1c Approval of Gambling Permit to conduct raffle, Chan Rotary
CITY, OF
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690COUlTSRORIVE . P.O. BOX 147- CHANHASSEN, MINNESOTA 553t1
(612)931~ 1900.. AA)((~t2)937"5739
MEMORANDUM
TO: Mayor
City Council
City Manag~r
FROM:
Scott Harrt Public Safety Director lfA
September 26, 1997
DATE:
SUBJECT:
Chanhassen RQtaty Club - Raffle
This memo is to respond to the Mmnesota Lawful Gambling Appticatio~ftqm theCh..ma8$en R()tary
Club. The background investigation conducted reveals no reasons thatt&e lieenses shollld\)e denied.
It is the recommendation of staff that thiS p(:nnit\)e approved.
g:lsafety\lesJi.\pnblins
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"d'fGovemment!'tJurisdiction! !,,!,
(s this gambling premises located within city limits?D Yes 0 No
If Yes, write the name of the City:
City Name
" ';;::"1:
If No, write the name of the County and the Township:
County Name Township Name
:heck the appropriate status of the Township: 0 organized 0 unorganized 0 unincorporated
''<'' ,....""....,... "'_''''''''''''~:''''' :.......,';"""_..,'''~,.,,_ .'"":"......,. '_,0': ..,......,. 'i""~"""", '.~'''_' .........~.. ,-...-,.,..., -~"''''',,,,,,, ~. :....-:.-.........,.: ""'''',--, .,..,-,...:-~ ".. ''''-.' ,.~,::
Local [JnitOfGt)f"ernment"'Aclrnowledgm~nf";",,.
1. The city must sign this application if the gambling
premises is within city limits. .
2. The county and township must sign this applica-
tion if the gambling premises is not within city limits.
3. DO NOT submit this application to the Gambling Control
Board if it is denied by the local unit of government.
4. NOTE: A Township may not deny an application.
Upon submission of this application to the Gambling Control Board, the exemption will be issued not
more than 30 days (60 days for cities of the 1st class) from the date the local unit of govemment
signed the application, provided the application is complete and all necessary information has been
received, unless the local unit of government passes a resolution to specifically prohibit the activity. A
copy of that resolution must be received by the Gambling Control Board within 30 days of the date
filled in below. Cities of the first class have 60 days in which to disallow the activity.
City or County Acknowledgment of Receipt of Township Acknowledgment of Awareness of
Application Application
Signature of person receiving application Signature of person acknowledging application
JUBLIC SAFETY DIRECTOR
SCOTT HARR
Date Received: 9/29/97
Title of..trefSon recei' pplication
~, j-------
Date Signed:
Title of person acknowledging application
Oath of Chief Executive Officer
a this application and all information is true, accurate and complete.
Date: "1-26 -9
Submit the application at least 45 days prior to your scheduled date of activity.
Be sure to attach the $25 application fee and a copy of your proof of nonprofit status.
Mail the complete application and attachments to:
Gambling Control Board
1711 W. County Rd B Suite 3005
Roseville, MN 55113
This publication will be made available in alternative format (i.e. large print, braille) upon request.
Questions on this -form .should-be directed to. the Licensing Section of. the. Gambling Control Board at
(612)639-4000.
Hearing impaired individuals using a TOO may call the Minnesota Relay Service at 1-800-627-3529 in the
Greater Minnesota Area or 297-5353 in the Metro Area.
The information requested on this form will be used by the Gambling Control Board (GCB) to determine your
compliance with Minnesota Statues and rules governing lawful gambling activities. All of the information
that you supply on this form will become public information when received by the GCB.
. 4
LG220
Rev06J96
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OaytimePhone NQmberof Treasurer
)8l Fraternal
o Veterans
o Retiglous
o Other nonprofit
, . 1hebOx theUndicatestfie .Ivt\A",~ '^~ attached . thf8
yoUr~etIOn: ,-". "Ir "tn""'" to
oaRS lettetindlc:$ting:lt1cx1'rte tax exempt status.
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o CeftificaIe of good standing from the MlnneS01a Secretary of State'8 ofticeJ
SA chader ~ yottre.an aftiIl8te of a patent nonprotIt organiZation .j
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DProof pnwk)usly submill8d and on file wJtbthe Gambling Ccnttol Boanf
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Gamblinli'RremisealiJfOmiaflon
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Name of EstablIShment whete gat';t1bIin9 activltywHI be ~
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Street~~lLJ--
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$We Zip Code
'0 tl1?t ~e
Oate(s) of activity ( p'
the da~ of the dt'aWing)
II~~/CJ
Check the boX or boxes which indicate the type of gambling- actMty'yout organization will be conducting
o *8ingo 31 Raffles 0 *Paddlewheels 0 .PulJ..tabs CJ *Tlpboards
.Equi~for theseactiYities JJl_ be'~ ti'Qrn a ~_ ~s,trib.utor
__ ': ',;.. . .. ' < + _,'..--'':'., :e..,. ,. .._',""
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FbrBoard Use Omy
Date &. tni~als ofSpeeialist
, 8e sure the Local, Unito.fGovemmentand thEr CEO of your organization sign.
the reverse side of tNs:~. .
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[s this gambling premises located within city limits?D Yes D No
If Yes, write the name of the City:
City Name
If No, write the name of the County and the Township:
County Name Township Name
:heck the appropriate status of the Township: D organized D unorganized 0 unincorporated
.~" : ,""",."."': .., ,....",.,,...~.H. "''''''.'''''_'''h'~,,~_ ....:",~...." ,-.,.",,"......,.., 'I!'""",,_, ~ ......_ ,.......~.~.. ..-: ..., ....,..,...,., .. '.......,i.~..-.. .,,~~. ._-
1. The city must sign this application if the gambling
premises is within city limits. .
2. The county and township must sign this applica-
tion if the gambling premises is not within city limits.
3. DO NOT submit this application to the Gambling Control
Board if it is denied by the local unit of government.
4. NOTE: A Township may not deny an application.
Upon submission of this application to the Gambling Control Board, the exemption will be issued not
more than 30 days (60 days for cities of the 1st class) from the date the local unit of govemment
signed the application, provided the application is complete and all necessary information has been
received, unless the local unit of government passes a resolution to specifically prohibit the activity. A
copy of that resolution must be received by the Gambling Control Board within 30 days of the date
filled in below. Cities of the first class have 60 days in which to disallow the activity.
City or County Acknowledgment of Receipt of
Application
Signature of person receiving application
JUBLIC SAFETY DIRECTOR
3COTT HARR
Date Received: 9/29/97
Title o~on recei' pplication
-1<', / ~--_____
Oath of Chief Executive Officer
a this application and all information is true, accurate and complete.
Township Acknowledgment of Awareness of
Application
Signature of person acknowledging application
Date Signed:
Title of person acknowledging application
~
Date: "1-26 -9
Submit the application at least 45 days prior to your scheduled date of activity.
Be sure to attach the $25 application fee and a copy of your proof of nonprofit status.
Mail the complete application and attachments to:
Gambling Control Board
1711 W. County Rd B Suite 300S
Roseville, MN 55113
This publication will be made available in alternative format (i.e. large print, braille) upon request.
Questions on this.form .$hould-be directed to. the Licensing Section of the. Gambling Control Board at
(612)639-4000.
Hearing impaired individuals using a TDD may call the Minnesota Relay Service at 1-800-627-3529 in the
Greater Minnesota Area or 297-5353 in the Metro Area.
The information requested on this form will be used by the Gambling Control Board (GCB) to determine your
compliance with Minnesota Statues and rules governing lawful gambling activities. All of the information
that you supply on this form will become public information when received by the GCB.