HomeMy WebLinkAbout18-02-11 RESOLUTION 18-02-11
CITY OF OAK PARK HEIGHTS
WASHINGTON COUNTY, MINNESOTA
RESOLUTION GRANTING THE APPLICATION OF
DUCKS UNLIMITED ST CROIX VALLEY
TO CONDUCT A ONE-DAY RAFFLE AT
HIEGHTS HALL & CLUB ON MAY 3,2018
"WHEREAS, Mike Dvorak, on behalf of Ducks Unlimited St. Croix Valley, has
applied with the State of Minnesota Gambling Control Board for a permit to conduct a
one-day raffle on May 3, 2018 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 Ducks Unlimited St. Croix Valley with the State of Minnesota
Gambling Control Board.
NOW, THEIZEFORE, BE IT RESOLVED BY THE CITY COUNCIL FOR
THE CITY OF OAK PARK HEIGHTS AS FOLLOWS:
That the application of Ducks Unlimited St. Croix Valley with the State of
Minnesota Gambling Control Board to conduct a one-day raffle on May 3, 2018 at the
site of Heights Hall & Club, 5880 Omaha Avenue North, within the City of Oak Park
Heights is hereby approved with no waiting period.
Passed by the City Council of Oak Park Heights this 27`h day of February, 2018.
Maiy cCom(ber
ATTEST/J- / Ma or
Eric A. Jo on
City Ad istrator
MINNESOTA LAWFUL GAMBLING 11/17
LG220 Application for Exempt Permit Page 1 of z
An exempt permit may be issued to a nonprofit Application Fee (non-refundable)
organizationlaw
conducts lawApplications are processed in the order received. If the application
lawful gambling on five or fewer days, and is postmarked or received 30 days or more before the event, the
awards less than $50,00{} in prizes during a calendar
year. application fee is $100; otherwise the fee is $150.
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-',\ Previous Gamblin
Name: f �czfLj (^' .^d �[� '�7-C�.�r /',� ��r Permit Number: lt202' -`7-b/l
Minnesota Tax ID Federal Employer ID
Number, if any: � Number (FEIN), if any:
Mailing Address: y o
City: GZ State: Jyl/`� Zip:S—J County: �
Name of Chief Executive Officer (CEO):
CEO Daytime Phone:/3- 7oJ nj G CEO Erna il: -7
(permit will be emailed to this email address unless otherwise indicated below)
Email permit to (if other than the CEO):
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 6.51-296-2803, 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 both 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): ,1�lT ,,,/ � c/, _
Physical Address (do not use P.O, box):
Check one://��
City: 0244 Rha zf"r Count r _
Township: Zip: County:
Date(s) of activity (for raffles, f
indicate the date of the drawing): l0A � 3 /
Check each type of gambling activity that your organization will conduct:
Bingo ED Paddlewheels 0 Pull-Tabs 0 Tipboards
Raffle (total value of raffle prizes awarded for the calendar year, including this raffle. $_��-
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 the List of Licensees tab, or call 651-539-1900.
11/17
LG220 Application for Exempt Permit Page 2of2
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
n The application is acknowledged with no waiting period. he application is acknowledged with no waiting period.
The application is acknowledged with a 30-day waiting he 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.
QThe application is denied. ❑The application is denied.
Print City Name: f)hr -I—T Print County Name:
Signatur of Cityerso � Signature of County Personnel:
r
Title: Date: 2- Z I 'Z-1 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 wi hfn �da f the event date.
Chief Executive Officer's Signature: Date: 2
�Slgih !Se 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