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Return to: Charitable Gambling'-Control Board 1821 University Avenue72 Rm. N475 St. Paul, MN 55104 -3383 Phone: 612/642 -0555 ONE DAY OFF -SITE LAWFUL GAMBLING APPLICATION • A licensed organization may, upon approval of this application, conduct gambling on a premises other than a licensed site one day per calendar year for not more than 12 hours. • If there are fewer than 60 days between the date that the city /county signs the application and the date of the off -site gambling, include a waiver from the city /county waiving its 60 -day disapproval period. • Print clearly 'or type. Attach a copy of the lease for the off -site premises. • After review, the application will be returned to the organization with approval or denial indicated below. Organization St. Jerome Church License No. A — 01122 — 001 Address (street or P.O. box number) 380 E. Roselawn Ave. City IMplewood State LIn Zip Code 55117 Phone No. (612) 771 1209 OFF -SITE INFORMATION 1. Name of premises where off -site lawful gambling will be conducted Venetian Inn 2. Address of off-site premises 2814 Rice St. City or township Little Canada State Tin Zip Code 55113 3. Date of one -day event April 16, 1989 4. Has your organization conducted off -site gambling this year? DYES C2;140 If YES, give date of event 5. Attach a lease for the one day off-site lawful garbling. 6. Name of chief executive officer (please print) Father Kenneth Ludescher Signature R Ar. ( w.vh� 1 .u,��K/_�yv ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and, if approved, will become effective 60 days from the date of receipt (noted below) unless a resolution of the local governing body is passed that specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of the below noted date. The city or county may choose to waive the 60-day acknowledgement period by resolution. Attach the written waiver to this request. 7. Name of city or county (local governing body) , CITY OF LITTLE CANADA 8. Signaju re of pers re eivi g pp ca ion // 42--C j/j` 7 Title fT.FRK- TBFAgUBER Date received 1/24/89 If s e is located within a township, items 9 and 10 must be completed in addition to the county signature. 9. Name of township 10. Signature of person receiving application Title FOR BOARD USE ONLY Approved I I Denied I Page 32 Executive Secretary r...,.1:..., r..n4rr,1 Pe, rd Date