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HomeMy WebLinkAbout2017-214 (Premises Permit for Gambling Eagles 94) RESOLUTION 2017-214 APPROVING MINNESOTA PREMISES PERMIT FOR LAWFUL GAMBLING FOR EAGLES 94, LOCATED AT 14200 60TH ST. N., STILLWATER,MINNESOTA WHEREAS, the Eagles 94 have submitted an application to the City of Stillwater requesting City approval of a Minnesota Gambling Premises Permit application located at Eagles 94, located at 14200 60th St. N., Stillwater, MN; and WHEREAS, it has been demonstrated that the organization is collecting gambling monies for lawful purposes. NOW THEREFORE, BE IT RESOLVED that the City of Stillwater approve the local gambling located at Eagles 94, 14200 60th St. N., Stillwater, MN. The City Clerk is directed to attach a certified copy of this resolution to the application to be submitted to the Gambling Control Board. Adopted by the City Council for the City of Stillwater this 7th day of November, 2017. Z-•242' > . Ted Kozlowski, Mayor ATTEST: 41 2, (Pmktad McCarty,Acting ty Clerk . MINNESOTA LAWFUL GAMBLING 6/15 Page 1 of 2 LG214 Premises Permit Application Annual Fee $150 (NON-REFUNDABLE REQUIRED ATTACHMENTS TO LG214 1. If the premises is leased,attach a copy of your lease. Use LG215 Mail the application and required attachments to: Lease for Lawful Gambling Activity. Minnesota Gambling Control Board 2. $150 annual premises permit fee,for each permit(non-refundable). 1711 West County Road B,Suite 300 South Make check payable to"State of Minnesota." Roseville, MN 55113 Questions? Call 651-539-1900 and ask for Licensing. ORGANIZATION INFORMATION Organization Name: Cr 49 f e-5 7I License Number: 400, 6-9-®a Chief Executive Officer(CEO) Bob Zia ' c I Daytime Phone: .[ I.: -39t. '`62.70 Gambling Manager: i -i►n-e_ CAM ll Daytime Phone: "7iS-&AD' `S3 GAMBLING PREMISES INFORMATION ` Current name of site where gambling will be conducted: 1E4AJ to S CI 4-1 List any previous names for this location: Street address where premises is located: I LI 245 O _ 6 04''a-= Mo • (Do not use a P.O.box number or mailing address.) City: . OR Township: County: Zip Code: Ci Does your organization own the building where the gambling will be conducted? SijYes n 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? Dyes %No ElDon'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? fYes No (Don't know GAMBLING BANK ACCOUNT INFORMATION; MUST BE IN MINNESOTA Bank Name: Bank Account Number: Bank Street Address: City: State: MN Zip Code: ALL TEMPORARY AND PERMANENT OFF-SITE STORAGE SPACES Address (Do not use a P.O. box number): City: State: Zip Code: MN MN MN p LG214 Premises Permit Application 6/15 Page 2 of 2 ACKNOWLEDGMENT BY LOCAL UNIT OF GOVERNMENT: APPROVAL BY RESOLUTION CITY APPROVAL COUNTY APPROVAL for a gambling premises for a gambling premises located within city limits located in a township City Name: 6'h ''L County Name: Date Approved by City©C Crro�uncil: Verrtrly!/�vr1 Date Approved by County Board: Resolution Number: ?bi—/ ' c 1 4--/' 1 Resolution Number: (If none,attach meeting minutes.) (If none,attach meeting minutes.) Signature of City Personnel: Signature of County Personnel: 9, ..c714. A,46w1Title: e d 4011.&)i SMSate Signed: /17 ac917 Title: Date Signed: TOWNSHIP NAME: Complete below only if required by the county. Local unit of government On behalf of the township,I acknowledge that the organization is must sign. applying to conduct gambling activity within the township limits. (A township has no statutory authority to approve or deny an application, per Minnesota Statutes 349.213,Subd. 2.) Print Township Name: Signature of Township Officer: Title: Date Signed: ACKNOWLEDGMENT AND OATH 1. I hereby consent that local law enforcement officers, 6. I assume full responsibility for the fair and lawful operation of the Board or its agents, and the commissioners of all activities to be conducted. revenue or public safety and their agents may enter and inspect the premises. 7. I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the Board and agree, if licensed, 2. The Board and its agents, and the commissioners of to abide by those laws and rules, including amendments to revenue and public safety and their agents, are them. authorized to inspect the bank records of the gambling account whenever necessary to fulfill requirements of 8. Any changes in application information will be submitted to the current gambling rules and law. Board no later than ten days after the change has taken effect. 3. I have read this application and all information submitted to the Board is true,accurate,and complete. 9. I understand that failure to provide required information or providing false or misleading information may result in the 4. All required information has been fully disclosed. denial or revocation of the license. 5. I am the chief executive officer of the organization. 10. I understand the fee is non-refundable regardless of license approval/denial. Signature of Chief Executive Officer(designee may not sign) Date Data privacy notice:The information requested on this information when received by the Board. Minnesota's Department of Public Safety, form(and any attachments)will be used by the All other information provided will be Attorney General,Commissioners of Gambling Control Board(Board)to determine your private data about your organization until Administration,Minnesota Management& organization's qualifications to be involved in lawful the Board issues the permit. When the Budget,and Revenue; Legislative Auditor, gambling activities in Minnesota.Your organization has Board issues the permit,all information national and international gambling the right to refuse to supply the information; however, provided will become public. If the Board regulatory agencies;anyone pursuant to if your organization refuses to supply this information, does not issue a permit,all information court order;other individuals and agencies the Board may not be able to determine your provided remains private,with the specifically authorized by state or federal law organization's qualifications and,as a consequence, exception of your organization's name and to have access to the information; individuals may refuse to issue a permit.If your organization address which will remain public. Private and agencies for which law or legal order supplies the information requested,the Board will be data about your organization are available authorizes a new use or sharing of able to process your organization's application. Your to: Board members,Board staff whose information after this notice was given;and organization's name and address will be public work requires access to the information; anyone with your written consent. This form will be made available in alternative format,i.e.large print,braille,upon request. An equal opportunity employer ot• Ater THE BIRTHPLACE OF MINNESOTA d STATE OF MINNESOTA ) ss COUNTY OF WASHINGTON ) I, J. Thomas McCarty, do hereby certify that the foregoing is a true and correct copy of a Resolution adopted by the City of Stillwater, at a meeting held, according to law, at Stillwater, Minnesota, on the 7th day of November, 2017, as the same appears on file and of record in the offices of the City. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the official seal of said City of Stillwater, this 7th day of November, 2017. -7)1024(44 Thomas McCarty, Acting ity Clerk CITY HALL: 216 NORTH FOURTH STREET • STILLWATER, MINNESOTA 55082 PHONE: 651-430-8800 • WEBSITE: www.ci.stillwater.mn.us