05-25-1999 Council Agenda - Laserfiche WebLink

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East LG 2100R PRINTED:02 /11/99 STATE OF MINNESOTA GAMBLING CONTROL BOARD ORGANIZATION LICENSE RENEWAL APPLICATION IFOR BOARD USE ONLYI I I I I I I LICENSE NUMBER:A -00864 EFFECTIVE DATE:08 /01/97 EXPIRATION DATE:07 /31/99 ORGANIZATION INFORMATION Vora Little Canada Vol Dept— it:7Ra - MN SALES & USE TAX PERMIT #: 9679984 325 Little Canada Rd E Little Canada MN 551171628 COUNTY:Ramsey PHONE NUMBER: 612 - 484 -2722 Richard Boss III 57 E Bryan Little Canada MN 55117 CHIEF EXECUTIVE OFFICER INFORMATION DATE OF BIRTH: 11/08/42 PHONE NUMBER: 612 -484 -5797 TREASURER INFORMATION DATE OF BIRTH: 11/20/56 James Gustafson PHONE NUMBER: 612 - 484 -7973 ORGANIZATIONS REGULARLY SCHEDULED MEETINGS ARE: 2nd Monday AT 7:30 PM NUMBER OF ACTIVE MEMBERS OVER THE AGE OF 18: 36 ACKNOWLEDGMENT I DECLARE THAT: • I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; • ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE; • THE COMPENSATION SCHEDULE IS CURRENT AND ON FILE WITH THE BOARD; ▪ THE PROOF OF NONPROFIT STATUS FOR THE ORGANIZATION IS ON FILE WITH THE BOARD; -OUR ORGANIZATION REMAINS IN GOOD STANDING AS A NONPROFIT CORPORATION WITH THE MINNESOTA SECRETARY OF STATE'S OFFICE AND /OR CONTINUES TO BE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INCOME TAX EXEMPT ORGANIZATION AND, IF APPLICABLE, OUR CHARTER REMAINS IN GOOD STANDING WITH OUR NATIONAL ORGANIZATION; •ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; • I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; •I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; • I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF THE GAMBLING CONTROL BOARD AND AGREE, IF LICENSED, TO ABIDE BY THOSE LAWS AND RULES, INCLUDING AMENDMENTS TO THEM; • A MEMBERSHIP LIST OF THE ORGANIZATION WILL BE AVAILABLE WITHIN SEVEN DAYS AFTER IT IS REQUESTED BY THE GAMBLING CONTROL BOARD; -ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND THE LOCAL UNIT OF GOVERNMENT WITHIN 10 DAYS OF THE CHANGE; • A LICENSE TERMINATION PLAN WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD WITHIN 30 DAYS OF TERMINATION OF ALL PREMISES PERMIT(S); THE GAMBLING MANAGER IS BONDED AND LICENSED AS REQUIRED BY MINNESOTA STATUTE; AND • I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE LICENSE. ilIEF E SIGNAT IVE OFFICER L/� DATE 05/18/99 Page 134