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HomeMy WebLinkAbout12-04-20 RESOLUTION 12 -04 -20 • CITY OF OAK PARK HEIGHTS WASHINGTON COUNTY, MINNESOTA RESOLUTION GRANTING THE APPLICATION OF AMERICAN CANCER SOCIETY TO CONDUCT A ONE -DAY RAFFLE AT STILLWATER SENIOR HIGH SCHOOL ON AUGUST 3, 2012 WHEREAS, Jon Carlson, on behalf of the American Cancer Society has applied with the State of Minnesota Gambling Control Board for a permit to conduct a one -day raffle on August 3, 2012 at the site of the Stillwater Senior High School, 5701 Stillwater Boulevard 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 the American Cancer Society 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 the American Cancer Society with the State of Minnesota Gambling Control Board to conduct a one -day raffle on August 3, 2012 at the site of the Stillwater Senior High School, 5701 Stillwater Boulevard 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 24 ay of A ril, 2012 avid Be et ATTEST: Mayor nie A �3ri a n Pt City Administrator - Infiriw • Minnesota Lawful Gambling Page 1 of 2 5/11 LG220 Application for Exempt Permit Application fee If application Dostmarked or r c ived: An exempt permit may be issued to a nonprofit organization that: less than 30 days ore 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 $-So-- Organization name Previous gambling permit number �� S O�t Minnesota tax ID number, if any Federal employer ID number, if any ES aI. �Ci 31 4i• -O - 7 aq0,:VP L41 -0 -qo3 Type of nonprofit organization. Check one. 17 1 Fraternal Religious (� Veterans Other nonprofit organization Mailing address City State Zip Code County Q s ao a kA019 128 S4-t I Mtn - tJ Sal ao r Iw Name of chief executive officer (CEO) Daytime phone number h0ail address Hof, Ca CUS ass - 1� 11D a IZL_SC#1 t 0 2 Attach a copy of of the following for 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. _ _I onprofit 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 [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 at 877- 829 -5500. 1 - 71M - 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. GAMBLING PREMISES INFORMATION Name of premises where the gambling event will be conducted. For raffles, list the site where the drawing will take place. S�A p r W _& Address (do not use PO box) City or township Zip Code County 5 `1 ©► 17i l l c * C ' I d IJ • St i 1 L 12 a-+ er, Date(s) of activity (for raffles, indicate the date of the drawing) IC'ru D I a- Check the box or boxes that indicate the type of gambling activity your organization will conduct: Bingo* Raffles Paddlewheels* Pull -Tabs* Tipboards* * Gambling equipment for pull -tabs, bingo paper, tipboards, and paddlewheels must be obtained from a distributor licensed by the Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to www.gcb.state.mn.us and click on List of Licensed Distributors, or call 651 - 639 -4000. • LG220 Application for Exempt Permit Page 2 of 2 6111 LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT If the gambling premises is within city limits, If the gambling premises is located in a township, a a city official must check the action that the city is county official must check the action that the county is taking on this application and sign the application. taking on this application and sign the application. A township official is not required to sign the application. The application is acknowledged with no waiting The application is acknowledged with no waiting period. period. application is acknowledged with a 30 day The application is acknowledged with a 30 day The a PP waiting period, and allows the Board to issue a waiting period, and allows the Board to issue a permit after 30 days. permit after 30 days (60 days for a 1st class city). The application is denied. _The application ) ids denied.. j�p �pin Print county name Print city name V��(i` r�� 1 , I " On behalf of the county, I acknowledge this application. Signature of county personnel receiving application On behalf of.the ' I ackno e this application. Signat re of cit pe on e r ceiv n application /1 / VV''' ►m Title Date Title U ( ate '!-v !- (Optional) TOWNSHIP: On behalf of the township, I acknowledge that the organization is applying for exempted gambling activity within the township limits. [A township has no statutory authority to approve or deny an application [Minnesota Statute 349.166)] Print township name Signature of township official acknowledging application Title Date w CHIEF EXECUTIVE OFFICER'S SIGNATURE - The information provided in this application is co plete and accurate to the best of my knowledge. I acknowledge that the financial report will be compl ettVned to the Board within 30 days of the dafe of ur gambling activity. ` , 'I Chief executive officer's signature Date Complete a separate application for each gambling event: Financial report and recordkeeping • one day of gambling activity required • two or more consecutive days of gambling activity A financial report form and instructions will • each day a raffle drawing is held be sent with your permit, or use the online fill -in form available at Send application with: www.gcb.state.mn.us. Within 30 days of the a copy of your proof of nonprofit status, and activity date, complete and return the • application fee for each event financial report form to the Gambling Make check payable to "State of Minnesota." Control Board. Questions? To: Gambling Control Board Call the Licensing Section of the Gambling 1711 West County Road B, Suite 300 South Control Board at 651 - 639 -4000. Roseville, MN 55113 This form will be made available in alternative format (i.e. large print, Braille) upon request. Data privacy notice: The information Your organization's name and Private data about your organization are available requested on this form (and any address will be public information to: Board members, Board staff whose work attachments) will be used by the Gambling when received by the Board. All requires access to the information; Minnesota's Control Board (Board) to determine your other information provided will be Department of Public Safety; Attorney General; organization's qualifications to be involved private data about your Commissioners of Administration, Minnesota in lawful gambling activities in Minnesota. organization until the Board Management &Budget, and Revenue; Legislative Your organization has the right to refuse to issues the permit. When the Auditor, national and international gambling supply the information; howeve r, if your Board issues the permit, all regulatory agencies; anyone pursuant to court organization refuses to supply this information provided will become order;r other individuals and agencies specifically • information, the Board may not be able to public. If the Board does not authorized by state or federal law to have access determine your organization's qualifications issue a permit, all information to the information; individuals and agencies for and, as a consequence, may refuse to issue provided remains private, with the which law or legal order authorizes a new use or a permit. If your organization supplies the exception of your organization's sharing of information after this notice was given; information requested, the Board will be name and address which will and anyone with your written consent. able to process your organization's remain public. application. - I