HomeMy WebLinkAbout[04c] Gambling Permit('TI'ti' OF BT. JOfikYH
MEETING DATE: February 7, 2008
Council Agenda Item C
AGENDA ITEM: Gambling Permit - MN Deer Hunters Association -Central MN Chapter
SUBMITTED BY: Administration
BOARD/COMMISSION/COMMITTEE RECOMMENDATION:
PREVIOUS COUNCIL ACTION:
BACKGROUND INFORMATION:
BUDGET/FISCAL IMPACT:
ATTACHMENTS: Application for Exempt Permit
REQUESTED COUNCIL ACTION: Gambling Application -Accept the Lawful Gambling
Application for Exempt Permit for the MN Deer Hunters Association -Central MN Chapter for an event
to be held at Trobec's Event Center on September 24, 2008.
~: yep-.. .,.
P~int~Form
Major
Minnesota Lawful Gambling
Page 1 of 2 6/07
LvZZOApplication for Exempt Permit For Board Use Only
An exempt permit may be issued to a nonprofit organization that: Fee IS $50 fOr Check#
• conducts lawful gambling on five or fewer days, and
• awards less than $50,000 in prizes during a calendar year. eBC~'1 event $
ORGANIZATION INFORMATION
Organization name Previous gambling permit number
Central Minnesota Chapter_ Y1~N~~- ~~~:~5 ~„~_
Type of nonprofit organization. Check (~) one.
^ Fraternal ^ Religious ^ Veterans ~ Other nonprofit organization
Mailing address City State/Zip Code County
6085-321st. St.Cloud MN. 56303 Sterns
Name of chief executive officer (CEO) Daytime phone number
Tim Clement 320-252-6543
ATTACH A COPY OF ~~ OF THE FOLLOWING FOR PR OOF 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
___ Internal 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 falls under a parent organization, attach copies of ~ 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.
Olnternal Revenue Service -proof previously submitted to Gambling Control Board
If you previously submitted proof of nonprofit status from the Intemal Revenue Service, no attachment is required.
GAMBLING PREMISES INFORMATION
Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place)
Trobeck's Event Center
Address (do not use PO box) City Zip Code County
213-20th Ave.SE St.Joseph 56374 Sterns
Date(s) of activity (for raffles, indicate the date of the drawing)
September 24,2008
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 Control Board. To find a licensed distributor, go to
www.gcb.state.mn.us and click on List of Licensed Distributors, or call 651-639-4076.
LG220 Application for Exempt Permit Page 2 of 2
Organization Name 11/04
Local Unit of Government Acknowledgment
If the gambling premises is within city limits, the
city must sign this application.
On behalf of the city, I acknowledge this application
If the gambling premises is located in a township, both
the county and township must sign this application.
On behalf of the county, I acknowledge this application.
Check the action that
the city is taking on this application.
^ The city approves the application with no
waiting period.
Check the action that
the county is taking on this application.
The county approves the application with no
waiting period.
The city approves the application with a 30 day ^ The county approves the application with a 30 day
waiting period, and allows the Board to issue a
permit after 30 days (60 days for a first class waiting period, and allows the Board to issue a
city). permit after 30 days.
The city denies the application.
The county denies the application.
Print name of city Print name of county
Signature of city personnel receiving application ur o coun personne receiving app ica ion
Title
Title
Date / /
Date / / TOWNSHIP: On behalf of the township, I acknowledge that
the organization is applying for exempted gambling activity
within the township limits. (A township has no statutory
authority to approve or deny an application
(Minnesota Statute 349.213, subd. 2).]
Print name of township
Signature of township official acknowledging application
Title
Date / /
Chief Executive Officer's Signature
The information provided in this application is complete and accurate to the best of my knowledge. I acknowledge that the
financial report will be completed and returned to the Gambling Control Board within 30 days of the date of our gambling
activity. _ ) ~
Chief executive officer's signature ~~/
Name (please print) Date / /
Mail application and attachments
Send:
Complete an application for each the completed application,
gambling activity: a copy of your proof of nonprofit status (see instructions), and
• one day of gambling activity a $50 application fee. Make check payable to "State of Minnesota".
• two or more consecutive days of
gambling activity To: Gambling Control Board
• each day a raffle drawing is held 1711 West County Road B, Suite 300 South
Roseville, MN 55113