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Home My WebLink About[04i] Gambling Permits Council Agenda Item 4(i) MEETING DATE: November 14, 2016 AGENDA ITEM: Gambling Permit – Requested Action: Approve the Application to Conduct Off-Site Gambling for the St. Joseph Lions for an event to be held on January 20, 2017 at Sal’s Bar and December 4, 2016 at Bad Habit. . SUBMITTED BY: Administration BOARD/COMMISSION/COMMITTEE RECOMMENDATION: PREVIOUS COUNCIL ACTION: BACKGROUND INFORMATION: The Council must review and accept gambling permits that will allow lawful gambling at specific sites. The St. Joseph Lions has submitted a request to conduct at meat raffle for both the dates stated above. Staff will monitor the required quarterly contribution reports to assure that the 10% contribution is satisfied. The St. Joseph lions have historically exceeded the contribution requirement. BUDGET/FISCAL IMPACT: ATTACHMENTS: Request for Council Action Gambling application REQUESTED COUNCIL ACTION: Accept the premise permits to allow the St. Joseph Lions to operate lawful gambling at Sal’s Bar, 109 MN St W on January 20, 2017 and Bad Habit, 15 MN W, on December 4, 2016 This page intentionally left blank MINNESOTA LAWFUL GAMBLING 6/15 Page 1 of 2 LG230 Application to Conduct Off-Site Gambling No Fee ORGANIZATION INFORMATION Organization Name: St Joseph Lions License Number:02021 Address: 12870 287th St. City: St. Joseph , MN Zip: 56374 Gambling Manager Name: Scott D. Bloch Daytime Phone:320-845-7843 Chief Executive Officer(CEO) Name: Joseph Bechtold Daytime Phone:320-363-4483 GAMBLING ACTIVITY Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. From O/ / 20/ /7 to 0/ /20 / /7 Check the type of games that will be conducted: 112 Raffle Pull-Tabs []Bingo Tipboards Paddlewheel GAMBLING PREMISES Name of location where gambling activity will be conducted: Sal's Bar and Grill Street address and City (or township): 109 West Minnesota St., St. Joseph Zip: 56374 County: Stearns • Do not use a post office box. • If no street address, write in road designations (example: 3 miles east of Hwy. 63 on County Road 42). Does your organization own the gambling premises? [ ]Yes If yes, a lease is not required. ✓ No If no,the lease agreement below must be completed, and signed by the lessor. LEASE AGREEMENT FOR OFF-SITE ACTIVITY (a lease agreement is not required for raffles) Rent to be paid for the leased area: $0 (if none, write "0") All obligations and agreements between the organization and the lessor are listed below or attached. • Any attachments must be dated and signed by both the lessor and lessee. • This lease and any attachments is the total and only agreement between the lessor and the organization conducting lawful gambling activities. • Other terms, if any: Lessor's Signature: ✓ / /. / Date: /v/2?hG' Print Lessor's Name: L"`>//r CcliL1 CONTINUE TO PAGE 2 S LG230 Application to Conduct Off-Site Gambling 6/15 Page 2 of 2 Acknowledgment by Local Unit of Government: Approval by Resolution CITY APPROVAL COUNTY APPROVAL for a gambling premises for a gambling premises located within city limits located in a township City Name: County Name: Date Approved by City Council: Date Approved by County Board: Resolution Number: Resolution Number: (If none,attach meeting minutes.) (If none, attach meeting minutes.) Signature of City Personnel: Signature of County Personnel: Title: Date Signed: Title: Date Signed: TOWNSHIP NAME: Complete below only if required by the county. Local unit of government On behalf of the township, I acknowledge that the organization is must sign. applying to conduct gambling activity within the township limits. (A township has no statutory authority to approve or deny an application, per Minnesota Statutes 349.213, Subd. 2.) Print Township Name: Signature of Township Officer: Title: Date Signed: CHIEF EXECUTIVE OFFICER (CEO) ACKNOWLEDGMENT The person signing this application must be your organization's CEO and have their name on file with the Gambling Control Board. If the CEO has changed and the current CEO has not filed a LG200B Organization Officers Affidavit with the Gambling Control Board, he or she must do so at this time. I have read this application, and all information is true, accurate, and complete and, if applicable, agree to the lease terms as stated in this application. Signatu of C4r' (must be CEO's signature;designee may not sign) Date Mail or fax to: No attachments required. Minnesota Gambling Control Board Suite 300 South Questions? Contact a Licensing Specialist at 651-539-1900. 1711 West County Road B Roseville, MN 55113 Fax: 651-639-4032 This publication will be made available in alternative format(i.e. large print, braille) upon request. Data privacy notice: The information requested on this form(and any If the Board does not issue a permit,all information provided remains attachments)will be used by the Gambling Control Board(Board)to private,with the exception of your organization's name and address which determine your organization's qualifications to be involved in lawful will remain public. gambling activities in Minnesota. Your organization has the right to refuse to supply the information; however, if your organization refuses to supply Private data about your organization are available to: Board members, this information,the Board may not be able to determine your Board staff whose work requires access to the information; Minnesota's organization's qualifications and,as a consequence, may refuse to issue a Department of Public Safety;Attorney General; commissioners of permit. If your organization supplies the information requested,the Board Administration, Minnesota Management&Budget,and Revenue; will be able to process your organization's application. Legislative Auditor;national and international gambling regulatory agencies; anyone pursuant to court order; other individuals and agencies Your organization's name and address will be public information when specifically authorized by state or federal law to have access to the received by the Board. All other information provided will be private data information; individuals and agencies for which law or legal order about your organization until the Board issues the permit. When the authorizes a new use or sharing of information after this notice was given; Board issues the permit,all information provided will become public. and anyone with your written consent. An Equal Opportunity Employer MINNESOTA LAWFUL GAMBLING 6/15 Page 1 of 2 LG230 Application to Conduct Off-Site Gambling No Fee ORGANIZATION INFORMATION Organization Name: St Joseph Lions License Number:02021 Address: 12870 287th St. City: St. Joseph , MN Zip: 56374 Gambling Manager Name: Scott D. Bloch Daytime Phone:320-845-7843 Chief Executive Officer (CEO) Name: Joseph Bechtold Daytime Phone:320-363-4483 GAMBLING ACTIVITY Twelve off-site events are allowed each calendar year not to exceed a total of 36 days. From 13- / tt IL to 12 / /� tv Check the type of games that will be conducted: V Raffle Pull-Tabs Bingo Tipboards Paddlewheel GAMBLING PREMISES Name of location where gambling activity will be conducted: Street address and f�7 / ( /�� l 'n City (or township): I5 � I"( i(�/1L�SOT S� J (Qg 1- 7 h 1'",i'" Zip: 5 � 4- County: SfeivotS • Do not use a post office box. • If no street address, write in road designations (example: 3 miles east of Hwy. 63 on County Road 42). Does your organization own the gambling premises? Yes If yes, a lease is not required. • V No If no, the lease agreement below must be completed, and signed by the lessor. LEASE AGREEMENT FOR OFF-SITE ACTIVITY (a lease agreement is not required for raffles) Rent to be paid for the leased area: $0 (if none, write "0") All obligations and agreements between the organization and the lessor are listed below or attached. • Any attachments must be dated and signed by both the lessor and lessee. • This lease and any attachments is the total and only agreement between the lessor and the organization conducting lawful gambling activities. • Other terms, if any: 4 Lessor's Signature: Date: (U I �� Print Lessor's Name: Aorey, g idet,N CONTINUE TO PAGE 2 LG230 Application to Conduct Off-Site Gambling 6/15 Page 2 of 2 Acknowledgment by Local Unit of Government: Approval by Resolution CITY APPROVAL COUNTY APPROVAL for a gambling premises for a gambling premises located within city limits located in a township City Name: County Name: Date Approved by City Council: Date Approved by County Board: Resolution Number: Resolution Number: (If none, attach meeting minutes.) (If none, attach meeting minutes.) Signature of City Personnel: Signature of County Personnel: Title: Date Signed: Title: Date Signed: TOWNSHIP NAME: Complete below only if required by the county. Local unit of government On behalf of the township, I acknowledge that the organization is must Sign. applying to conduct gambling activity within the township limits. (A township has no statutory authority to approve or deny an application, per Minnesota Statutes 349.213, Subd. 2.) Print Township Name: Signature of Township Officer: Title: __ Date Signed: CHIEF EXECUTIVE OFFICER (CEO) ACKNOWLEDGMENT The person signing this application must be your organization's CEO and have their name on file with the Gambling Control Board. If the CEO has changed and the current CEO has not filed a LG200B Organization Officers Affidavit with the Gambling Control Board, he or she must do so at this time. I have read this application, and all information is true, accurate, and complete and, if applicable, agree to the lease terms as stated in this application. Signatur/1-3Z1(must be CEO's signature;designee maynot sign) Date 9 9 9 ) Mail or fax to: No attachments required. Minnesota Gambling Control Board Suite 300 South Questions? Contact a Licensing Specialist at 651-539-1900. 1711 West County Road B Roseville, MN 55113 Fax: 651-639-4032 This publication will be made available in alternative format(i.e. large print, braille) upon request. Data privacy notice: The information requested on this form(and any If the Board does not issue a permit,all information provided remains attachments)will be used by the Gambling Control Board(Board)to private,with the exception of your organization's name and address which determine your organization's qualifications to be involved in lawful will remain public. gambling activities in Minnesota. Your organization has the right to refuse to supply the information; however,if your organization refuses to supply Private data about your organization are available to: Board members, this information,the Board may not be able to determine your Board staff whose work requires access to the information; Minnesota's organization's qualifications and,as a consequence,may refuse to issue a Department of Public Safety;Attorney General;commissioners of permit. If your organization supplies the information requested,the Board Administration, Minnesota Management&Budget,and Revenue; will be able to process your organization's application. Legislative Auditor; national and international gambling regulatory agencies; anyone pursuant to court order; other individuals and agencies Your organization's name and address will be public information when specifically authorized by state or federal law to have access to the received by the Board. All other information provided will be private data information; individuals and agencies for which law or legal order about your organization until the Board issues the permit. When the authorizes a new use or sharing of information after this notice was given; Board issues the permit,all information provided will become public. and anyone with your written consent. An Equal Opportunity Employer