HomeMy WebLinkAbout11-03-09 • RESOLUTION 11 -03 -09
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 5, 2011
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 5, 2011, at the site of the 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 5, 2011, 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 22nd day of h, 2011.
/9 44*
der
B det
AT ST. / Mayor
Eric A. • son
City A nistrator
•
Page 1 of 2 2/10
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 less than $50,000 in prizes during a calendar year. $100 $50
ORGANIZATION INFORMATION Check# $
Organization name Previous gambling per it number
, � (4 C- /- A a/ iv / CJ SI . C� - J ,,,r G 4. " ` ey _.. ..
Type of nonprofit organization. Check o ne.
Fraternal Religious I I Veterans 41 nonprofit organization
Mailing address City State Zip Code County
/.9 . , ,,,
Name chief execu ive officer (CEO) Daytime one number Email address
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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.
III 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
W 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 whe gambling activity will be conducted (for raffles, list the site where the drawing will take place)
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Address (do not use PO box) City Zip Code County
...) A A A . - , (7),,,4. , 1 `r, _5'3 -- 1,01‘,
Date(s) of activity (for raffles, indicate the date of the drawing) v '
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Check the box or boxes that indicate the type of gambling activity your organization will conduct:
E] Bingo* Raffles 0 Paddlewheels* 0 Pull -Tabs* ❑ Tipboards*
* Gambling equipment for pull -tabs, bingo paper, tipboards, and Also complete
paddlewheels must be obtained from a distributor licensed by the
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. Print Form
To find a licensed distributor, go to www.gcb.state.mn.us and click on List Reset Form
4110 of Licensed Distributors, or call 651- 639 -4076.
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
a city official must check the action that the city is coun official must check the action that the county is taking
taking on this application and sign the application. on this - •plication and sign the application.
A towns ' . official is not required to sign the applic. on.
The application is acknowledged with no waiting period. The app' ation is acknowledged with no waiti • period.
The application is acknowledged with a 30 day waiting The application is acknowledged with a 30 • :y waiting
period, and allows the Board to issue a permit after 30 period, an. -flows the Board to issue a , -rmit after 30
days (60 days for a 1st class city). days.
The application is denied. The application • denied.
/� ` C 601 pia tic t jIC ,., Print county name
Print city name (, I d [ ' ' 1 �s On behalf of the county, • cknowle ' • e this application.
On behalf of the cit 1 I acknowledge this app 'c Lion. Signature of county official -cell/ g application
Sign -ture o city o' ': recz. , g application A
� ar�a. _ 1 � Title a to / /
� g, JJ�� � (Optional) TOWN IP: On behalf of , e township, I
Title ( i� P/( � Date ;) / �2' /�� ( acknowledge that the • rganization is applyim or exempted gambling
activity within towns ip limits. [A township has ' o statutory authority
to approve or den an application [Minnesota St- ute 349.166)]
Print townshi. name
Signatu -- of township official acknowledging app ation
Titl: Date /
CHIEF EXECUTIVE OFFICER'S SIGNATURE
i 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 rett e to the c : - • ithin 30 days of the date of our gambling activity.
Chief executive officer's signature i ,fi / /--.,......_.— 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
Board at 651 - 639 -4076.
To: Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113 Print Form Reset Form
This form will be made available in alternative the Board will be able to process your information; Minnesota's Department of
format (i.e. large print, Braille) upon request. organization's application. Your organization's Public Safety; Attorney General;
name and address will be public information Commissioners of Administration, Minnesota
Data privacy notice:The information requested when received by the Board. All other Management & Budget, and Revenue;
on this form (and any attachments) will be used g
by the Gambling Control Board (Board) to information • provided will be private data until Legislative Auditor, national and international
determine your organization's qualifications to the Board issues the permit. When the Board gambling regulatory agencies; anyone pursuant
be involved in lawful gambling activities in issues the permit, all information provided will to court order; other individuals and agencies
become public. If the Board does not issue a s ecifically authorized by state or federal law to
Minnesota. Your organization has the right to permit, all information provided remains private, p
refuse to supply the information requested; with the exception of your organization's name have access to the information; individuals and
however, if your organization refuses to supply agencies for which law or legal order authorizes
this information, the Board may not be able to and address which will remain public. Private a new use or sharing of information after this
data are available to Board members, Board Notice was given; and anyone with your written
determine your organization's qualifications staff whose work requires access to the g y
• and, as a consequence, may refuse to issue a
permit. If you supply the information requested, consent.