Agenda - Council - 06/23/1987 - Laserfiche WebLink

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' Gambling License Application ;~.~ Type of Application: C1Class A ~'Class B I-IClass..C *. [-IClass D Page 2' .... ' ~,Yes []No 23. Is gambling premises located within city limits? ~Yes []No 24. ,Are all gambling activities conducted at the premises listed in # 19 of this application? If not, complete a separate application for each premises (except raffles) as a separate license is required for each premises. [~Yes ~,No 25. r-) Yes,~lo 26. I-] Yes ¢I~,N o 28. Does organization own the gambling premises? If no, attach copy of the lease with terms of at least one' year. .Doestheorganizationleasetheentirepremises?lfno, attachasketchof I 27. imountofMonthlyRent the premises indicating what portion is being leased. A lease and sketch is not required for Class D applications. ~ Do you plan on conducting bingo with this license? If yes, give days and times of bingo occasions: · Days~-.'A Times ~.Yes r-INo 29. Has the $10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained? Attach copy of bond. ' ~ c~,T'? '33. Address J34. City, State,Zip 32. ~ss~r Name 35. Ga~b~ing Mana~er Name ' . 36. Address , / ~ . ~ ~'37. City, State, Zip ~-~..~ . . :~ By my signature below, local law enforcement officers or agents of the Board are hereby authorized to enter upon the site, ' ' . ¢' ~ at an~ time, gambling is being conducted, to observe the gambling and to enforce the law for any unauthorized game or ' ' .~; : By my signature below, the Board is hereby authorized, to inspect the bank records of th~ General Gambling Bank Account :-: 2~wh~never necessary to lq!fill requirements of current~ambling rules and?w. : -,.:~ .:..L ..,=~ ...... ~ ..... '.~: I hereby declar~ that: 1. I have read this application and all information submitted to the Board; " ":" . 2. All information submitted is true, accurate and complete; 3. All other required information has been fully disclosed ' 4. t am the chief executive officer of the organization; -' · 5. I assume full responsibility for the fair and lawful operation of all activities to be conducted; ' ' . 6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, .. if licensed, to abide by those laws and rules, including amendments thereto. -~ 40. Official, ~egal Name of Organization J 41. Signature (must be signed by Chief Executive Officer) A~KNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING 'BODY ' · I hereby acknowledge receipt of a copy of this application. By acknowledging receipt, I admit having been served wi~h notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, will become effective 30 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30 days of the below noted date... 42. Name of City or County (Local Governing Body) r .,r ..-,.' _ ,~ '7' Signatur. e'~)f person receiving application ~tle ~ate received {30 dag period . ~e~ins from this datel /~,- ,',, ,~.,.-.~.-r/~ / '~ ~- 7 44. Name of Person delivering application to Local Governing B~y cG-0001-02 (8/86) White Copy-Board If site is located within a township, item 43 must be corn ~leted, in ' addition to the county signature. 43. Name of Township Signature of person receiving application X Title ~ Canary-Applicant Pink-Local Governing Body