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<br />· '\ Submit one check for all renewal fees, payable to State of Minnesota
<br />
<br />Organization requirements: Current license term: 3/1/2006 to 2/29/2008
<br />1. An annual organization, license fee of $350 is required. Renewing license term: 3/1/2008 to 2/28/2010
<br />
<br />Authorization #: 2926 ,
<br />Organization: Anoka Ice Arena Assoc
<br />4111 7th Ave N, Anoka, MN 55303
<br />CEO: Dave Johnson
<br />1614 River Pointe Ct, Anoka, MN 55303
<br />
<br />Treasurer: ,John Lichter
<br />15665 Juniper Ridge Dr, Ramsey, MN 55303
<br />(763)427-16~4
<br />
<br />Gambling Manager Requirements:
<br />1. An annual gambling manager license fee of $100 is required.
<br />
<br />bl" A h " " 6 003 Current License Term: 3/1/2006 to 2/29/2008
<br />Gam mg Manager ut Orlzatlon: GM-0292 - Renewing license term: 3/1/2008 to 2/28/2010
<br />
<br />Rick Sterling Wesp [jj' The individual listed is not renewing their Iice'!se. We have endosed a LG212
<br />855 Jefferson St, Anoka, MN 55303 application for the new applicant '
<br />( )9 805 ,Note: The gambling manager duties may not be assumed by an
<br />763 13-8 Bond: # 5195474 . " individual until they are licensed by the Minnesota
<br />, Company: United Fire & Casualty Gambling Control Board.
<br />
<br />Gambling Manager Affidavit and Consent Statement
<br />
<br />(763)427-8163
<br />County: Anoka
<br />
<br />r------l
<br />~ Check this box If your
<br />lorganlzatlon qualifies for I
<br />I the waiver of the $350 I
<br />I organization license fee I
<br />defined in MN Statute
<br />L _ 349.16 SubcU _ J
<br />
<br />(763)753-2737
<br />
<br />Annual Goal for
<br />Charitable
<br />Contributions ,5
<br />
<br />0/0
<br />
<br />1. I have never been convicted of a felony or a crime
<br />involving gambling.
<br />2. I have never committed a violation of law or Board rule
<br />that resulted in the revocation of a license issued by the '
<br />Board within five years before the date of the license
<br />application.
<br />3. I have never been convicted of a criminal violation
<br />involving fraud, theft, tax evasion, misrepresentation, or
<br />g?lmbling.
<br />4. I have never been convicted of (i) assault, (ii) a criminal
<br />violati(;m involving the use of afirearm,or (Hi) making
<br />terroristi,c threats. '
<br />5. I have never been, or am I now, connected with or
<br />engaged in an illegal business.
<br />6. I have never had a sales and use tax permit revoked by
<br />the commissioner of revenue within the, past two years.
<br />7. I have never, after demand, failed to file tax returns
<br />required by the commissioner of revenue.
<br />8. I do not owe $500 or more in delinquent taxes as defined
<br />in section 270.72.
<br />9. I have been an active member of the organization for at
<br />least two years at the time of our organization's initial license
<br />application, or have been an active member for at least the
<br />most recent six months prior to the effective date of our
<br />organization's license renewal. '
<br />10. I am not a gambling manager or an assistant gambling
<br />manager. for another organization.
<br />11. I am not a lessor, 'a member of the lessor's immediate
<br />family or a person residing in the same household as the
<br />lessor, or an employee of a lessor of a premises where this
<br />organization has a permit issued from the Board to conduct
<br />lawful gambling.
<br />
<br />-82-
<br />
<br />12. I am not involved directly or indirectly as a bingo hall owner,
<br />,manufacturer. or distributor.
<br />13. I am not the chief executive officer of this organization.
<br />14. I am not the treasurer of this organization.
<br />15. I was not an officer of an Qrganizationat a time when an
<br />. offense occurred which caused that organization's license to be
<br />revoked.
<br />. Background Check. By signature of this document, the
<br />undersigned authorizes the Departments of Public Safety and ,
<br />Revenue to conduct a criminal and tax background check or review
<br />and to share the results with the Gambling Control Board. Further,
<br />I understand, agree, and hereby irrevocably consent that suits and
<br />actions relating.to the subject matter of this gambling manager
<br />license application, or acts or omissions arising from such
<br />application, may be commenced against me or my organization and
<br />I will accept the service of process in any court of competent
<br />jurisdiction in Minnesota by service on the Minnesota Secretary of
<br />State of any summons, process, or pleading authorized by the laws
<br />of Minnesota.
<br />Failure to provide required information or providing false or
<br />misleading information may result in the denial or revocation of the
<br />license. .
<br />Changes in the information submitted in this application will be
<br />submitted in writing no later than 10 days after the change has
<br />taken, effect. '
<br />
<br />I have read this application and declare that all information
<br />submitted is true~,ccurate, and complete.,
<br />, ~~;,. k/~---
<br />
<br />Signature, in ink, of gambling manager applicant
<br />
<br />Date: I~ I~~
<br />
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