04-26-1989 Council Agenda - Laserfiche WebLink

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MINNESOTA DEPARTMENT OF REVENUE GAMING DIVISION 3 Mail Station 331.5 St. Paul MN 55146 -3315 GAMBLING LICENSE RENEWAL APPLICATION For Board Use Only Paid Ant Check No Date. LICENSE NUMBER: 9- 31485 -313 / EFF. DATE: 1/(/1(88 / AMOUNT OF FEE: $110.31 1. Applicant -Legal Name of Organization MORN SUBURBAN YOUTH ASSOC ROSEVILLE 2. Street Address PO Box 13253 3. City, State, Zip Roseville, MN 55113 4. County Ramsey 5. Business Phone (612 )633 -9156 6. Name of Chief Executive Officer R Robert Matson 7. Business Phone (612 )633 -1156 8. Name of Treasurer or Person Who Accounts for Revenues it a.cs Title: 9. Business Phone ( 612 ) 248--2-5131341-112k -9a .Mat :st..., CZcr wCt_, 10. Name of Gambling Manager thEtenat II re) `"`"'"r to"'t c,rT 11. Bond Number RPS316933 12. Business Phone (612 )633 -1156 13. Name of Establishment Where Gambling Will Take Place little Canada Bingo Hall little Canada 14. County Ramsey 15. No. of Active Members 231 16. Lessor Name lovers Warehouse 17. Monthly Rent: :12811 78. It Bingo will be conducted with this license, please specify days and times of Bingo. Days Times Days Times TL: C1- 'K -1 100-0CC Pm. Tt- +,,:. -.c-c:i 90':3C -1 :I' p "71.3 C.-7S- °1 , Cc -t I CC o,r 19. Has license ever been: 0 Revoked Date ❑ Suspended Date: ❑ Denied Date- 20. Have internal controls been submitted previously? pc Yes ❑ No (If "No," attach copy) 21. Has current lease been filed with the board? 5a Yes ❑ No (If "No," attach copy) 22. Has current sketch been filed with the board? OA Yes ❑ No (If "No," attach copy) Days Times 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. 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. 1 assume full responsibility for the fair and lawful operation of all activities to be conducted; 6. 1 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, including amendments thereto. OATH 23. Official Legal Name of Organization fly, ti+ Svr3VC.es u-� Ate. , fl G-•\ ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY 1 hereby acknowledge receipt of a copy of this app ication. By acknowledging receipt, I admit having been sery with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the Board, will become effective days from the date of receipt (noted below), unless a resolution of the local governing dy is passed which specifically disallows such activi a copy of that resolution is received by the Charitable Gambling Control Board within ys of the below noted date. 24. City/County Name (Local Governing Body) " CITY OF LITTLE CANADA Township: If site is located within a township, please complete items 24 and 25: Signature of Person Receiving Application: 25. Signature of Person Receiving Application tie Date Received (this date begirty " .LERK- TREASURER 4/17/89 period) Title: Name of Person Delivering Application to Local Governing Body: Township Name vagc 35 CG -00022 -01 (5/87) White Copy -Board Canary- Applicant Pink -Local Governing Body