HomeMy WebLinkAbout11-02-07 RESOLUTION 11 -02 -07
• CITY OF OAK PARK HEIGHTS
WASHINGTON COUNTY, MINNESOTA
RESOLUTION GRANTING THE APPLICATION OF
THE AMERICAN CANCER SOCIETY
TO CONDUCT A ONE -DAY RAFFLE AT THE
STILLWATER AREA HIGH SCHOOL ON AUGUST 6, 2011
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 6, 2011, at the site of the Stillwater Area 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 6, 2011, at the site of the
Stillwater Area High School, 5701 Stillwater Boulevard North, within the City of Oak
Park Heights and the same are hereby approved with no waiting period.
Passe. ' y the City Council of Oak Park Heights this 22nd day of February, 2011.
fi A
L.._ AV
r avid Beau• et
Mayor
rif . J. son
Cit d inistrator
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•
Page 1 of 2 7/10
Minnesota Lawful Gambling Application fee for each event
LG220 Application for Exempt Permit If application postmarked 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 Tess than $50,000 in prizes during a calendar year. $100 $50
ORGANIZATION INFORMATION Check# $
Organization name Previous gambling permit number
Ai v- icare, ed raeer S o cie fiy X - 3 7 0 7 3- 08-00
Type of nonprofit organization. Check one.
Fraternal Religious Veterans Other nonprofit organization
Mailing address City State Zip Code County
el S ao pant Knob Rd ft nda fcace mit) 5 5 actko7cL
Name of chief executive officer (CEO) Daytime phdne number Email address
To H. Cd r�so� �51-a5S -B //d
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.
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 [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 1 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.
X 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 gambling activity will be conducted (for raffles, list the site where the drawing will take place)
51,1(w etc r Se nior /b 7eh /
Address (do not use PO box) City Zip Code County
5701 S r , //weicv- t3 / ✓d• M l IC Pd r1' /iciek.ts SSoba 100,5. 4 iim n--
Date(s) of activity (for raffles, indicate the date of the drawing)
AVIA-A 2&11
Check trge box or boxes that indicate the type of gambling activity your organization will conduct:
n Bingo" ® Raffles 0 Paddlewheels" 0 Pull -Tabs* f Tipboards"
* Gambling equipment for pull- tabs., bingo paper, tipboards, and Also complete
paddlewheels must be obtained from a distributor licensed by the Page 2 of this form.
Gambling Control Board. EXCEPTION: Bingo hard cards and bingo
number selection devices may be borrowed from another organization
authorized to conduct bingo. , Pfint Form
To find a licensed distributor, go to www.gcb.state.mn.us and click on List Reset Form
of Licensed Distributors, or call 651 - 639 -4000.
LG220 Application for Exempt Permit Page 2 of 2 1/10
LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT
If the gambling premises is within city limits, If the gambling premises is located in a township, a
IP a city official must check the action that the city is county official must check the action that the county is taking
taking on this application and sign the application. on this application and sign the application.
A township official is not required to sign the application.
y The application is acknowledged with no waiting period. The application is acknowledged with no waiting period.
The application is acknowledged with a 30 day waiting The application is acknowledged with a 30 day waiting
period, and allows the Board to issue a permit after 30 period, and allows the Board to issue a permit after 30
days (60 days for a 1st class city). days.
_The application is denied. The application is denied.
//'�� }� � Print county name
Print city name l 1 I L (" / l.t tl t/ � [� p, - L t \ � On behalf of the county, I acknowledge this application.
On behalf of the cit , acknowledge this applictiah Signature of county official receiving application
Signature of cit • -I reeling app ation At_ Title Date / /
(, ,/ /� /� (r (OptionalZ TOWNSHIP: On behalf of the township, I
•
Title DI7U , I bI C irk- tv Date 0 ./ 9 / L I i acknowledge that the organization is applying for exempted gambling
1 activity within 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 / /
• CHIEF EXECUTIVE OFFICER'S SIGNATURE
The information provided in this application ' : •. •lete and accurate to the best of my knowledge. I acknowledge that the
financial report will be completed and e . t • • e • ard within 30 day of he date of our gambling activity.
Chief executive officer's signature � . IP/ - 67 1 l- Date
Complete a separate application for -1 I h 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.
Make check payable to "State of Minnesota."
To: Gambling Control Board
1711 West County Road B, Suite 300 South pnt Form¢, ° i05Rt Fbft*t
Roseville, MN 55113 , - °' :.w � �'
• the Board will be able to process your information; Minnesota's Department of
This form will be made available in alternative organization's application. Your organization's Public Safety; Attorney General;
format (i.e. large print, Braille) upon request. name and address will be public information Commissioners of Administration, Minnesota
Data privacy notice:The information requested when received by the Board. All other ment & Bud national and Revene;
on this form (and any attachments) will be used information provided will be private data until l e Ma nage Auditor, get: and int
by the Gambling Control Board (Board) to the Board issues the permit. When the Board gambling regulatory agencies; anyone pursuant
determine your organization's qualifications to issues the permit, all information provided will to court order; other individuals and agencies
be involved in lawful gambling activities in become public. If the Board does not issue a specifically authorized by state or federal law to
Minnesota. Your organization has the right to permit, all information provided remains private,
have access to the information; individuals and
refuse to supply the information requested;
with the exception of your organization's name agencies for which law or legal order authorizes
• however, if your organization refuses to supply and address which will remain public. Private - a new use or sharing of information after this
this information, the Board may not be able to data are available to: Board members, Board
determine your organization's qualifications Notice was given; and anyone with your written
staff whose work requires access to the consent.
and, as a consequence, may refuse to issue a
permit. If you supply the information requested,