1c St. Hubert Church Gambling P C OF
CHAN EN
690 City Center Drive
PO Box 147
7hanhassen, Minnesota 55317
Phone
952.937.1900
General Fax
952.937.5739
~gineering Department Fax
952.937.9152
Building Department Fax
952.934.2524
Web Site
www. ci. chanhassen, mn. us
TO:
FROM:
Todd Gerhardt, Acting City Manager
Karen J. Engelhardt, Office Manager
DATE: June 20, 2001
SUBJ:
Approval of Temporary Gambling Permit Request, St. Hubert's
Church, August 17-19, 2001
St. Hubert's Church has submitted an application for a temporary gambling
permit for their annual Harvest Festival on August 17-19. This request is
identical to previous years and they have applied for bingo, raffles, and pull-
tabs. Law Enforcement has completed a background investigation on the
applicants and did not find any negative comments.
RECOMMENDATION
Staff recommends adoption of a resolution approving the application as
submitted.
!City nf Clm,hassen. ,4 arm,ina cnmmmdt~, with
Minnesota Lawful Gambling
LG220 - Application for Exempt Permit
Organization Information
//nization name '~
eet
Name of chief executive officer (CEO)
~t nam&T~ ~~
Name of treasurer
Type of Nonpro~t Organization
Page 1 of 2 3/01
For Board Use Only
Fee - $25 Foo Pakt
Check No.
Previous lawful gambling exemption number
s ,t zl C r, ty
Daytime phone number of CEO
Daytime phone number of
Check the box that best describes your organization:
[~] Fraternal
Religious
!'-"] Veteran I I Other nonprofit organization
Check the box that indicates the type of proof your organization attached to this application:
[--1 IRS letter indicating income tax exempt status
[~] Certificate of Good Standing from the Minnesota Secretary of State's Office
I-"] A charter showing you are an affiliate of a parent nonprofit organization
[~ Proof previously submitted and on file with the Gambling Control Board
Gamblinq Premises Information
Narpe,pf premises wt ere, gambling activity/~ll be co.nduc;ed (for raffles, Ii, the site where .the drawing will take place)
Address (do not use PO box) ~ ~, ., State/Z, ip Code County_
Dl~e(s) of activity (for ra~icat~e date of the~ng)
Check the~ox or boxes that indicate the type of gambling activity your organization will be conducting:
~.*Bingo ~affles (cash prizes may not exceed $12,000) ~leP'addlewheels
*Equipment for these actMties must be obtained from a licensed distributor.
This form will be made available in
alternative format (i.e. large pdnt, Braille)
upon request. The information requested
on this form (and any attachments) will be
used by the Gambling Control Board
(Board) to determine your qualifications to
be involved in lawful gambling actMties in
Minnesota. You have the dght to refuse to
supply the information requested; however,
if you 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 permit. If you supply
the information requested, the Board will
be able to process your application.
Your name and and your organization's
name and address wilt be public informalJon
when received by the Board. All the other
information that you provide will be private
data about you until the Board issues your
permit. When the Board issues your
permit, all of the information that you have
provided to the Board in the process of
applying for your permit will become public.
If the Board does not issue you a permit,
all the information you have provided in the
process of applying for a permit remains
pdvate, with the exception of your name
and your organization's name and address
which will remain public.
Private data about you are available only to
,ulI-Tabs r-'l *Tipboards
the following: Board members, staffofthe
Board whose work assignment requires
that they have access to the information;
the Minnesota Department of Public Safety;,
the Minnesota Attorney General; the
Minnesota Commissioners of
Administration, Finance, and Revenue; the
Minnesota Legislative Auditor, national and
international gambling regulatory agencies;
anyone pursuant to court order; other
individuals and agencies that are
specifically authorized by state or federal
law to have access to the information;
individuals and agencies for which law or
legal order authorizes a new use or shadng
of information after this Notice was given;
and anyone with your consent.
LG220 - Applicatigrbfor Ex ~.,*n~ Permit
Organization Name ~:>'T- ~ O ¥) ~'~
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.
Check the action that
the city is taking on this application.
D T
he city approves the application with no
waiting period.
~city approves the application with a 30 day
LvJ waiting period, and allows the Board to issue a
permit after 30 days (60 days for a first class
city).
DThe city denies the application.
(Signature of ,~ity I~monnel~rdceiving application)
Q,~ Q ? Page2 of 2
l ~' ~ ~ ~ ~ f~ 3/01
If the gambling premises is Iocat~,d 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 county is taking on this application.
DThe county approves the application with no
waiting period.
DThe county approves the application with a 30 day
waiting period, and allows the Board to issue a
permit after 30 days.
DThe county denies the application.
Print name of county
(Signature of county personnel receiving application)
Tit~ __
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 (Minn. Stat. sec.
349.213, subd. 2).]
Print name of township
(Signature of township official acknowledging application)
Date / /
Chief Executive Officer's Signature
The information provided in this ~3,glication is complete and accur, at~ t9 the best of my knowledge.
· .
Chef execut~e office~ signatu r ~L..
Name (please print) ~.(~J ,. ~-["C.. fL~4 B ,~'~C._.{~ Date
Mail Application and Attachments
At least 45 days prior to your scheduled activity date send: o the completed application,
- a copy of your proof of nonprofit status, and
o a $25 application fee (make check payable to "State of Minnesota").
Application fees are not prorated, refundable, or transferable.
Send to:
Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113
If your application has not
been acknowledged by the
local unit of government or
has been denied, do not
send the application to the
Gambling Control Board.
City of Chanhassen
Check List for Gambling Applications
Date:
6/14/01
Applicant:
Business:
Lawrence Robert Blake
St. Hubert's
Driver's License Check:
Valid
Criminal History Check:
Clear
In House Record Check:
Clear
In house checked by: Carol Dunsmore
'City of Chanhassen
Check List for Gambling Applications
Date:
6/14/01
Applicant:
Business:
Stephen Donald Ulrick
St. Hubert's
Driver's License Check:
Valid
Criminal History Check:
Clear ·
In House Record Check:
Clear
In house checked by: Carol Dunsmore