HomeMy WebLinkAbout[04c] GamblingMEETING DATE: March 20, 2008 ~
AGENDA ITEM: Gambling - Requested Council Action: Accept the Premise Permit
application for American Legion Post 328 to operate lawful
gambling at 101 - Minnesota Street West
SUBMITTED BY: Administration
BOARD/COMMISSION/COMMITTEE RECOMMENDATION:
PREVIOUS COUNCiI ACTION:
BACKGROUND INFORMATION: Annually the Council must approve all Premise Permits for Lawful
Gambling. As part of the renewal process each organization is required to submit a financial summary
illustrating that at Ieast 109~0 of the proceeds have been expended in the defined trade area. Based on
the submitted information the Ordinance requirement has been satis~ed.
BUDGET/FISCAL IMPACT:
ATTACHMENTS: 1j Minnesota lawful Gambling License Renewa! Application
2) Summary Financial Statment
REQUESTED COUNCIL ACTION: Accept the Premise Permit application for the American Legion Post #
328 to operate lawful gambling at 101 Minnesota Street West.
. Minnesota Lawful Gambling
b"~e (LG200R) Lawful Gambling License Renewal Application
~ ~~~
Corrections should be made directly on this application
- Submit one check for the combined total of renewal fees, ,payable to State of Minnesota
Organization requirements: Current license term: 7/1/2006 to 6/30/2008
1. An organization liccnse fee of $350 paid annually. " Renewing lic~nse tert3'i: 7/1/2008 to 6/30J201~
Authoriaation #: 137~ 0 r Gheck this box if your ~
~nganization: AmeriCal7 Legi0rl POSt 328 (320 363-$631 iorc~anizat~on qua~itiestor (
~ I the waiver of the $350 i
Box 381, St. Joseph; MN 56374 Cou~ty: St~8P11S organizatioa Jicense fee
CEO: Kenneth Joseph Hiemenz I def~ed ir, MN sc~t~te I
~ _ 349.16 Subd_6 _ J
PO'Box 372, St. Joseph, MN 56374 (320)363-8803
,~Y~~ ~ ~s e~~:fi~
Treasurer: • j~ g~~ ~.~7 .~f~, ~~~, Annual Goal for
~-r~T CC'TRT so~ St. Joseph, MN 56374 ' Charitable
(320)363-~.~~-~g Contributions %o
Gamblin~ Manager I~equirements:
1. A gambling manager license fee of $10~ paid annually.
Gambling Manager Authorization; GM-01373-002 Current License Term: 7~ 1/2006 to 6/30/2008
Renewing license term: 7/1/2008 to 6/30/2010
Ma1'Ii11 AI1d1'ew Fabel' ~: The individual listed is not renewing their license. We have enclosed a LG212
11837 Co Rd 51, St. Joseph, MN 56374 appl+cation for the n~w applicant.
(320)363-7682 Note: The gambling manager duties may not be assumed by an
BOnd: # RPS54722~i individual until they are licensed by the Minnesota
Company: Old Republic Gambling Control Board.
Gambling Manager A~davit and Consent Statement
1. I have never been convicted of a felony or a crime
involving gambling.
2. I have never committed a violation of law or Board rule
that resaited in the revocation of a license issued by the
Board within five years before the date of the license
applieation.
3. I have never been. convicted of a criminal violation
involving fraud, theft, tax evasion, misrepresentation, or
garnbling.
4. I have never been convicted of (i) assault, (ii) a criminal
violation involving the use of a firearm, or (iii) making
terroristic threats.
5. I have never been, or am I now, connected with or
engaged in an illegal business.
6. I have never had a sales and use tax permit revoked by
the commissioner af revenue within the past hvo years.
7. I have never, after demand, failed to file tax returns
required by the commissiqner of revenue.
8. I do not owe $500 or more in delinquent taxes as defined
in section 270J2.
9. I have been an active member of the organization for at
least two years at the time of our organization's initial license
application, or have been an active member for at least the
most recent six months prior to the effeetive date of our
organization's license renewaL
1Q I am not a gambling manager or an assistant gambling
manager for another organization.
11. I am nof a lessor, a member of the lessor's immediate
family or a person residing in the same household as the
lessor, or an employee of a lessor of a premises where this
organization has a permit issued from the Board to conduct
lawful gambling.
12. I am not invo)ved directly or indirectly as a bingo hall owner,
manufacturer, or distributor.
13. I am not the chief executive officer of this organization.
14. I am not the treasurer of this organization.
15. I was not an officer of an, organization at a time when an
ofFense occurred which caused that organization's license to be
revoked.
Background Check. By signature of this document, the
undersigned authorizes the Departments of Public Safety and
Revenue to conduet a criminal and tax background check or review
and to share the results with the Gambling Control Board. Further,
I understand, agree, and hereby irrevocabfy consent that suits and
actians relating to the subiect matter of this gambling manager
license application, or acts or omissions arising from such
application, may be commenced against me or my organization and
I will accept the service of process in any court of competent
jurisdiction in Minnesota by service on the Minnesota Secretary of
State of any summons, process, or pleading authorized by the laws
of Minnesota.
Failure to provide required information or providing false or
misleading information may result in the denial or revocation of the
license.
Changes in the information submitted in this application will be
submitted in writing no later than 10 days after the change has
taken efFect.
I have read this application and declare that aN information
submitted 's true~a~ c~~u~r~ate~ a co lete:
~C2~i%L~c.~/ ~C~'~~'~ -
Signature, in ink, of gambling manager applicant
Date: ~~ C~~S'
license Number: 1373
License Expiration: 6/30/2008
~remises permit requiremer~ts:
... An premises permit fee of $150 paid, annually, 2. A separate resolution of approval including the site address from
the local unit of godernment, (The local unit of government does not sign this renewal application) and 3. A LG215
lease agreement for each site your organization does not own is required.
Site number 002 ~; Check this box if this site has been discontinued or will not be renewed.
American Legion Post 328
10r 1N Minnes~ta St, St. J~seph, MN 56374 Stearns County
~---~Township of (if applicable) GaI7lbllllg dCGOUl1t # 300290901
Qrganization owns this site: Y ist State Bank
Box 159, St. Joseph, MN
-, ~ _ '
Does your org~nization conduct bingo at this site Y/ N 56374
Is the local resolution of approval attached? Y/ N; If yes; the attach a list of the days and beginning times of your bingo activities:;
License Number: 1373
License Expirafion: 6/30/2008
~hief Executive Officer's Acknowlectgement and Oath
I declare that:
I have read this application and all information subrnitted to the Baard. All information is true, accurate and complete.
A~I cather required information has been fully disclosed. I am the chief ex"ecutive officer of the organizatton.
I assume full responsibility for the fair and lawful operation of all gam~ling activities to be conducted. " i vvill familiarize myself
with the laws of Minnesota governing lawfuf gambling and rules of the Board and agree, if licensed, to abide by those laws and
rules, including amendments to them.
I certify that the gambling manager is bonded and licensed as
required per Minnesota Statutes. I have read this application and declare that all
I understand that failure to provide required information or providing inform tion subrnitted is true, accurate, and
false or misleading information may result in deniai ar revocatian of compl e. ~
the license: ^~1~~~ . 1.~~~V~^
A termination plan wil! be submitted to the Board within 30 days of Signature, in ir ,lc,,,~ e f chief executi icer
. termination of our gambling operation. ~ 4 J
Date:~~t~~ /~
..................................•---..........,
: Mail complete renewal application (aN pages), and .
; one check made payable to the State of Minnesota ~
: for all renewal fees by: 5~~~20~g to: Gambling Control Board' ;
; J.711 VV Co Rd B#300 S :
~... ...... _..... .• .................. ... Roseville,MN 55113 .... .. ....._..:
Licensing Contact: Deb Lewis
Email: . deb.lewis@gcb.state.mn.us
Phone: {651)639-4077
Fax #: (651) 639-4032
The information requested on this form (and any attachmentsj will be used by the Gambling Control Board (Board) to determineyour ,
qualifications to be involved in lawful gambling activities in Minnesota, and to assist the Board in conducting a background investigation of you.
You have the right to refuse to supply the information requested, however, ifyou refuse to supply this information, the Board may not be able to
determine your qualifications and, as a consequence, may refuse to issue you a license. If you supply the iRforrnation reques~ed, the 8oard wiN
be able to process your application.
Your name and address will be public information when received by the Board. All the other information that you provide will be private data
about you until the Board is5ues your license. When the Board issues your (icense, alf of the information thatyou have provided to the Board in
the process of applying for your license will become public except for your Social Security number, whieh remains private. If the Board does not
issue you a license, all information you have provided in the process of epplying for a license remains private, with the exception of your name
and address which will remain public.
Private data about you are available on)y to the following: Baard members, Board staff whose work assignment requires that they have access
to the information; the Minnesota Departrnent of Public Safety; the Minnesata Attorney General; the Minnesota Commissioners of Administration,
Finance, and Revenue; the Minnesota Legislative Auditor, national and international gambling regulatory agencies; anyqne pursuant to court
order; other individuals and agencies that are specifically authorized by state or fiederal law to have access to the i~formation; individuals and
agencies for which law or legaf order awk~orizes a new use or sharing of information after thi~ Not'rc~ was given; and anyone with your w~itten
consent.
Organization Renewal App: Report
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