CCAgenda_93Jan13 - Laserfiche WebLink

Home Browse Search

LG210AR 0 (1) FOR BOARD USE ONLY OCT 9 1991 e3/9/ Gambi Cofgffitmesota Lawful Gambling Organization License Renewal Application w... .v::::..r...: v�. rr:. A,}".:}: }.A.::� a te: <<r: License number Class of license Indicate in the 'class of license' box the license lass that describes the types of gambling your organization will be conducting: A -03191 A I Class A Pull -tabs, tipboards, paddewheels, raffles. bingo Class C Bingo only Class B Pull -tabs, tipboards, paddewheels, raffles Class D Raffles only f�ifJ �a•�/�.j...Q T �0�: /��1�( Y�':L::r iii.:.^:: r- i" i::: t�: i?: {:::Ti':::'::ilii:C::iif:::T iii: i.:{ v- i�.}}} h};:};+ ij}: t3.. y; :.iji:::jJC:iv :Yii'.:ii:::ii::i �iii:::J'iir•.v: ;.>�2"Q,�' .iR::i� .F.:Rt4i� n...................... v:. a...... :..1.•::::::.v.1... :111:::: rv::::.:v11} Name of organization Business ID Number (MN Sales Use Tax Permit) Roseville Area Youth Hockey Association 1206974 Business Address of Organization Street or P. 0 Box (Do not use address of gambling manager) 625 Transit City State Zip Code Daytime phone number Roseville, Minnesota 55113 Ramsey I 612 488-8926 Full name of chief executive officer Last Name First Name Middle Name Maiden 'Title Date of birth Daytime phone number Borash Anthony Lee President 17 -29 -54 (612) 378 -1003 Address of chief executive officer Street or P. O. Box 203 West Skillman City State Zip Code County Roseville Minnesota 55113 I Ramsey ►easu 1n 7.e urer.t foritaffo4<':`< Full name of oroani7ation's treasurer Last Name First Name Middle Name Maiden e Date of birth Daytime phone number Warner James Lee I Titl Treasurer 1 6 -4 -69 I (612) 296 -7333 When does the organization hold regular meetings? Number of Active Members 612 O (must be age 18 and older) Monday following Day of week 3rd Simday Time 7:00 P.M. r: :::g }::a 0 :s, }:MS {{:vx {xm^ .a.{�x•.:..r enc :.:..c:c{{aa.. :r {a.�rtrr {�xy :m :3 •:f•}:{::: .+:uv .':::.••f':s:?:'8:: r: •::r :..f :r.....: r:.n ..f f.:.�: f.......... x li:: x: v.: {.i: {:v. }Y Li'{s }'r. w. nv.... r....^y {m:m n n•.i' r y v::r }-0 {5.....: .{a ry ry v: a :•F.i :v. :r {r., J:..} :::r£.•iv +fi:: ...:v::: r:.... v:: :S :.At: v:tiv .Tvi: {ii +i {ii:: ..h.. n.• fi. {:{.:f•:.: i• a1.6 nt :::R v'I.. :i::}::'r :Ski i. 'h::• J:4'•.: ...A ry }i v::: v f•:x•. •.vin: n. •'•tv++ ::xf n. v v j� ri{•'f. {in: {i .v: }�J;:::i':. v.L......{.. }f. n.....{...n. {.::•4,i }i{..:C.3�:::. n.. w.i 4f: {{.f {w'..: v. n..t :n. {.r'riY: i:{: ,,,,}�/��y �.•��('::tis :i::: 'v.: :•-•r�� :}r::. -.v$Arr�v: ::arr:Y•::: ii6rlvl�S/�4/�� I.l.icGF4 :n+:. .'F {i'e •Fi :.f }:.i• f.:n 1 declare that I have read this application and all information submitted to a membership Ilst of the organization will be available within seven days the board; after it is requested by the board; all information is true, accurate and complete; any changes in application information will be submitted to the board and •the compensation schedule is current and on file with the local unit of government within 10 days of the change; board; a license termination plan will be submitted to the board within 15 days of •the intemai controls are current and on file with the board; termination of all premises permit(s); all other required information has been fully disclosed; I certify that the gambling manager is bonded and licensed as required by 1 am the chief executive officer of the organization; Minnesota Statute; and I assume full responsibility for the fair and lawful operation of •I understand that failure to provide required information or providng false all activities to be conducted; or misleading information may result in the denial or revocation of the I will familiarize myself with the laws of Minnesota governing license- lawful gambling and rules of the board and agree, if licensed, to abide by those laws and rules, including amendments to ytk them; fry Signature r hief ecutive Date �O l/(, Mail with required attachments to: (1 .(I Gambling Control Board 11)/ V v Rosewood Plaza South, 3rd Floor 1711 W. County Road B Roseville, MN 55113 a