HomeMy WebLinkAbout17-02-09 RESOLUTION 17-02-09
CITY OF OAK PARK HEIGHTS
WASHINGTON COUNTY, MINNESOTA
RESOLUTION GRANTING THE APPLICATION OF
MN DEER HUNTERS ASSOCIATION, ST. CROIX CHAPTER,
TO CONDUCT A ONE-DAY RAFFLE AT
HIEGHTS HALL & CLUB ON APRIL 8, 2017
WHEREAS, James McArdle, on behalf of MN Deer Hunters Association, St.
Croix Chapter, has applied with the State of Minnesota Gambling Control Board for a
permit to conduct a one-day raffle on April 8, 2017 at the site of Heights Hall & Club,
5880 Omaha Avenue North; and
WHEREAS, the City of Oak Park Heights has reviewed the application and finds
that its purposes meet the necessary community standards; and
WHEREAS, the City of Oak Park Heights has solicited the input of the public
and there have been no objections to the granting of the application for the raffle permit
as applied for by MN Deer Hunters Association, St. Croix Chapter, with the State of
Minnesota Gambling Control Board.
n NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL FOR
THE CITY OF OAK PARK HEIGHTS AS FOLLOWS:
That the application of MN Deer Hunters Association, St. Croix Chapter, with the
State of Minnesota Gambling Control Board to conduct a one-day raffle on April 8, 2017
at the site of Heights Hall & Club, 5880 Omaha Avenue North, within the City of Oak
Park Heights and the same are hereby approved with no waiting period.
Passed by the City Council of Oak Park Heights this 28th day of February, 2017.
M Y/IcColnber
TES Mayor
Eric . ohnson
City ministrator
MINNESOTA LAWFUL GAMBLING 12/16
LG220 Application for Exempt Permit Page 1 of 2
An exempt permit may be issued to a nonprofit Application Fee (non-refundable)
organization that: Applications are processed in the order received. If the application
conducts lawful gambling on five or fewer days,and is postmarked or received 30 days or more before the event,the
awards less than$50,000 in prizes during a calendar application fee is$100; otherwise the fee is$150.
year.
If total raffle prize value for the calendar year will be Due to the high volume of exempt applications, payment of
$1,500 or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite
your county by calling 651-539-1900. service, nor are telephone requests for expedited service accepted.
ORGANIZATION INFORMATION
Organization /� l Previous Gambling
Name: CLIA/ astd- n4ea Asioc .91. Clift rcd Permit Number:
Minnesota Tax ID Federal Employer ID
Number,If any: Number(FEIN), If any:
Address: "2 11 ludd Trat C,
City: <'?///tA/,4 TQ1- _State:_ mAJ Zip: �508 County:
Name of Chief Executive Officer(CEO): :1+4/pi c-S ,(
Daytime Phone: Cr!/oZ- 901 --J aq Email: Irv► Y' 4
NONPROFIT STATUS
Type of Nonprofit Organization(check one):
= Fraternal = Religious Veterans Other Nonprofit Organization
Attach a copy of one of the following showing proof of nonprofit status:
(DO NOT attach a sales tax exempt status or federal employer ID number, as they are not proof of nonprofit status.)
A current calendar year Certificate of Good Standing
Don't have a copy? Obtain this certificate from:
MN Secretary of State, Business Services Division Secretary of State website,phone numbers:
60 Empire Drive,Suite 100 www.sos.state.mn.us
St. Paul, MN 55103 651-296-2803,or toll free 1-877-551-6767
IRS income tax exemption(501(c))letter in your organization's name
Don't have a copy? To obtain a copy of your federal income tax exempt letter,have an organization officer contact the
IRS toll free at 1-877-829-5500.
= IRS-Affiliate of national,statewide,or international parent nonprofit organization (charter)
If your organization falls under a parent organization,attach copies of h2th of the following:
1. IRS letter showing your parent organization is a nonprofit 501(c)organization with a group ruling,and
2. the charter or letter from your parent organization recognizing your organization as a subordinate.
GAMBLING PREMISES INFORMATION
Name of premises where the gambling event will be conducted
(for raffles, list the site where the drawing will take place):
Address(do not use P.O. box): �O O l f m CJ1& �yeee Al.- /
City or
Township: // [ 5S®gv? 014S/l/a 6—10A)
STl// .[�G,7't!i/` _ Zip: County:
Date(s)of activity(for raffles,
indicate the date of the drawing): ! f
Check each type of gambling activity that your organization will conduct:
=Bingo =Paddiewheeis =Pull-Tabs =Tipboards cro
rRaff9e (total value of raffle prizes awarded for the calendar year,including this raffle: $ 1
Gambling equipment for bingo paper, bingo boards,raffle boards, paddlewheels,pull-tabs,and tipboards must be obtained
from a distributor licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo ball selection
devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor,go to
www.mn.gov/gcb and click on Distributors under List of Llc+ensaw,or call 651-539-1900.
LG220 Application for Exempt Permit Page 212/16
2of 2
LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT (required before submitting application to
the Minnesota Gambling Control Board)
CITY APPROVAL COUNTY APPROVAL
for a gambling premises for a gambling premises
located within city limits located in a township
®The application is acknowledged with no waiting period. QT'he application is acknowledged with no waiting period.
=The application is acknowledged with a 30-day waiting a application is acknowledged with a 30-day waiting
period, and allows the Board to issue a permit after 30 days period,and allows the Board to issue a permit after
(60 days for a 1st class city). 30 days.
The application is denied. =IThe application is denied.
Print City Name: k r -�-Ee.(�� Print County Name:
Signature of City a Anel• Signature of County Personnel:
Title: b+z4 UaLK Date:3 I '�1-7 Title: Date:
TOWNSHIP(if required by the county)
On behalf of the township, I acknowledge that the organization
is applying for exempted gambling activity within the township
The city or county must sign before limits. (A township has no statutory authority to approve or
submitting application to the deny an application, per Minn. Statutes, section 349.213.)
Gambling Control Board. Print Township Name:
Signature of Township Officer:
Title: Date:
CHIEF EXECUTIVE OFFICER'S SIGNATURE (required)
The information provided In this application is complete and accurate to the best of my knowledge. I acknowledge that the financial
report will be completed and returned to the Board within 30 days of the event date. �7
Chief Executive Officer's Signature: Date: /2,aa�
(Sig re must be CEO's signature;designee may not sign)
Print Name:
REQUIREMENTS MAIL APPLICATION AND ATTACHMENTS
Complete a separate application for: Mail application with:
• all gambling conducted on two or more consecutive days,or a copy of your proof of nonprofit status,and
• all gambling conducted on one day.
application fee(non-refundable). If the application is
Only one application is required if one or more raffle drawings are postmarked or received 30 days or more before the event,
conducted on the same day. the application fee is$100; otherwise the fee is$150.
Financial report to be completed within 30 days after the Make check payable to State of Minnesota.
gambling activity is done: To: Minnesota Gambling Control Board
A financial report form will be mailed with your permit.Complete 1711 West County Road B,Suite 300 South
and return the financial report form to the Gambling Control Roseville,MN 55113
Board.
Questions?
Your organization must keep all exempt records and reports for Call the Licensing Section of the Gambling Control Board at
3-1/2 years (Minn. Statutes, section 349.166, subd. 2(f)). 651-539-1900.
Data privacy notice: The information requested application. Your organization's name and ment of Public Safety;Attorney General;
on this form(and any attachments)will be used address will be public information when received Commissioners of Administration,Minnesota
by the Gambling Control Board(Board)to by the Board. All other information provided will Management&Budget,and Revenue;legislative
determine your organization's qualifications to be private data about your organization until the Auditor,national and international gambling
be involved in lawful gambling activities in Board issues the permit. When the Board issues regulatory agencies;anyone pursuant to court
Minnesota. Your organization has the right to the permit,all information provided will become order; other individuals and agencies specifically
refuse to supply the information;however, if public. If the Board does not issue a permit,all authorized by state or federal law to have access
your organization refuses to supply this information provided remains private,with the to the information; individuals and agencies for
information,the Board may not be able to exception of your organization's name and which law or legal order authorizes a new use or
determine your organization's qualifications and, address which will remain public. Private data sharing of information after this notice was
as a consequence,may refuse to issue a permit. about your organization are available to Board given;and anyone with your written consent.
If your organization supplies the information members, Board staff whose work requires
requested,the Board will be able to process the access to the information; Minnesota's Depart-
This form will be made available in alternative format(i.e.large print,braille)upon request.
An equal opportunity employer
ttttettt�t tcevt�tiutr Service rIMen I of the Treasury
Itrgon�t M,d-esi negion ntt, :,n ►r• i to A
CUn1nu55►oner Y 0 Y PUCN;:1,•(:w;►on
,d)f) Vedclat O►nlding
316 N.ltobr►i St.,St.Paul,Mann.55 lot
Peo-o►i to contact:
Minnesota Deer Hunters Association J. H. Butorac
460 Peterson Rd Tefcl,l►one Number.
Grand Rapids Minnesota 55744 612-725-7487
It Av# 110ply to:
AN STP - JHB:em
n;ilr
Employer Identification Number: 41-1390958
Accounting Period Ending: June 30
Form 990 Required: IXi Yes 1_1 No
Dear Applicant:
Based on information supplied, and assuming your operations will be as stated in
your application for recognition-of exemption, we have determined you are exempt
from Federal- income tax under Lection 501(c)(3) of the Internal kevenue Code.
we have further determined that you,a re not a private foundation within the mean
ing of section 509(x) of the Code, becW6se you are an organization described in
section 509(x)(2);
If your sources of support, or your purposes, character, or method of operation
change. -Please let us know so we can consider the effect of the change on your
exempt.status and foundation status. Also, you should. inform us of all changes
In your name or address.
loo� Generally, you are not liable for social security(FICA) -taxes unless you file a
,waIver of exemption certificate as provided in the Federal Insurance Contribu-
tions Act. If you have paid FICA taxes without filing the waiver. you should
contact us. You are*not 1-fable for the tax imposed under the Federal Unemploy-
ment Tax Act (FUTA).
Since you are not a private foundation, you are not subject to the excise taxes
under Chapter 42 of the Code. However, you are not automatically exempt from
other Federal excise taxes. If you have any questions about excise, employment,
or other Federal taxes, please let us know.
Donors may deduct contributions to you as -provided in section 170 of the Code.
Bequests, legacies, devises, transfers, or gifts to you or for your use are
deductible for Federal estate and gift tax purposes if they meet the appli-
cable provisions of section 2055, 2106. and 2522 of the Code.
The box checked in the heading of this letter shows whether you must file
Form 990, Return of Organization Exempt from Income tax. If Yes is checked,
.You are required to file Form 990 only if your gross receipts each year are
normally more than $10,000. If a return is required, it must be filed by the
ISth day of the fifth month after the end of your annual accounting period.
The law imposes a penalty of $10 a day, up to a maximum of $5.000, when a re-
turn is filed late, unless there is reasonable cause for the delay.
-2-
you are not required tof� deral business �
t1"ncc�me undertax returns
sectionunless
sllyou
ofare
the
subject to the tax on unrlated
Code- If you are subject to this tax, you must file an income tax return
on Form 490-T• In this letter. we unrelatedre not etraderlorgbusiness aswhether ydefrof nedr
present or proposed activities a
in section 513 'of the Code.
You need an employer identification number even if you have no employees .
If an employer identification youandyou rrpllebeered on advisedyofritpplpieasen use
a number will be assigned to y
that number on all returns you file and in all correspondence with the In-
ternal Revenue Service.
Because this letter could hshouldskeep any
yin yourons about permanentyour recordsmpt status
and foundation status, you
If you have any questions, please contact the person whose name and telephone
number are shown in the heading of this letter.
Sincerely yours.
/-5aii-es R. t�e1ls
f,llpE�eals Office
Photocopy of letter to:
David R. Busch