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Home My WebLink About[04d] Gambling Permitcrrv o~ Kr Jr~c+MN[t MEETING DATE: Council Agenda Item 4 d February 21, 2008 AGENDA ITEM: Gambling Permit- Requested Action: Accept the Gambling Application of the Watab Creek Whitetails for an event to be held on September 11, 2008 at the EI Paso Club. SUBMITTED BY: Administration BOARD/COMMISSION/COMMITTEE RECOMMENDATION: PREVIOUS COUNCIL ACTION: BACKGROUND INFORMATION: -The City is required to accept all applications for lawful gambling within the City Limits. BUDGET/FISCAL IMPACT: ATTACHMENTS: Gambling Application REQUESTED COUNCIL ACTION: Accept the application of the Watab Creek Whitetails for an event to be held on September 11, 2008 at the EI Paso Club. Print Form, Major Minnesota Lawful Gambling LG220 Application fo'r Exempt Permit For Board Use Only An exempt permit may be issued to a nonptofit organization that: Fee IS $5O for Check# • conducts lawful gambling on five or fewer days, and • awards :less than $50,000 in prizes during a calendar year. each event ~ ORGAN{ZATION INFORMATION Organization name Previous gambling permit number Watab Creek Whitetails Chapter Type of nonprofit organization. Check. ('~) one. ^ Fraternal ^ Religious ^ Veterans ~ Other nonprofit organization Mailing address City StatelZip Code County 34934-140th Ave. Avon MN. 56310 Sterns Name of chief executive officer (CEO) Daytime phone number Dave Raab 320-356-7427 ATTACH A COPY OF QNE OF THE FOLLOWING FOR PROOF OF NONPROFIT STATUS ~ Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status. _ Nonprofit Articles of Incorporation OR a current Certificate of Good Standing. Don't have a copy? This certificate must be obtained each year from: Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651-296-2803 _ lnternal Revenue Service -IRS income tax exemption (501(c)]letter in your organization's name. Don't have a copy? To obtain a copy of your federal income tax exempt letter, send your federal ID number and the date your organization initially applied for tax exempt status to: IRS, P.O. Box 2508, Room 4010, Cincinnati, OH 45201- Internal Revenue Service -Affiliate of national, statewide, or international. parent nonprofit organization (charter) If your organization faNs under a parent organization, attach copies of both of the following: a. IRS letter showing your parent organization is a registered nonprofit 501(c) organization with a group ruling b. the charter or letter from your parent organization recognizing your organization as a subordinate. Internal Revenue Service -proof previously submitted to Gambling Control Board If you previously submitted proof of nonprofit status from the Internal Revenue Service, no attachment is required. GAMBLING PREMISES INFORMATION Name of premises where gambling activity will be conducted (for raffles, list the sitewhere the drawing will take place) EI Paso Club Address (do not use PO box) City Zip Code County 200-2nd St. NW St.Joseph 56374 Sterns Date{s) of activity (for raffes, indicate the date of the drawing) September 11,2008 Check the box or boxes that indicate the type of gambling activity your organization will. conduct: ^ *Bingo (~ Raffles ^ *Paddlewheels ^ *Pull-Tabs ^ *Tipboards * Gambling equipment for pull-tabs, tipboards, paddlewheels, and bingo (bingo paper, hard cards, and bingo number selection device) must be obtained from a distributor licensed by the Gambling ControLBoard. To find a licensed distributor, go to www.gcb.state.mn.us and click on List of Licensed Distributors,. or call 651-639-4076. Page 1 of 2 6107 LG220 Application for Exempt Permit Page 2 of 2 s/o7 LOCAL UNIT OF GOVERNMENT ACKNOW LEDGMENT ff the gambling premises is within city limits, ff the gambling premises is located in a township, both the city must sign this application. tfie county and township must sign this application. Check ('~) the action that the city Is taking on Check (~) the action that the county is taking on this application, this application. _The application is acknowledged with no waiting period. The application is acknowledged with no waiting period. The application is acknowledged wdh a 30 day waiting The application is acknowledged with a 30 day waiting period, and allows the Board to issue a permit after 30 Period, and allows the Board to issue a permit after 30 days (60 days fora 1st class city). days. The application is denied. The application is denied. Print city Warne Print county name On behalf of the county, !acknowledge this applicafion. On behalf of the city, /acknowledge this application. Signature of county personnel receiving application Signature of city personnel receiving application Title Date / / Title Date / ~ TOWNSHIP: Onbeha/fofthetownship,lacknowledgethatthe o-ganization is applying for exempted gambling activity within the township limits. [A township has no statutory authority to approve ordeny an application [Minnesota Statute 349.213, subd. 2}] Print township name Signature of township official acknowledging application Title Date / / CHIEF EXECUfi1VE OFFICER'S SIGNATUR E The information provided in this application is complete and accurate to the best of my knowledge. 1 acknowledge that the financial report will be complet d returned to fhe and within 30 days of the date of our gambling activity. Chiefexecutiveofficerssignatu ~ Date ~ / ~~ / ~~ Complete an application for each gambing activity: Financial report and recordkeeping • one day of gambling activity required • two or more consecutive days of gambling activity A financial report form and instructions will be • each day a raffle drawing is held -sent with your permit. Within 30 days of the Send application with: activity date, complete and return the financial a copy of your proof of nonprofit status, and report form to the Gambling Control Board. • $50 application fee for each event. Questions? Make check payable to "State of Minnesota." Call the Licensing Section of the Gambling To: Gambling Control Board Control Board at 65139-4076. 1711 West County Road B, Suite 300 South Roseville, MN 55113 Data privacy. This form will be made available in aRemaffve format (i.e. large print, BraNle) upon request. The information requested on this form (and any attactxrrents) will be used by the Gambling Control Board (Board) to determine your qualifications to be involved in lawful gambling at~ivities in Minnesota. You have the right to refuse to supply the information requested: however, if you refuse to soppy this information, the Board may not be able to determine your qualifications and, as a consequence, may refuse to issue you a permit. ff you soppy the infornation requested. the Board wiA be able to process your applicatlon. Your name and and your orgardzatlon's name and address will be public information when received by the Board. All the ottrer information you provide will be private data ur>iil the Board issues your permit. 1Nfien the Board issues your permit, all of the information provided to the Board will become public. Hthe Board does not issue a pemat, aA information provided remains private, with the exception of your name and your organization's name and address wttrch will remain public. Private data are available tor: Board members, Board staff whose work requires access to the information; Minnesota's Department of Public Safety; Atton~r General; Commissioners ofAdministration, Finance, and Revenue; LegislativeAudkor, national and international gambling regulatory agerxies; anyone pursuant to court order, other individuals and agenaes that are speclficaly authorized by state or federal law to have access to the information; individuals and agenaes for which law or legal order authorizes a new use or sharing of information after this Notice was given: and anyone wish your consent.