.....:.....:..............:::......:.....::....::.:......:.. . . . ... . . . Name of ation i� ti� - . �D� � /� �� 1� 33 Business Address of Organization-S t or P.O Box(Do not use the address oi your gambling manager) 7 /�/�/-� � lflG City State Tip Code County Daytime phone number ,- �' /�� �- %O C� �'/l'/C`).E (�° � Name of chief executive officer(cannot be your gambiing manager) Title Daytime phone number ��-/�YSc.,O � �7�.�w 1�b�7"Hy�i�'�s�lh� (�� ' ��� Bingo Occasioas If applying for a class A or C permit. fill in days and beginning&ending hours of bingo occasions: -'- No more than seven bingo occasions may be conducted by your�anization per week. Day Beginning/Ending Hours Day Begtnning/Ending Hours Day Beginning/Ending Hours ��`"--- to to tn "` tn to to �`� to If biago�vill not be coaducted.check heze � . C.:V n:t��V:+�•r:•,•��•••••••••••�ti:4::it•.VrT:Ai:•.4:v:n"'4i•::v:?.•.:v::.�.�:v::•!.•:n':•v.v�q. . :.:,:: .:K•:. �. ............ . .... .n... ..k�.. ................. .....Y.1�...r.,r,4:i'�'.'�'FFii:}}iiiii::^iiii...v.::k<........� �..:vv:i::•:!?'•::}};:titi}:x. SKf. ...n.N.. .......v Y� �....,;. .... .. . . .. . .. ..:4rv:•:>:::�....5•ix•.: •:� ..:...r... :: . ......:. �v:.......... ...::•...... .... ................ . ...................i.....................�............r..xr...r:::::;x.............::::4ii:n.....:::::::::v:wi:iiiii:�:•iw:..r: .. . ..... . .. .. . ... ..... ....... .... ............; . ...;. .:..:::..;...::::..;�.;.....p ...y::i:::�.i'::n}:::.:::i:::: ... . .......S.x:....n.r x:::/.v 4i:�:•i'r'•i}:tih::::•n}Y.};w:.i:sii;w:w::•..:v:..'•iiii:•iiiii::x::::::v.:r}x:::.�::::s:.::.??'..::::..::�::.?:•:?if.:r.;;:tiir:i:'f. . .:.{w::.�:.. � :. www . . . . :.: .i} . {�� . � .......:v ey..;..:n..... �' ..l•i::•'/.:ti?'; :iYJ�':•:i: . ..... . ...r....r.`..... ii'f.•:':..i•i.titi?vi::+vii:ti:•::•: ..lf.i:i}'{'... /...:�'vii:;tii:i•;i:;:;{�:• iiiL . .�:>: ..... .......n. r::..F.ti.tir,:•''•'•:;i�ti,�.i:.$}.?.'i.i:4i}::;::•S:titi4 � $�::�Q � .......::::..:.............,:..:: �3. b ;::� �� .>:..:,:,..., ....... ............... . ,..::.. . .;. ...,.., .,.:::,,:::>::><:<::>:;»::;:;:.:;:::::;;;:;:.:.::::....... .... ........ ...::>:::::.,::::....,..:.�>:.;:..:�.:...... ,::::..:::.:.:..:::..::;::::::,:.:;:.:;;;:.:::::.::.. ...�.��..�.Sf�............ ........................�.v:........................:. ....:• ..................................�?r::i?{•i}ii?;rifh...:n.....v.......n..................::::.:v:n............... x:::::::.::::::...�v.:v:.�::::...........................;. ....... ....�. .......................... w::..........:::..::::..::................................................n..n..............................................................:w::.�::::::::•._:.:�::::.::.�:•. ame o esta �s ment where_g�am ing nnl con Veet ss( not use a post office box number) �o� ���i� '�.� ' � �r 7��•QJ9� .4 v� Is the premises located within city limits? �J Yes �No If no,is township �wganized � unorganized Q unincorporated City and County where gambling premises is located OR Township and Counry where gambling premises is bcated if outside of city limits '�5�'O��r� D��ms�-`l � . Name and address of legal owner of premises City State Tp Code 'j��o� .��iz l� ��3 ��j.��r7��Q�� 5�'�/��i� /1��v .33�/�G Does your organization own the uild�ng where the gambling will be conducted? �YES p NO : ,,„.A.., If no,attach the folbwing: �;�:: • a copy of the lease(form LG202)with terms fo�at least one year. � � * a copy of a sketch of the floor plan with dimensions,showing what portion is being leased. �, A lease and sketch are not required for Class D applications. ,:. :.,•�.:r.,:,,., •:.,,f•:;N;N::. :>:z:,..;r•>;;::•::::.:•..::. .:•:.::•• ::v�..,;.::;<.:••;;r<...v .:«::�::r::•;:.:::;:r.::<„ . ,...z::;::<•. . . : . ., s•:....;.••:,.�.:.:.:..; . .... . .: . . ••.N�,.,:.:�:.,,.,, ,.;:,•,:,.,...... ::,.. .,,..,:;:;�::....,. >f::.� . �s.fi.,,......,,,�:•:::.:::...x......... �::.:::..,. :..,•,•::.:...::.::. ,:,:::: . ..:• ,....... . ...... ,.. ..,....,............:.::..:::.:.::•'•;.:;.....,..tt..:..........r..::••............... ....::,,.::�::•::::.�Y.;...::':'::.>.'.�Yt;.`::.>.•:::•:.:'.;n;.;:r+�::::t<•:fi::::•:.f. .......::.......t•.9:`, ..�... 3� .'rot'. ..:...:..::: •::....::...:.:.:...:::.:::::....................... ............. . :.,.................. .......................2�........,.v.....................5..............:... ......t.:::.......,:::+>:::•:::::::.�."�a..•:::. ...,,., �� , y+�.'"."..°.,...t,n:...:::r... :,... ...,.......... ..:.,;.......,....;..,.,..., .::. ........ . ...�:.,.,.;�...::,•::::,..:::•::•::.:::::::..:•.... .,'�.�.. : .. . .....:... ... .:: . .. ...... .r:•........ ......... :::�:,,..........:�::.::::..... .�p.ar.r.s'+��• � .`7fL��'�11S4"$'`��`�]AYi�St1�fY�f`.�:`•.cr'.:;•r`.�{;?::5':+�:3:2$f::';<%,:.`;::`i`;::','•:;;'::;_?F � . ,A�c�ar::�ss;::af::ax�..:. e:::� �c�.�of� �imb�in �. :: =aeax...�� :.::::.. � .........x. .......:.::�:� ndd�ss c�� r�e Zp ���7 �/��/f /�U� ,���/���. /�4� �"� �� ,S 3" r' y� � ' '°4. . 3, � �'4. � *!1��?S3�n� ':r _ ' , . � Minnesota Lawfui GambNng `1 � 23��3 ;� � � Premise Permit Application - Part 2 of 2 �+ �� `" � �:,.� � 3'�.5:•,v,.?t:.:.:::.F'::£:F:.SS. �. �::..:. .}.. .::::.' .�: :.:..:.;,r.r.....<Y'-:d•.5'°K•:.v. � �•:;:x,ru{.;:;.cv,xq:i�;.x..� :.Ff:r.:..cy.c..�<:�,'�.y..:.5..:.:ax•;::>.'�;.v:,w.v,�. �,�., ry..,. ��'t,,l-. :::•::::::: :. . �.C. ....f,,;:y�..::�JY i.9,s,,..:...:. +c� �,,,.;,/.ns.... :..::.....r,.�,.;• •..f...:::...., ;:r..:..:•::..� �x� <•f:{•. .:.n:,� "� ........ .. .!�•�;<.::.?? .:..::.. :.�....:.:.:.. '�?3%+Yt�•::� f:.. �.;h.. x:.::.•.'•?S,"'a<9�'+'�'.'..'�::•:••::: f,�.;£ . . •.... ...... ...:.:..:. .. ... . ,_:�. :•.........•.:::.:.. .,,:•:::..•T,`.�:o-:•.,+p;>:::.�:.::�:!i.+i•+S•.:+. 3' F.,,; .�,�.`„l.,.;: ��.... •:i:/..::5}:ii:•:}:�::i:i%•i.•.•ii�' :',Jf'.:',>��r.'.;x�,<y,;. } �' Yr •::x.:::r%,:::'+:::�:��:: +..':::. t� 3i '•�3���.�,�+.',��.`,'�.��,.��,�,,�.:. •.£•:.;<:+'i, ...>.�f...:...r......:::::.::..:::..:,,..........�... ..f.f. �amblLr�ci;�ctrtT�::�CE�icnE;;�it�forma�>:::::<:::;::;:::>:>::»�>:::::::::::;::<::::.::..::::.�:.:.�::.:.<.:r:::-•:;.::.. ............ ......... . .,�� .......,... ........ ,...... : ; :: — •�- �_. Bank Name Bank Acoount Number � �� w =� �i�n �,����- ,v�f�v�� L ����� �-ia � -�-��-s— _ ,,.-:� ��°, h n ress iry tate p ^�� - . o°� o,S"" f� �-1,/� 6/�./a /�-,�-rc . S�/Jf��� /1�iv �.��� � . �:" ��...•::....:.�.:«:•. ,� �.r .. .>:.. �::.-y`���: ::.:::- :.:f�.--�,��::.,1�./�.,:.:. ...,_,.. �,��! ,.,.,....-...:,.::�� ,y.,�} �..y�,��•.,c,•yf,r�.c;;:.,•:::t�::... ... :.:.:::•:.�:.i:...•: i if •�flfW.:��f��p I.�.Yy.} :�4FKCN:71V.•Cl�ft��W7ii� .:.i:Ci/RK/li�Yl!CY,31�,�}Fr'Jy{�//Ni%'+ ' +.:::�::::::t.:w:,.y;,.>:.:..:•::rs.::: a(f�f.��..�.h�.......... .. . ��:.... � ' 'r . •:::.::::,:::;<::•+;.»::•r;;::;;•,•::;::-::::::::::::.:...........................::.�::::.::1'•��•�'•S"4:•::::::::::::::::::::..•::,.:.A.'•:°:::::::::.::::::::::::::::�:::.::::::...::::......:.....::.:......,......::..;.,,.;..;,f.... s„ � �,•:::.�•..• ...r,.!r..;:rf.�'i+�, . ............:...,................. .:::::••:::::::::::::::.r.r:::•:r:• :.:�:::.:..:�:�.:::..,..;..:::.:::•::::::•.�::.�.�:•..:�::•.;•:::::•. .:;::.�:..�:.: .:::•: :r:::... ......::::..�..::•::•;>:::.. .. .:;:t.::•::•:>:•::•x•>:;vd::::i:�:::::;...:::f�::�:::::::.�:.�........... •f••.:::!••:::�:�' � •''r.�:r'w�::;i:r::::.: •::f•::..:::.�:::::::::•:.:.. ..r........... ;,i:i::`•;.;':::'•4��. �10c'#R11Z8bC��:O`�B@'Sflf8l��1JaJ�170t�8��_�tJ�IE�S:• r.::. .,:,n..,..,.<:...:;:::..;:::pt:;:;:.+,..::•;:•;:•:�:•::::a:�:c•.......,..,.......:.....,.. .....i�:...:��:;:�:�:;`.•:�:rS:;:�S:�>:�:�:::+�:s:::;�:�;::'.... ...........�•. .:S ,....... ame ress Ti e ,/�tiT°�v �/�'-%���42 � �a3ys��r��.� �� G. /h. - G s� o�-,o � ,i°E r�� s G ti / 1! �� k� z� �cJ--�— �Q2f�l'�i°�'�s�,o��� ` ��/�E'A� 7",R/G��l/J��iv 163�/ 5 y��i/1�3�ti�� l��c� ��i�s�,d�<�- :<.�«:::::.,.::.:<.:r:;,.;:<n::::.;:.:.<..>.;, _ r<.:«,;«..,:.v;;,<:,<.;:.,:,.»:,:.:;;;>:.;:.;:.>:.::.;:>::;<.;::<,.: ,.::<.;.::.:.,,:.:«;;:<:;:<,,.,. �:��.:::.<s;:<;.h.>:.:,...:..;>:N,v.: :;'t:i:;'x:.:<;.::::}:::;:!.'•.:•.'•::.•,'::;.,.,,;.yy '•,"•U`".;, .......:: ,•::.,.::::::: �,:�:::.:........./.'!.....:..:...,..,...:.........................•:::::::::... .....:.v.....:.:..:r.7%�....r....,.,........,.........,........::•............:......r...........:.. •», ,:,, . l./.....................r ..i..t.... ..t...... ..,,-:.::•,.,y.•::,n,:;c r,.r . ......:::::::...............,.::.::::.::::.r:>:::.:....,.::....,..... ::..r•::•::-.�:::::•:.........::::,::::::•::::::::::::::..•:-.�:••.:,: ::.::;:.,•::;::::�:.;;:;:.;;.;.;y,,;;..,:.,. .....�.:::::.....: ..........:.::::: :.., r..:.:::�:•:.•.:::::..:::�::::.•........................ ........:::.::.......:::::....,..,......,t,:........,,......,.:.............................:....::......,,...; <;.:::::•:• :..,.:�:::•:.o•.�+ .<.::,..S,,.t• 5: . . ..a..:....... ...:.. ....:................. .:::::::.�.�.•..•.::::::::�•:::•::..•t•.�:....•.::.••...t:•:•::. .M1.;.;...•:•..••:::::::......:::<•:.:•: ...fk.o.... • �::k..... . /. G .�..v.. ..a..s.............,. ,..J....s...>...;.;..;:}•:•.,•.:,c•.....,;r....{,...:•:::w.....;..::::..�;.;<•:�;'•�••.�::..� :�::i�i:?•.�:.,•::r.::•:::,..... .,y.J' ,.� +..�' .:.F..r : •:•T } . 3{f}v? :�•'f.!S�'-'r.'+I.%r r �.v .A ii:�:$�4r�'i'i::::;ii:i:�:.'•"i:i.`.iY�Yi: :v:�{::i:�:il:i{:::•,:;:;:;i`y"�{•••; .... ,� . . . . y......... ; . . .. .. T.��:.;w,w:r.•i.ri.iii:iY+: �i-�::W:�:nv:v:r.r.::•��:i:•:'•:::::r+im:::v:r:iw':;::., Ackntawl me� ::,..,.:�.;:::.-::::.�::.::::>::::.:.:::.;:::. .:;.�.:�.:>:.:f�:::.�;;:.:.,�<.��.::;.,�,.>.:. � Y:v�i:::..;.:.s:r�n... �:." \Cx:r.�:::r.:.vx:.•::•%i:T'ii::•Yi:i.;•:.,in•i... n..............M1 n:i:�i:rrr• . . .... f....� f.v.�C.4.1. ....................::...:..:...:... �.::..^:.�:;.::.:.::::e{.iSii.:.....................C.......:Ah.....r:?:::.::?.::?v.w::n..............n..i........F.�:i?;ni::?{�i::i. .......r....... �vn.........v.vw:l�?� ................................... .................... ..vw:.:x::v::.�.........r...........r...�..{................... r n................................ x:::.::. ..............n........................r........' .................................... ..�::::::::::::::::::ii:.:ti.}:y:...............................................................sy::::::.w:.�:.................................F.w:::::.�:. ::v........................ . . Gam g Site Au o za on •I am the chief executive officer of the organization; I hereby consent that local law enforcement officers.the •I assume full responsibility for the fair and lawful opera- board or ageMs of the board,or the commissioner of tion of all activities to be conduded; •� s' revenue or public safety,or agents of the commissioners, .�Will familiarize myself with the laws of Minnesota 3'; may enter the premises to enforce the law. goveming lawful gambling and rules of the board and "'�"" � y' Bank Records Informatioa agree, if licensed,to abide by those laws and rules, •- � The board is authorized to inspect the bank records of the including amendments to them; � ��� gambiing account whenever necessary to fulfill `� •any changes in application information will be submitted �.: requirements of current gambling rules and law. "'� � : �' Oath to the board and local unit of government within 10 days . .:. of the change;and `?' I declare that: •I understand that failure to provide required information '�' �; •1 have read this application and all information submitted or providing false or misleading information may resuft in � �,�:. to the board is true,accurate and complete; the denial or revocation of the license. -^..��� •all other required information has been fully disclosed; S' nature of chief executive officer Date n�;:�,Q � � v�� I� ` � � — 9/ �„� , ..v.}.;:.:::.:::n. .:.»..::. ,� �..............::.>:.:::.�:::::::::::::::::..�:.�:::::::.:.�::.:.:.�:::::::._::::.:.:�..:...�:::.�::::::::::::::::.�::.::.:_:::.:...... .......::»:::.::.::..........................::::: :. .::::::::::.... ..................................................................:.::......................................::::::>:.:::;>:>:::::.:>:::::<:.::.::>::.:>::::�::::.:::>:.:::.:::::::... ........................ ........:.,< � .:. f................................................................................................................................................................................... ,....... ............... .................................................... ................ ...... ............. ....................................................................::::•::::•.�::::::•.:;•;:•;;:•>;;;:;;:.;x::�::•;:.o-<•::::•:•...... .. -. r.l... .t.8r.::{x:.:�•.�::::•n ,.f. .,fr. r.;f.,} : ::::.�....... :::.� ...........................n.....:::: r ............... :::v; .............rr....... .......x:::.v:::::::r....r....r....m:::::.............. .......... .;�r., � , .. . .....:.........:.....:...... .... ....;....... , r . . ............:........ ....... . .�::::i:::iv,v,+•:}r.�::::::::.��:::.:�:::r:;{y;.j;.;:.;r{r:ni0n::i�.. .:n44;v,r;rr;..i y^' ,. ,. .�:: .. - . �� ':{� ' � ' � 'i•i:?•i::+ri:•i:•::•i:?•i:•:'::::�::':•`.�:i�::�::�i:•:i•:ii::r�:i::•:: ::.i•..-:.xv::,1..;.:...::wi:::::. .i�$:�:: { p u;�. •:•:x<•::•:::t•:r�•::•::•:::•::•::•:t•::•:>:•::•>::::•>:.::•:::::::•-•:: •:x.f..rr::�::.�rr::-:r:::::::...::::::::.�.+C;�. ...'r,..:..r.•: :�.�ca�::�::<:Governm�nt::Ack�o.�ied .em�rt�:::<:<.:.:�:..,::::.<.:::::::::::::::::.:::::::::::::::::«.::.�.. .>�,:,,�.�.,v.. ...� ..................... r...... . �::.::.: � ............................................................................ .............................v............................................... .<:.:.�<:::�::>.:.:.:::>:<:::>:;.:::::::<:;:::::<.,:.<::.:�v..<..:�,,::,, .::::.:::::.�:::,:::::::.�::::::..:::::::::.:::._.:.::::.:::::.:�:.:.:::.::::::::::::::.:.::_:9�............................. .. ......... ... .......---......:<.:�<::..:..:::.:......................r-..........:.�:...........:� _ 1. The city'must sign this application if the gambling prem- 4. �py of the local unit of qovernmenYs resolution a� : ises is bcated wRhin city limits. QrovinQ this aoolication must be attached to this aoolication.� '; 2. The county'•AND township••must sign this application if 5. If this appl'�cation is denied by the bcal unR of government. _ the gambling premises is bcated within a township. �should not be submitted to the Gambling Control Board. 3. The bcal unit government(city or county)must pass a Townshtp: By signature below,the township acknowledges resolution specifically approving or denying this application. that the organization is applying for a premises permit within ` �r � township limits. Clt ' or Count •' Townshi •' �� City or Counry Name ^ A� Township Name %EJ ....�,� Sig ature o on reoei��lication Signature of person reoeiving appl'ication ;` � � �.T .._;,.;_::� Tide ('_9�o-n�-�-4,�.,n I Date Reoeived Title I Date Received .. � . // —l� � _..: : Ref the instrvd'ans for required attachments. �- Mail to: Gamblln�Control Boa�d ~ 4 Rosewood Plasa South,3rd Floor : 1T11 W.Counry Road B ---..--� ' ` ,�� � Rosevllte,MN 55113 LG214(Part 2) _.,_�;.j (R.v7/29�91)