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1f St. Hubert's Gambling Permit CITY OF 7700 Market Boulevard PO Box 147 Ohanhassen, MN 55317 Administration Phone: 952227.1100 Fax: 952227.1110 Building Inspections Phone: 9522271180 Fax: 9522271190 Engineering Phone:9522271160 Fax:9522271170 Finance Phone: 9522271140 Fax: 952227.1110 Park & Recreation Phone: 952.2271120 Fax: 952.2271110 Recreation Center 2310 Coulter Boulevard Phone: 9522271400 Fax: 952227.1404 Planning & Natural Resources Phone:952.227.1130 Fax:952~227.1110 Public Works 1591 Park Road Phone: 9522271300 Fax: 9522271310 Senior Center Phone: 952227.1125 Fax: 952227.1110 Web Site v,~.ci chanhassen.rnn.us MEMORANDUM TO: Todd Gerhardt, City Manager FROM: Karen J. Engelhardt, Office Manager 0~/t DATE: February 2, 2004 SUB J: Approval of an Application for Exempt Gambling Permit, St. Hubert Catholic Community, April 24, 2004 St. Hubert Catholic Community has submitted an application for an exempt gambling permit for their annual Spring Fling fundraiser. The permit will be raffle off quilts and the funds raised will benefit the school. Law Enforcement has completed a background investigation on the applicant and did not find any negative comments. RECOMMENDATION Staff recommends approval of the application as submitted. The City of Chanbassen. A growing communily with clean lakes, quality schools, a charming downtown, thriving businesses, winding trails, and beautiful parks A great place lo live, work, and play Minnesota Lawful Gambling LG220 Application for Exempt Permit Or~lanization Information Omanization name , c S et , ciF-. ,/ I / Name of chief ex~u~ve o~cer (CEO)  name L~ name Name of ~easurer Fi~.name , n me Type of Nonprofit/{)rganlzation Page 1 of 2 6/03 Fee $50 I ~2 pal%rd uesOnly I Check No. Previ°us lawful ~_linI(~)Pi°n number State/Zip Code County Daytime phoc~u~/mbeLof CEO Da~imo phone number of Check the box that best descr~ your organization: [] Fratemal I~ Religious [] Veteran [_.J'Other nonprofit organization Check the box that indicates the type of proof your organization attached to this application: [] IRS letter indicating ~ncome tax exempt status [] Certificate of Good Standing from the Minnesota Secretary of State's Office .A charter showing you are an affiliate of a parent nonprofit organization roof previously submitted and on file with the Gambling Control Board Gamblin~ Premises Information Name of promises wh.e~ gambling activity will be conducted (for raffles, list the site where the drawing will take place) Address (do not use PO box) I te.,pco* /cou Date(s) of activity (for raffles, indicate the date of the drawing) Ch~ ~he bo~ or box~ that ~ad~e th® type of g~abllng ~htity your oqteniz'~tion will he condu~ng: []'Bingo ¢.[:l..~ffiea{m~p~esmeynote×ceed$12,000) []'Peddlewh~ [~]'PalI-Tabs ["']~"l'lpbO~rd~' *~quipment for the,~ aativities muat he obtained from a licom~t distributor. Thia form will bo made available in 'four name and and your orgenization's altemative format (i.e. large print, Braille) upon request. The information requested on this form (and any attachments] will be used by the Gambling Control Board (Board) to determine your quaitifcatio~.s to be involved in lawful gambling activities in Minnesota. You have the right to refuse to if you refuse to supply this information, the Board may not be able to determine your qualir~..ations 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. neme end ad('~'ess will he pubr~c information when received by the Board. All Ihs other information that you provide will be pdvate 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 ramaths private, with the exception of your name end your orgaaization's name and address which will remain public. Privata data about you ara avalisble only to the following: Board membem, staff of th~ Board whose wonk assignment requires that they have access to the information; the Minnesota Attorney General; the Minnesota Commissioners of Administration, Finance, and Revenue; the anyone pursuant to court order; other individuals and agencies that are specifically authorized by state or federal law to have access to the information; indivk~als and agencies for which law or of information atter this Notice was given; and anyone with your consent. LG220 Application for Exempt Permit Organization Name ,~'7'-/ ./"/L) Local Unit of Government Acknowledgment If the gambling premlse~ Is within city limits, the oity must sign this appftoatlon. On behalf of the cityl ! acknowledge this application. Check the a~lon that the city le taking on this application. B The city approves the application with no waiting period. D The city 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 city). B The city denies the application. Print name of city (Slgnetum of city personnel receiving application) Title Date / / Page 2 of 2 '6/03 If the gambling premises Is located In s township, both Ihs county and township must sign this appllcaifon. On behalf of the county, I acknowledge this application. Check the action that the county Is taking on this application. B The county approves the application with no waiting period. B The county the application with a 30 da approves waiting period, and allows the Board to issue a permit after 30 days. B The county denies the application. Print name of county (Signature of county personnel receiving application) Title Date / /.__ TOWNSHIP: On behaff of lhe township, I acknowledge that the organlza~ Is applying for ex~ .t~ gambling ac6vity within the township limits; [Atownship has no statuto~j authority to approve or deny an application (Minn. StaL sec. 349.213, subd. 2).] Print name of township (Signature of township official acknowledging application) Trae. Date / / I Chief Executive Officer's Slgnature fl The information provided in this application is 0bmp~,te and [t~x:u~at..e to thq best of my knowledge; Chief executive officer's signature C~ ~ Name(pl.seprint) ~ ST-~'~- d/',(/'CIZ Date_~_/ / Mall Application and Attachments At least 45 days prior to your scheduled activity date send: the completed application, a copy of your proof of nonprofit status, and a $50 application fee (make check payable to "State of Minnesota"). Application fees am not prorated, refundable, or transferable. Send to: Gambling Control Board 1711 West County Road B, Suite 300 South Roaevllle, MN 55113 ff your application has not been acknowledged by the local unit of govemmant or has been denied, do net send the application to the Gambitng Control Board, LG~20 Application for Exempt Permit, Information Sheet 6/03 Who may be Issued An exempt permit can be issued to nonprofit organizations conducting lawful gambling an exempt permit? activity on five or fewer days, and awarding less than $50,000 in prizes during a calendar year. (Raffles: Total cash prizes for a raffle may not exceed $12,000.) Separate applications required Complete a separate application for each occasion. An occasion may be either: 1. One day of gambling activity. · If your organization wants to conduct gambling activity on April 5, May 5, and June 5, you must submit a separate appl~ation and fee for each activity date. -OR- 2. Two or more consecutive days of gambling activity. · If your organization wants to conduct gambling on July 3, 4, and 5 at the same site, you may submit only one application and one fee. Raffle: If you am conducting a raffle, each day a drawing is held constitutes one day of gambling. If drawings are held on more than five days in a calendar year, your organization must obtain an organization license, a gambling manager's license, and a premises permit. How to obtain a copy of proof of nonprofit status IRS Income Tax Exemption Minnesota Secretary of State Certificate of Good Standino - Nonorofit Articles of Incomoration Attach a copy of your organization's Certificate of Good Standing (317A) showing incorporation as a nonprofit organization. This certificate can be obtained from the Minnesota Secretary of State: Minnesota Secretary of State Business Services Division 180 State Office Building St. Paul, MN 55155 Phone: 651-296-2803 OR Under a nationaloroanization If your organization falls under a national organization, attach both of the following: 1. a copy of the IRS letter showing that your national organization has been a registered nonprofit 501 (c) organization and carries a group ruling, and 2. a copy of the charter, or letter from your national organization, recognizing your organization as a subordinate. Not under a national oroanization If your organization does not fall under a national organization, attach a copy of the IRS income tax exemption [501(c)] letter in the name of your organization, showing income tax exempt status. 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 R O. Box 2508 Room4010 Cincinnati, OH 45201 Sales tax exempt statue or federal ID employer numbers are not proof of Income tax exempt status. Financial report and recordkeeping required · A financial report form and instructions will be sent with your permit. · Complete and return the financial report form to the Board within 30 days of your date of activity. · Your organization must keep its gambling records for 3-1/2 years. Questions? Call the Licensing Section o_f the Gambling Control Board at 651-639-4000. If you use a TTY, call the Board by using the Minnesota Relay Service and ask to place a call to 651- 639-4000. Or, check our web site at www. gcb.etate, mn.us.