Agenda - Council - 11/13/2018 - Laserfiche WebLink

Home

MINNESOTA LAWFUL GAMBLING LG214 Premises Permit Application REQUIRED ATTACHMENTS TO LG214 1. If the premises is leased, attach a copy of your lease. Use LG215 Lease for Lawful Gambling Activity. 2. $150 annual premises permit fee, for each permit (non-refundable). Make check payable to "State of Minnesota." ORGANIZATION INFORMATION Organization Name: Chief Executive Officer (CEO) Gambling Manager: GAMBLING PREMISES INFORMATION Current name of site where gambling will be conducted: List any previous names for this location: Street address where premises is located: _ e (Do not use a P.O. box number or mailing address.) City: 6/15 Page 1 of 2 Annual Fee $150 (NON-REFUNDABLE) Mail the application and required attachments to: Minnesota Gambling Control Board 1711 West County Road B, Suite 300 South Roseville, MN 55113 Questions? Call 651-539-1900 and ask for Licensing. OR Township: Does your organization own the building where the gambling will be conducted? Yes License Number: Daytime Phone: Daytime Phone: No If no, attach LG215 Lease for Lawful Gambling Activity. A lease is not required if only a raffle will be conducted. Is any other organization conducting gambling at this site? Yes Zip Code: Don't know Note: Bar bingo can only be conducted at a site where another form of lawful gambling is being conducted by the applying organi- zation or another permitted organization. Electronic games can only be conducted at a site where. paper pull -tabs are played. Has your organization previously conducted gambling at this site? Yes No GAMBLING BANK ACCOUNT INFORMATION; MUST BE IN MINNESOTA Bank Name: Bank Street Address: Bank Account Number: City: /4 d%;d. ALL TEMPORARY AND PERMANENT OFF -SITE STORAGE SPACES Address (Do not use a P.O. box number): City: Don't know State: MN Zip Code: State: Zip Code: MN MN MN