5.5. SR 11-24-2003TO:
FROM:
DATE:
SUBJECT:
MEMORANDUM
Mayor and City Council
Joan Schmidt, City Clerk
November 24, 2003
Consider Application for Exempt Permit for Gambling
Request
The Church of St. John The Baptist has requested to hold a benefit at the Elk River
American Legion Post 0112, 525 Railroad Drive N.W., on January 17, 2004. At this benefit
they would conduct raffles.
Background
The city's code requires council approval for premise permits as well as the State of
Minnesota requires a resolution approved by council. However, the city code does not
address an exempt permit. In checking with the State of Minnesota Lawful Gambling
Division, the licensing specialist stated that whether the city requires council approval for an
exempt permit is dependent upon how the city wishes to handle; some cities allow the City
Clerk to sign the form. In the near future, I would like to discuss with the council exempt
permits for gambling.
Action Requested
· Council motion to approve an exempt permit for the Church of St. John The Baptist
to conduct raffles at their benefit on January 17, 2004.
S: \Council\J oan\ Gambling\ExemptPermit.doc
Minnesota Lawful Gambling
LG220 Application for Exempt Permit
Fee $50
Organization Information
Page 1 of 2 (web) 6/03
tFor Board Use Only
Fee Paid
Check No.
Organization name
Street ~ cO. ~ ~ ~2 0 /
Name of chief executive officer (CEO)
First name
Name of treasurer Fimt name
City
!
Last name
Last name
Type of Nonprofit Organization
Previous lawful gambling exemption number
I State/zip code I County
Daytime phone number of dEO
Include area code
Daytime phone number of
treasurer. Include area ~ode
Check the item that best describes your organization:
Fraternal ~' Religious
Veteran __ Other nonprofit organization
Ch~k the item that indicates the type of proof your organization attached to this application:
IRS letter indicating income tax exempt status
Certificate of Good Standing from the Minnesota Secretary of State's Office
__ A charter showing you are an affiliate of a parent nonprofit organization
)~ Proof previously submitted and on file with the Gambling Control Board
Gambling Premises Information
Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place)
Address (do not use PO box) [ City '/
I
Date(s) of activi~ (for raffles, indicate the date of the drawing)
Check the item(s) that indicate the ~pe of gambling activi~ your organization will be conducting:
~ *Bingo ~ Raffles (cash prizes may not exceed $12,000) *Paddlewheels
*Equipment for these activities must be obtained from a licensed distributor.
I
State/zip code [ County
I
__ *Pull-tabs *Tipboards
This form will be made available in
alternative format (i.e. large print, Braille)
upon request. The information requested
on this form (and any attachments) will be
used by the Gambling Control Board
(Board) to determine your qualifications to
be involved in lawful gambling activities in
Minnesota. You have the right to refuse to
supply the information requested; however,
if you refuse to supply this information, the
Board ~ay not be able to determine your
qualifications and, as a consequence, may
refuse to issue you a permit. If you supply
the information requested, the Board will
be able to process your application.
Your name and and your organization's
name and address will be public
information when received by the Board.
All the other information that you provide
will be private data about you until the
Board issues your permit. When the Board
issues your permit, all of the information
that you have provided to the Board in the
process of applying for your permit will
become public, l:f the Board does not issue
you a permit, all the information you have
provided in the process of applying for a
permit remains private, with the exception
of your name and your organization's name
and address which will remain public.
Private data about you are available only to
the following: Board members, staff of the
Board whose work assignment requires
that they have access to the information;
the Minnesota Department of Public
Safety; the Minnesota Attorney General;
the Minnesota Commissioners of
Administration, Finance, and Revenue; the
Minnesota Legislative Auditor, national and
international gambling regulatory agencies;
anyone pursuant to court order; other
individuals and agencies that are
specifically authorized by state or federal
law to have access to the information;
individuals and agencies for which law or
legal order authorizes a new use or sharing
of information alter this Notice was given;
and anyone with your consent.
LG220 Application for Exempt Permit
Organization Name
Local Unit of Government Acknowledgment
If the gambling premises is within city limits, the
city must sign this application.
On behalf of the city, I acknowledge this application.
Check the action that
the city is taking on this application.
DThe city approves the application with no
waiting period.
DThe city approves the application with a 30 day
waiting period, and allows the Board to issue a
permit after 30 days (60 days for a first class
city).
DThe city denies the application.
Pdnt name of city
(Sign~.ature of city personnel receiving application)
~tle
Date / /
Page 2 of 2
web 6/03
If the gambling premises is located in a township, both
the county and township must sign this application.
On behalf of the county, I acknowledge this application.
Check the action that
the county is taking on this application.
DThe county approves the application with no
waiting period.
DThe county approves the application with a 30 day
waiting period, and allows the Board to issue a
permit after 30 days.
DThe county denies the application.
Print name of county
(Signature of county personnel receiving application)
Title
Date / /
TOWNSHIP: On behalf of the township, I acknowledge that
the organization is applying for exempted gambling activity
within the townshiplimits. [Atownship has no statutory
authority to approve or deny an application (Minn. Stat. sec.
349.213, subd. 2).]
Print name of township
(Signature of township official acknowledging application)
Title
Date__/ /
Chief Executive Officer's Signature
The information provided in this application is complete and accurate to the best of my knowledge.
Chief-executive officer's signature
Name (please print)~d./~,4..,--~ Date /
Mail Application and Attachments
At least 45 days prior to your scheduled activity date send:
· the completed application,
· a copy of your proof of nonprofit status, and
· a check for $50. Make check payable to "State of Minnesota".
Application fees are not prorated, refundable, or transferable.
Send to: Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113
Benefit
Rick Anderson Family
Elk River American Legion Post 0112
Saturday, Jan 17, 2004
1:00 - 5:00 pm
Pork Chop Dinner $10. O0 Advance
$12. O0 at the door
Advanced tickets may be purchased at: The Bank of Elk River Walmart Branch in Elk
River and American Family Insurance 21370 John Milless Drive, Rogers (located in the
Chamber of Commerce Building) or call 763-218-4661.
Rick was diagnosed in September 2003 with Prostate Cancer metastasis to the bones.
Rick, 40 years old, lives in Elk River with his wife Linda and their two children Amanda
and Travis. Due to Rick's illness he can no longer work. Family and friends are holding
a benefit to raise money for Rick's medical andpersonalfinancial obligations.
Please send your tax deductible donations to:
The Bank of Elk River
c/o Rick Anderson Benefit Fund, 630 Main St., Elk River, MN 55330
Silent Auction - Door Prizes - Bake Sale
2003 AppliCation for EXempt Pe~i~
Proper 657 Main Broadway South Hwy Raffles 12-2-03
Economic Str Pizza 10
Resource
Mgt
River City PO Box 553 Sherbume 13372 Raffles 10-4-03
Snow Riders County Orono Road
Fairgrounds
Elk River 509 Lake Orono Gary Street Raffles 7-4-03
Area Highway 10 Park & Hwy 10
Chamber of
Commerce
Suburban 554 3rd Suburban 554 3rd 3-11-03
Northwest Street Norwest Street
Builders Builders
Assoc Assoc