05-14-2003 Council Agenda - Laserfiche WebLink

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Minnesota Lawful Gambling Lawful Gambling Compensation Schedule - LG205 5 /00 Organization name rr / License number a..r\e..L. rSisr/Ga -e .5ocict 0,.5-- G Business address of organization (do not use address of gambling manager) Street City State/Zip cede Si s cc. . / l /t' /e Ca eiads rQc i,/��e dR-nA. dc. Mr/ .ss //7 Business phone number Name "off chief executive officer C... . / r`� ` Ject•n r 1, o'Java et (6•r/ ) V41, V7t.r Compensation Schedule • Compensation means wages, salaries, and all other forms of payment for services rendered in the conduct of lawful gambling. • Do not include wages paid to employees who do not participate in the conduct of gambling, (i.e., bookkeepers, accountants, attorneys). • If no wages are paid, state "No compensation paid ", sign the LG205, and attach it to the LG200A application. • When submitting an updated compensation schedule with changes, be sure to include the wages for all positions. Position o- —seL-p nt 7 Amount to be Paid For All Employees Enter the minimum and maximum wage of each position listed If employees are not paid (volunteers), indicate $0. Minimum Mapmum and check the appropriate box. Check appropriate box: • Per Occasion Hourly Daily Weekly — 4onrlily Other (specify) Gambling Manager $ $ 1 Assistant Gambling Manager, If any $ $ BINGO: $ $ Caller Checker(s) $ $ Sales - $ $ paper Collectors cards) $ $ (hard Other (identify): J VWL , te—. $ $ v. . ».t1. // y OTHER THAN BINGO: Seller $ $ Seller $ $ Other (identify): $ $ Signature I affirm that the lawful gambling compensation schedule for organization changes in the compensation s ule will all employees is accurate and has been approved by our be submitted to the Board within ten days of the change. g�� `mil .23 / .Z .. / _ ..?..421.4..."-- I�'...tiw".. ..- Chief exe ive officeis signature / Date Mail lo: Gambling Control Board Suite 300 South 1711 West County Road B Roseville, MN 55113 This form will be made available in alternative format (i.e. large print, Braille) upon request. Ir you use a TTY, you can call us by using the Minnesota Relay Service at 1- 800 -627 -3529 and ask to place a call to 651 -639 -4000. The information requested on this form will become public information when received by the Board, and will be used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities.