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Council Agenda Item 4 k
MEETING DATE:
October 16, 2008
AGENDA ITEM: Premise Permit -Requested Action: Accept the Lawful
Gambling Premise Permit of the St. Cloud Boxer's Club to allow lawful gambling at the Stonehouse
Tavern and Eatery.
SUBMITTED BY:
Administration
BOARD/COMMISSION/COMMITTEE RECOMMENDATION:
PREVIOUS COUNCIL ACTION: The Council in 2007 approved the premise permit for
the St. Cloud Boxers Club for lawful gambling at the Trobec's Event Center. The Boxer's Club
discontinued lawful gambling at Trobec's as it was only open for special events.
BACKGROUND INFORMATION: The Boxer's Cfub is aware of the local trade contribution requirement
and are prepared to follow the guidelines of the Ordinance.
BUDGET/F{SCAL IMPACT:
ATTACHMENTS:
Gambling Application
REQUESTED COUNCIL ACTION: Accept the Lawful Gambling Premise for the St. Cloud Boxer's Club to
allow lawful gambling at the Stonehouse Tavern and Eatery.
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MinnesotaLawfu/Gamblina Annual Fee $150 s/o~ Page`1 oft
LG214 Premises Permit Application FOR BOARD USE ONLY
Check #
Organization Info
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Organization name y~0~~5 ~,1~®~c'KUU~ ~1~~ Licensenumber C~5`ZZ3
Chiefexecutiveofficer{CEO) I~it11 ~~6~~ ~~'~r'~11'JlY Daytime phone ~~"~ I `~ I
Gambling Premises Information
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Name of establishment where gambling will be conducted ~~~~~~! ~~ ~~'~=~~~`~ ~ ~r/1 C''~,~
Street address where premises is located ~ ~ ~ ~ "' CL4tr1r'~ t~C~!'~'~~
(Do not use a P,O. box number or mailing address)
City Township
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~~~<~~S Zip code
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^oes your organization own the building where the gambling will be conducted?
Yes ~No If no, attach LG215 Lease for Lawful Gambling Activity
Gambling Sank Account Information (must ne to Minnesota)
Bank account number
Bank name
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Bank street addrre~s~s~ l S~ City ~~ ~ i ~~~ StatelZip code ~~d
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All Temporary and Permanent Off-site Storage Spaces
{for gambling equipment and records related to this site -must be stored in Minnesota)
Address (Do not use a P.O. box number) City State/Zip code
dingo Occasions (including bar bingo)
TEn day and beginning/ending hours of bingo occasions (indicate A.M. or P.M.). An occasion may not exceed 8 hours.
Day Beginning/Endinq Hours D_ ~a . Be innin /E d~n Hours
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~G2'14 Premises P®rmit Application
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Page 2 of 2
Data Privacy
The information requested on thisform (andany attachments) When the Board issuesyour premises permit, aN permit information
will be used by the Gambling Control Board (Board) to provided will become public. Ifthe Board does not issue you a
determine your qualifications to be involved in lawful gambling premises permit, all the information provided remains private, with
activities in Minnesota, and to assist the Board in conducting a the exception of your name and address that will remain public.
background investigation of you. You have the right to refuse
to supply the information requested; however, if you refuse to Private data about you are avai{able to: Board members; Board
supply this information, the Board may not be able to staff whose work requires access to the information; Minnesota's
determine your qualifications and, as a consequence, may Department of Public Safety; Attorney General; Commissioners of
refuse to issue you a premises permit. If you supply the Administration, Finance, and Revenue; LegislativeAuditor; national
information requested, the Board will be able to process your and international gambling regulatory agencies; anyone pursuant to
application. court order; other individuals and agencies #hat are specifically
authorized by state or federal law to have access to the
Your name and address will be public information when information; individuals and agencies for which law or legal order
received by the Board. All other information you provide will authorizes a new use or sharing of information afterthis notice
be private data until the Board issuesyour premiss permit. was given; and anyone with your consent.
Acknowledgment and Oath
1. I hereby consent that local law enforcement officers, the Board or its agents,. and the commissioners of revenue or
public safety and their agents may enter the premises to inspect it and enforce the law.
2. The Board and its agents, and the commissioners of revenue and public safety and their agents are authorized to
inspect the bank records of the gambling account whenever necessary to fulfill requirements of ourrent gambling
rules and law.
3. I have read this application and all information submitted to the Board is true, accurate, and complete.
4. All required information has been fully disclosed.
5. I am the chief executive officer of the organization.
6. I assume full responsibility for the fair and lawful operation of all activities to be conducted.
7. I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the Board and agree, if
licensed, to abide by those laws and rules, including amendments to them.
8. Any changes in application information will be submitted to the Board no later than 10 days after the change has
taken effect.
9. I understand that failure to prouide required information or providing false or misleading informa#ion may result in
the denial or revocation of the license.
Signature ofi Chief Exec e Officer (designee may of sign) ~ Date
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Print name
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Application and Required Attachments Monthly Regulatory Fee
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1. LG214 Premises Permit Application there is a monthly regulatory fee of 0.1 /o (.001)
2. If the premises is leased, attach a copy of your lease. of gross receipts from lawful gambling
Use LG215 Lease for Lawful Gambling'Activity. conducted at the site. The fee is reported on the
3. Attach a resolution from the local unit of government that G1 Lawfu( Gambling Monthly Summary and Tax
shows approval of your application: Return and paid with the monthly tax report.
• if the premises is within a city, attach city approval, or
• if the premises is within a township, attach county
approval.
4. $150 annual premises permit fee, for each permit. Questions?
Make check payable to "Sfafe of Minnesota." Call the Licensing Section of the Gambling
Control Board at 651-639-4000.
Mail to:
Gambling Control Board
This form will be made available in alternative
1711 West County Road B, Suite 300 South format (i.e. large print, Braille) upon request.
RoseviNe, MN 55113