1h Chan Lions Pull Tabs-4th of July
C ITV OF
CHANHASSEN
iA
-
690 COULTER DRIVE. P.O. BOX 147. CHANHASSEN, MINNESOTA 55317
(612) 937-1900 . FAX (612) 937-5739
DATE:
May 20, 1997
1\\
Action by City AdminiS!rat"r
Endorsed vi ~A-
Modified~
Rejected
Date 'J - 'Z I-q l
Date Submitted to Commissiolf
MEMORANDUM
TO:
Don Ashworth, City Manager
....-
Date Sub;r.itted 10 Council
FROM:
Jerry Ruegemer, Recreation Supervisor
5.~. "!#I'Mf":t~
I r
SUBJ:
Chanhassen Lions Club Selling Pull Tabs at
the 4th of July Celebration
The Chanhassen Lions Club would like the opportunity to sell pull tabs on Thursday, July
3 at Chanhassen's Annual 4th of July Celebration. .
The Lions need a resolution from the City Council allowing them to conduct this one-day
off-site gambling at the celebration. This is required by the Minnesota Gambling Control
Board.
Recommendation:
Approval of a one-day off-site gambling permit for the Chanhassen Lions Club on
Thursday, July 3 at Chanhassen's Annual 4th of July celebration is recommended.
g:\park\4Ih\PullTabRequest
or Board Use onl
LG230
09120195
Minnesota Gambling Control Board
Application for Authorization to Conduct
One-Day Off-Site Gambling
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O~f!~~~~~,~~~
Organization Name
(hA;vjA5~~,v l/tJ?1S ('~/;
Class of Organization License
Base License Number
License Expiration Date
B '#03q~Cj-DO~
. Chief &ec~~ni~erYCF9) '~formatio~
$/J; /99
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"'!: :;~kj\jm~,:h;:i: U ',;,.,
Name of Chief Executive Officer (Cannot Be Gambling Manager)
Daytime Phone Number
P 4/l/{ Z/t;C/CSfl tJ
G'1i\ 'b'/'" ,>t p;:\'::::'::':;""'''\;::',;i'~:, "'/ &. 't.
am Ing,r r:~m,!$es nlorma,lon
. ,1,'- ",i.::!;,:ji:,i-j;';:]
,:,:;"," "'",,;;
(6;J-) 93.P- 9(/ ~.s/
Name of Establishment where gambling activity will be conducted
Cii';4 L,i.-"ier PCI rl\ '710 LC)U ITer lJrh!c i
Street Address City
c h t'7t1 ^ c155Cf\! jY) rv :S".5>- 3/
.'
Does your organization own the gambling premises? DYes I){I No
If no, a lease agreement must be submitted with this application. (See instructions)
Activity Dat~
.3
Date of One-Day OfT-Site Activity '1 / II / 97
The gambling activity conducted on this day may not exceed 12 hours
Type of Gambling Activity
Check the box or boxes which indicate the type of gambling activity your organization will be conducting
for this one-day off-site activity.
o Bingo
D Raffles ~'<..l Paddlewheels [8;l Pull-tabs D Tipboards
Local Unit of Government Jurisdiction
Is this gambling premise~'located withi~'city limits? ~ Yes D No
If yes, write the name of the city:
City Name (!,hA-~h ^~<;etJ
lfno, write the name of the county and the township:
County Name Township Name
Check the appropriate status of the township: D organized Dunorganized Dunincorporated
Local Unit q~ qs~vernment Acknowledgment
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. The local unit of government (city or county) that
signs this premises permit application must pass a
resolution specifically approving or denying this
application.
City or County Acknowledgment of Receipt of
Application
Signature oflZ.erson receiving application
1~() tiUL~~
Date Received
.s--Itv. - q 7
Title of person receiving application
Recrt'<lti"^" ~ i-tpCrVijL'f
Oath of Chief Executive Officer
I have read this application and all information is true, accurate and complete.
Signature of Chief Executive Officer: Date:
4. A copy of the local unit of government's resolution
approving this application must be attached to this
application.
5. DO NOT submit this application to the Gambling
Control Board if it is denied by the local unit of govern-
ment.
6. NOTE: A to\mship has no authority to deny an appli-
cation
Township Acknowledgment of Awareness of
Application
Signature of person acknowledging application
Date Signed
Title of person acknowledging application
Submit the application at least 30 days prior to your scheduled date of activity
and attach the resolution of approval from the local unit of government.
For gambling activity other than raffles, attach a copy of the lease agreement.
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 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.
LG130L
By agreeing to the tennS of this lease, it is mutually agreed that:
This lease is the total and only agreement between the lessor and the organization
conducting lawful gambling activities. There Is no other agreement and no other
consideration required between the parties as to the lawful gambling and other matters
related to this lease.
Date
Signature or Organization OfrlCial Oessee)
Date
AV~'-- 5-[0-1 7
S-/rJ f
::Sel'T <8 f? L{ e 3 ~ /'Vl er
Print name and title or person signing on behalf or your
organization
(t.kd' ~; e'l iL Q -h li"~ Ii1A': ~~ ell
Print name or person signing as Lessor
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 Ween sing Section of the Gambling Control
Board at (612)639-4000.
Hearing impaired individuals using a TOO may call the Minnesota Relay Service at
1-8()().627-3529In 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 GeB.