1j Gambling Permit/St. Hubert's
CITY OF
CHANHASSEN
1 City Cent" Drive, PO Box 147
],anhassm, MinnaOI4 55317
Phon, 612.937.1900
GIn"a/ FI1X 612.9315739
'nginrering FI1X 612.937.9152
,blic Saftty FI1X 612.934.2524
Vtb wwwcÎ.chanhlllicn.mn,us
MEMORANDUM
TO:
Mayor & City Council
Scott Botcher, City Manager
føA
Gambling Application for S1. Hubert Catholic Community
Father Stephen Donald Ulrick
Father Lawrence Robert Blake
u
~e City of Chanhlllien, A mlwÎnv communitv with cILan laka, oua/itv y;hook a charminr downtown. thriv;nr busiMm, and htautifù/ Mrk" A ",rat .la" In Ii,,,, lI~r", and .lav
FROM:
Carol Dunsmore, Support Staff'
DATE:
May 17,2000
SUBJ:
This memo is to respond to the license application for gambling at the above
location on August 20, 2000, The background investigation I have conducted
reveals no reason that the license should be denied.
If you need additional information, please let me know.
CD:ms
. ,
Previous lawful gambling exemption I}umber
10001
StatelZip Code County
~",J.c;QN Î1.tJ, /1
Daytime phorle number of
CEO'
qç'
Minnesota Lawful Gambling
Application for Exempt Permit - LG220
Organization Infonnation
g;nitLna; CA
t
~
Page 1 of2
10198
For,Board Use Only
Fee P8icI
Check No. '
InIUøI$
ReceIved --1. I
9ft) {,
Daytime phone number of
9/t>t
Type of Nonprofit Organization
Check the box that best describes your organization:
o Fraternal SBeligiOus
o Veteran 0 Othernonprofitorganizati.on,
Check the box that indicates the type of proof your organization attached to this application:
o IRS letter indicating income tax exempt status
o Certificate of GOod Standing, frprn the Minnesota Secretary of State's Office
Q A charter shOwing you are an affiliate of a parent nonprofit organization
, 1t)J-., Proof previously submitted and On file with the Gambling Control Board
Gambling Premises Infonnation
Nøme of premises where gø ling cIivity win be
Ii'
~ress (do not use PO box) City
0; I r\.; (\J ~'tÆ~~
Døte(s) of øclivity (for røffles. indicate the dllte of the drøwing)
,duded (for,ráfII~s, list the site where the drøwing will tøke place)
, :-r
Che e box or boxes thøt indicat the IYPe of gømbling øctivily yourorgønizlltion will be conducting:
~90 ~es 0 ·PøddlewheeJs KlÍ:fUII- Tøbs 0 *Tipboards
·Equipment for these áctivlties must be obtøined from ø licensed distributor,
This Ionn will be made avaDabIe in øJternative Your name and and your orgønization's name
lorrnIItíLe,!argeprintBraiIIe)upOnrequest The and address will be public Infonnation when
informøtion requested on this Ionn (and any received by the Board, All the other infonnation
øttachments) Will be used by the Gambling thøt you provide Will be private datø about you
Control Boørd (Board) to detennine your until the Board issues your permit. When the
qualificøtions to be ImioIvad in lawful gørnbling Board issues your permit, all of the infonnation
activities in M'mnesolll, You have the right to that you høve providad to the Board in the
refuse to supply the infonnation requested: process of applying for your pennitwiU become
however, ff you refuse to supply this information, public. If the Board does not issue you a permit,
the Board may not be able to determine your all the information you have provided in the
quafifications and, æa consequence, may refuse process ofapplying for a permit remains private,
to issue you a permit. If you supply the with the exception of your name ønd your
information requested, the Board wiN be able to orgønizatjon's name and address which Will
process your app6cation. remain public.
StøtelZip Code
MN
66'31
PñvaIe datø øbout you are available only to the
Iollowing: Board members, staff of the Board
whose work assignment requires that they have
access to the information; the Minnesota
Department of Public Safety; the Minnesotø
AtIomeyGeneral; the Minnesota Commissioners
of Administration, Finance, and Revenue; the
Minnesotø legislative AudRor. national ønd
international gambling regulatory agencies;
anyone pursuant to court order. otherindividuals
and agencies that are specificølly øuthOrized by
state or federøl law to have access to the
information; individuals and agencies for which
law or legal order authorizes ø naw use or
sharing of infoooation after this Notice was given;
ønd anyone with your consent
pøge20f2
"ppr...... fo' Exempt P...... - LG220 "'"
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I ...."" Unll" G_ot ,,"'-- (Ro,"'"'" by '-'
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1. ........""' ..._' BY""'" '" -. 1. ........... ...-' BY""'" ""0."""
...... .-........IÞ -,,....- ""'," --.. -","", ---"-'
30'" ,50 ..' '" _ ",,_ ..¡. ' ....... ""' --....... ...."', ,.,. ø'm,
allows the Board to issue ø permit before 30 døys,
, .........__w.--' "" ---
....-......... ","",' po""..... 3. ODnY'" ...,-, bY"'- -..-.'"
30 days l60 days for a first cløss city), cocu- 30 døys,
mentation attached. print name of county:
3. Deny the applicøtlon by passing ø resolution
within 30 dayS l60 days for a first clasS city),
(Signature of county personnel receiving øpplication)
Title
oate~~-
On behølf of the townshiP, I aCKnowledge thøt the
orgønization is applying for exempted gambling øctivity
within the townshiP limitS,
A township has no statutOry authority to approve or deny
an application lMinn, Stat sec. 349,213, subd. 2).
Print name of township: -
(Signature of township official acknowledging application)
Title
oate--d--d~
ChiefÐœculNe Officers signatUre
NamelPleaseprintL~' ~~~ u/~I't I<...
røte to, best of :y Knowledge,
Date.-£!3-t~
Chief Executive Officer's Signatur
The information provided in this applicøtion' CO
=
MaU APp\ication and AttaChmentls)
No \east 45 days prior to your scheduled activity date send:
. the completed applicøtiOn;
. a copy of your proof of nonprofit statuS, and
_ _ $25 _ "" ,,,,,,, __ ,..,... '" -- d U,......->· "",--- - _M "" """""
refundable. or trønsferøble.
send to: Gømþ\lng control eoørd
1711 West county Roød e. suite 300 south
Rosev\lle, MN 55113
..,.. _.... 00'''''''''''''''''' bY .. "'" "" d""- """ """.. - ",..
Gambling control Board,
~
.
APplication for Exempt Permit - LG220. Information Sheet
Who may be issued
øn exempt permit?
An exempt permit can be issued to nonprofit organizations conducting lawful 9ømbling
activity on five or fewer days, ønd awarding less than $50,000 in prizes during a calendar
year,
10198
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 øctivity on April 5, May 5, and June 5, you
must submit ø separate application and fee for each activity date.
-OR-
2, Two or more conSecutive days of 9ømbling øctivily,
. If your organization wants to conduct gambling on July 3, 4, and 5 øt the same site, you
møy submit only one application and one fee.
If you are conducting a raffle, each day a draWing is held constitutes one day of gambling, If
drawings are held on more than five days in ø ca/endør yeør, your organization must obtain øn
organizøtion license, a 9ømbling manøger's license, and a premises permit.
How to Obtain a Copy of Proof of Nonprofit Status
Minnesota Secretø'Y of State
Certificate of GOOd Standing - NonprofitArticles
¡if InCOl'PDration
Attach a copy of your organization's Certificate
of GOOd Standing (317 A) showing incorporation
as a nonprofit orgønization.
OR
IRS Income Tax Exemption
Under a nØtional orgønization
If your organizøtion falls under a national organization,
attøch both of the fOllowing:
1, a èopy of the IRS letter shOwing that your nøtional
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 nøtional
organization, recognizing your organization as a
SUbordinøte,
This certificate can be obtained from the
Minnesotø Secretary of State:
Minnesota Secretary of State
Business Services Division
180 State Office Building
St. Paul, MN 55155
Not under ø national oJ'! anization
If your organization does not fall under a national
organization, Øttach ø copy of the IRS income tax
exemption [501(c)J letter in the name of your
organization, showing income. tax exempt status,
Phone: 651-296-2803
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
Room4010
Cincinnøti, OH 45201
Phone: (513)684-3957
Sølea tax exempt status or federal ID employer numbers are not proof of income tax exempt status.
Financial report and
recordkeeping
required
. On the first wOrking day of the month in which your gambling øctivity is being held, the
Gambling Control Boørd will send your organization ø financial report form and instruCtions,
. Complete and return the financial report form to the Board within 30 days of your date of
activity,
. Your organization must keep your gambling reCOrds for 3-1/2 years,
Questions?
Call the licensing Section of the Gambling Control Board at 651-639-4000. If you use a TTY,
you can call the Board by using the Minnesota Reløy Service at 1-800-627-3529 and ask to
place a call to 651-639-4000,