06-10-1987 Council Agenda - Laserfiche WebLink

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Gambling License Application Type of Application: X:Ciass A LiClass B LiClass C i.'Class D Page 2 X.:Yes. .:No 23. Is gambling premises located within city limits? X.Yes 'No 24. Are all gambling activities conducted at the premises listed in #19 of this application? If not, complete a separate application for each premises (except raffles) as a separate license is required for each premises. iliYesX'No 25. Does organization own the gambling premises? If no, attach copy of the lease with terms of at least one year. L:IYesX No 26. Does the organization lease the entire premises? If no, attach a sketch of 27. Amount of Monthly Rent the premises indicating what portion is being leased. A lease and sketch $j, 630.95 is not required for Class D applications. X. :Yes E:No 28. Do you plan on conducting bingo with this license? If yes, give days and times of bingo occasions: Days Times Saturdays 7:15 -9:00 9:15 -11:00 Sundays 7:15 -9:00 9:15 -11.00 X. :Yes:: No 29. Has the $10,000 fidelity bond required by Minnesota Statutes 349.20 been obtained? Attach copy of bond. 30. Insurance Company Name State Surety Co. 31. Bond Number 273610 32. Lessor Name Mover's Warehouse, Inc. 33. Address 2233 No. Hamline Ave. #220 34. City, State,Zip Roseville, MN 55113 37. City, State, Zip St. Paul, MN 55117 35. Gambling Manager Name Lois Blomberg . 36. Address 132 Demont Ave. E. #341 44. Name of Person delivering application to Local Governing Body 38. Gambling Manager Business Phone 1 612 484 -2659 ............__ 39. Da member e gambling manager became of organization: 1970 GAMBLING SITE AUTHORIZATION By my signature below, local law enforcement officers or agents of the Board are hereby authorized to enter upon the site, at any time, gambling is being conducted, to observe the gambling and to enforce the law for any unauthorized game or practice. BANK RECORDS AUTHORIZATION By my signature below, the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to fulfill requirements of current gambling rules and law. OATH I hereby declare that: 1. I have read this application and all information submitted to the Board; 2. All information submitted is true, accurate and complete; 3. All other required information has been fully disclosed 4. I am the chief executive officer of the organization; ° 5. I assume full responsibility for the fair and lawful operation of all activities to be conducted; 6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, if licensed, to abide by those laws and rules, includin amendments t veto. 40. Official, Legal Name of Organization 41 . Si 9 net r 1 b'e signed by Chief E jive 0ffi St. oseph's Societ for Charity, Inc. x — 4_ si r LU 6e-0° r / Date / 1 ✓ ACKNOW GEM OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a qopy of this application. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the board, will become effective 30 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 30 days of the below noted date. 42. Name of City or County (Local Governing Body) City of Little Canada If site is located within a township, item 43 must be completed, in addition to the county signature. person receiving application Signature of //e3/4/ / X )7 43. Name of Township Clerk /Treasurer Date received (30 day period begins from this date) 6 -4 -87 Signature of person receiving application X_ 44. Name of Person delivering application to Local Governing Body Title CG- 0001 -02 (8186) White Copy-Board Page 11 Canary - Applicant Pink•Local Governing Body