HomeMy WebLinkAbout10-01-06 RESOLUTION 10 -01 -06
CITY OF OAK PARK HEIGHTS
WASHINGTON COUNTY, MINNESOTA
RESOLUTION GRANTING THE APPLICATION OF
DUCKS UNLIMITED — ST. CROIX VALLEY CHAPTER
TO CONDUCT A ONE -DAY RAFFLE AT
THE VFW POST 323 ON MAY 6, 2010
WHEREAS, Mike Dvorak, on behalf of Ducks Unlimited — St. Croix Valley
Chapter has applied with the State of Minnesota Gambling Control Board for a permit to
conduct a one -day raffle on May 6, 2010 at the site of VFW Post 323, 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 Chapter with the State of
Minnesota Gambling Control Board.
• NOW, THEREFORE, 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 Chapter with the State
of Minnesota Gambling Control Board to conduct a one -day raffle on May 6, 2010 at the
site of the VFW Post 323, 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 ""th day of January, 2010.
`avid Beaudet
T ST Mayor
Eric A Jo son
City Ad nistrator
•
Minnesota Lawful Gambling Page 1 of 2 7/09
Application fee
LG220 Application for Exempt Permit If aDDlication Dostmarked or received:
• An exempt permit may be issued to a nonprofit organization that: less than 30 days more than 30 days
- conducts lawful gambling on five or fewer days, and before the event before the event
- awards less than $50,000 in prizes during a calendar year. $100 $50
ORGANIZATION INFORMATION Check# $
°i- ganization name [ / Previous gambling permit number
r
Type of nonprofit organization. Check one.
Fraternal 0 Religious 0 Veterans k0ther nonprofit organization
Mailing address
r/ �J / / city / State Zip Code County
6? 0!/�d� / / ✓ 10, r
Name of chief executive officer (CEO) Daytime phone number Email address
14 ' )1/D12 /L /,,/2
Attach a copy of ONE of the following for proof of nonprofit status. Check one.
Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status.
1-01 Nonprofit Articles of Incorporation OR a current Certificate of Good Standing.
Don't have a copy? This certificate must be obtained each year from:
Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 Phone: 651 - 296 -2803
❑❑ IRS income tax exemption 1601(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 at 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:
a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and
b. the charter or letter from your parent organization recognizing your organization as a subordinate.
IRS - proof previously submitted to Gambling Control Board
If you previously submitted proof of nonprofit status from the IRS, no attachment is required.
GAMBLING PREMISES INFORMATION
Name of premises where gam 'ng activity will be conducted (for raffles, list the site where the drawing will take place)
Address (do not usetP � box) City Zip Code County
Sk�YU Axe
Date(s) of activity (for raffles, indicate the date of the drawing)
Check the box or bdxes thatfndicate the type of gambling activity your organization will conduct:
❑ Bingo* XRaffles ❑ Paddlewheels* ❑ Pull -Tabs* ❑ Tipboards*
* Gambling equipment for pull -tabs, bingo paper, tipboards, and
paddlewheels must be obtained from a distributor licensed by the I Also complete
Gambling Control Board. EXCEPTION: Bingo hard cards and bingo Page 2 of this form.
number selection devices may be borrowed from another organization
authorized to conduct bingo. I FIII-in & Print Form ,
To find a licensed distributor, go to www.gcb.state.mn.us and click on List I Reset Form
of Licensed Distributors, or call 651 - 639 -4076.
LG220 Application for Exempt Permit Page 2 of 2 7/09
LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT ,
If the gambling premises is within city limits, If gambling premises is located in a to ship, a
a city official must check the action that the city is coun official must check the action that the c my is taking
taking on this application and sign the application. on this plication and sign the application.
/ A towns h official is not required to sign a application.
The application is acknowledged with no waiting period. The appli lion is acknowledged wi no waiting period.
The application is acknowledged with a 30 day waiting The applica 'on is acknowledged a 30 day waiting
period, and allows the Board to issue a permit after 30 period, and ows the Board to ' sue a perm
o it after 30
days (60 days for a 1st class city). days.
The application is denied. The application denied. (�,
&/+ lr K tftit L,ft Print county name
Print city name (IC ��.� 1' On behalf of the county, ac wledge this application.
On behalf of the city, acknowledge this applicatio . Signature of county offid eceiving application
Signature of vi lication/�/ -
.'�/��0 �L Title / Date
- � I
�Q .}�� 1 (Optional) TO NSHIP: On beha of the township, I
Title I u' VI C It M Date 0 1 / 2 �0 / 10 ac organization is ap in
knowledge tha a g for exempted gambling
activity within t nship limits. [A townshi has no statutory authority
to approve or eny an application [Minnes a Statute 349.166)]
Print town ip name
i
Sign ure of township official acknowledging plication
Ti Date
CHIEF EXECUTIVE OFFICER'S SIGNATURE
• 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 retumedVo the kjArd NO ays of t e date of our gambling activity.
Chief executive officer's signature ��G %a Date
Complete a separate application for each gambing activity: Financial report and recordkeeping required
- one day of gambling activity, A financial report form and instructions will be sent with
- two or more consecutive days of gambling activity, your permit, or use the online fill-in form available at
- each day a raffle drawing is held www.gcb.state.mn.us. Within 30 days of the activity date,
Send application with: complete and return the financial report form to the
- a copy of your proof of nonprofit status, and Gambling Control Board.
- application fee for each event. Questions?
Make check payable to "State of Minnesota." Call the Licensing Section of the Gambling Control
To: Gambling Control Board Board at 651- 639 -4076.
1711 West County Road B, Suite 300 South
Roseville, MN 55113 Fill -in & Print Form I Reset Form I
Data privacy. This form will be made available the Board will be able to process your Board staff whose work requires access to the
in altemative format (i.e. large print, Braille) application. Your name and and your information; Minnesota's Department of Public
upon request The information requested on organization's name and address will be public Safety; Attomey General; Commissioners of
this form (and any attachments) will be used by information when received by the Board. Al Administration, Finance, and Revenue;
the Gambling Control Board (Board) to the other information you provide will be private Legislative Auditor, national and international
determine your qualifications to be involved in data until the Board issues your permit When gambling regulatory agencies; anyone pursuant
lawful gambling activities in Minnesota. You the Board issues your permit, all of the to court order, other individuals and agencies
have the right to refuse to supply the information Provided to the Board will become that are specifically authorized by state or
information requested; however, if you refuse to public. If the Board does not issue a Permit, 811 federal law to have access to the information;
supply this information, the Board may not be information provided remains private, with the individuals and agencies for which law or legal
able to determine your qualifications and, as a exception of your name and your organization's order authorizes a new use or sharing of
consequence, may refuse to issue you a permit name and address which will remain public. infornation after this Notice was given; and
If you supply the information requested, Prate data are available to: Board members, anyone with your consent