Agenda - Council - 02/11/2003 - Laserfiche WebLink

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-' '- ' ~ ;,~""~' ' .~. ~. ~. '~-- . ~ ~!. ~ ~ %, °, ·" .'... ~;'~41.· ~..~ ~ · ' - - ~., ~' % .! ~' ' o~.~.! >~-..!~,.~. ~.'-i,i',.'~J~-~.-:~ ~.-.. '~.-~/~.~!,~:~'~.~ ' MinneSota Lawful Gamblin ...~. Page 1 of 2 8/00 LG220 - Application for Exempt Permit e - $25 Organizatign Information, , Check No. Organization name ' isant~ Count~Chapter Pre,~ouslawful gambling exemption number Minnesota Deer Hunters...ASsociation /~- ~--F/~' ,- Q ~g~ ~ ~.O. /_.~ P'~ ~ City State/Zip Code County .... ~eD;- 3533, 3..~6th 5ane [,TE .Cambridge [v~' 55008 Isanti Name of chief executive officer (CEO) First name Last name Daytime phone number of CEO John Erlandson 763-689-4992 Name of treasurer DaYtime phone number of ..... First name Last name treasurer;. Joleen Kriesel 763~ Type of Nonprofit Organization Check the box that best describes your organization: [] Fraternal' [] Religious [] Veteran' [] Other nonprofit organi~zation Check the box that indicates the type of proof your organization attached to this application: [] iRS lett'er indicating income tax exempt status [] Certificate of Good Standing from the Minnesota Secretary Of State's Office [] A charier showing you are an affiliate of a parent nonprofit organization ~, Proof previously submitted and on file with the Gambling Control Board Gambling Premises Information .. Name of pramS'es where g.amb!ing ~ will be conduct~l (for raffles, [~t the sits where the drawing will 'take p~ce) Address (do not use PO box) City State/Zip Code I CountY 8404 161st Ave ~. Ramsay ~ 55303 ',l ~nok~.. Data(s) of activity (for raffles, indicate the da(e of the drawing) August 17, 2003 Check the box or boxes that ind'k~ate the b/pa of gambling activity your organization will 'be conducting: [] *Bingo [] Raffles ' [] *Paddlewheeis ~ J--~*Pulf-Tabs [] *TIpboards '*Equipment for these ~ must be oblained from a ~ce~sed distributor. I I I I I This form will. be made available in aJtemaflve format (i.e. large print, Braille) upon request. The lrn~rmation requested on this form (and any attachments) will be used by the Gambling Control Board (Board) to determine your qualirmati3ns to be bvotved In lawful gambling activities in brmnesota. You have tile ~ht to refuse to supply the Information requested; however, ~fyou refuse to suppty this imFormatbn, the Board may not be abla to determine your qualifications and, as a consequence, may re~ase to lssae you a permit, ffyou supply the Information requested; the Board will be able to proce~m your appr~etton. Your name and and. your organization's thefoliowing: name and address wil be public bf0rrnation Board who~e work assignment requires when recek, ed by the Board. All ~he other that they have access to the information; information that you provide wa be pdvate the Mhnesota Departme~tt of Pubic Safe,~, data about you un~ the BO~'m:I issues your the Minnesota Attorney General', the permit. When the Board issues your Minnesota Commissioners of permit, all of the information that you have AdmInistration, Finance, and Revenue; the provided to the Board in the process of' MlnnesotaLagistativeAud~r, na~onaland applying for your permit will become public, hternational gambling regulatory agencies; If the Board does not issue you a permit, anyone pursuant to court order;, other al the lnforma~n you have provtded ln the Individuals and agencies ~hat are process of applying for a permit remains specifically authorized by state-or federal pdvete, with the exception of your name. law to have access to the information; and your organization's name and address individuals and agencies for which law or which will remain public, legal order authorizes a new use or sharing Private data about you are available only to of Information after this Notice was given; and anyone with your consent. I I '1 I I -102-