1f. St. Hubert Gambling/LiquorCITY OF
CHANHASSEN
Administration
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MEMORANDUM
TO:
FROM:
DATE:
Todd Gerhardt, Acting City Manager
Karen J. Engelhardt, Office Manager
May 24, 2004
SUB J:
Approval of Temporary Gambling Permit Request and
Temporary On-Sale Liquor License, St. Hubert Catholic
Community, August 21 & 22, 2004
St. Hubert Catholic Community has submitted an application for a temporary
on-sale liquor license and a temporary gambling permit for their annual Harvest
Festival on August 21 & 22, 2004. The events will be held on the church
grounds at 8201 Main Street. The gambling license will allow them to conduct
bingo, raffles, a silent auction, and pull-tabs.
RECOMMENDATION
Staff recommends approval of the temporary on-sale liquor license contingent
upon receipt of liquor liability insurance covering the event, and a resolution
approving the temporary gambling permit for St. Hubert Catholic Community
for their Harvest Festival on August 21 & 22, 2004.
Minnesota Department of Public Safety
ALCOHOL AND GAMBLING ENFORCEMENT DIVISION
444 Cedar Street Suite 133, St. Paul MN 55101-5133
(651) 296-6979 Fax (651) 297-5259 TTY (651) 282-6555
WWW.DPS.STATE.MN.US
A PPI,I(iATION AND PEI~'~111
FOIl .4, ! TO 4 DAY 'I'EMPORAI~Y ON-SAI,E !JQUOR I,ICENSE
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Minnesota Lawful Gambling
LG220 Application for Exempt Permit
Fee $50
Page 1 of 2 (web) 12/03
For Board Use Only
Fee Paid
Check No,
Organization Information
O~anizatic~ n~me
reet
~ame o[ chie[ executive officer (CEO)
Fi~Dame~ j Last na~e
Name of treasurer
.alt
Type of Nonprofit Organiz~ti~
Previous lawful gambling exemption number
I E ~t\ ~.~ ~ ~ ~i~, ~'~ 1 St~re/Zip C°de ,~unty
.~aytime phone numbcz of CE/p
Daytime phone number of
(t~.~e a s_u~re r,;.:.. ,.,,
Check the box that best describes your organization:
[] Fraternal ~ Religious
[] Veteran [] Other nonprofit organization
Check the box that indicates the type of proof your organization attached to this application: [] IRS letter indicating income 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
[] Proof previously submitted and on file with the Gambling Control Board
Gambling Premises Information
qc, me of premises where gambling a~tivity will be conducted (for raffles, list the site where the drawing will take place)
Address (do not usc PO box) -I Ci.~v% ,- ,JJ State/ZipCod-e~--~0un~y
Date(s) of activity (for raffles, indicate the date of the drawing)
Check the~ox or boxes that indicate the ty~ of gambling activity your organization will be conducting:
'-'~*Bing~o ~ Raffles (cash prizes may not exceed $12,000) ~ *Paddlewheels ~*PulI-Tabs ~ *Tipboards
*Gambling equipment for pull-tabs, tipboards, paddlewheels, and bingo (bingo paper, hard cards, and bingo ball
selection device) must be obtained from a distributor licensed by the Gambling Control Board. To find a licensed
distributor, go to ~.gcb.state.mn.us and click on List of Licensed Distributors. Or call 651-639~000.
This form will be made available in alternative
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
qualifications to be involved in lawful gambling
activities in Minnesota. You have the right 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 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 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
private, 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
the following: Board members, staff of the
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 sharing of information
after this Notice was given; and anyone with
your consent.
LG220 Application for Exempt Permit
Organization Name
Page 2 of 2
12/03
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.
DThe city approves the application with no
waiting period.
DThe 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).
DThe city denies the application.
Print name of city
(Signature of city personnel receiving application)
Title
Date I /
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 county is taking on this application.
DThe county approves the application with no
waiting period.
DThe county the application with a 30 day
approves
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)
Title
Date / /
TOWNSHIP: On behalf of the township, I acknowledge that
the organization is applying for exempted gambling activity
within the township limits. [Atownship 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.
Chief executive officer's signature
Name (please print) )~ ~L.f¢~. 01~.tC~,,
Mail 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 are not prorated, refundable, or transferable.
Send to: Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113
Date / /
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.