04-12-1989 Council Agenda - Laserfiche WebLink

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11 NNLY ;OrA OGI'nR rNLNT I)F Rt.VENUE GAMING DIVISION Mail Station 3315 St. Paul MN 55146 -3315 GAMBLING LICENSE RENEWAL APPLICATION For Board Use Only Paid Amt: Check No. Date: LICENSE NUMBER a- 41111 -982 • / EFF. DATE: 81181188 / AMOUNT OF FEE: 7188. a8 1. Applicant -Legal Name of Organization LAKE OWASSO RESIDENCE VOLUNTEER COUNCIL X 2. Street Address 218 North Owasso Blvd 3. City, State. Zip Shoreview, NN 55126 4. County Ramsey 5. Business Phone (612 )494 -2234 6. Name of Chief Executive Officer Janet Thu1 7. Business Phone (612 )314 -6141 8. Name of Treasurer or Person Who Accounts for Revenues Joan Jenkins c,, L-u it. 114. I4uU.S.,/1,1t,C, y. C4_0..2) 9. Business Phone (612 )641 -6834 10. Name of Gambling Manager Betty Strohbeen 11. Bond Number 518667491 12. Business Phone (612 )183 -1283 13. Name of Establishment Where Gambling Will Take Place little Canada Ringo Hall Little Canada 14. County Ramsey 15. No. of Active Members .ffi aO 18. Lessor Name Meyers Warehouse 17. Monthly Rent: •'SVA -1 02983. ¢'f 18. If Bingo will be conducted with this license, please specify days and times of Bingo. Days Times a Days Times 1 Pny 0. Vitt /C YU; to 790. - to 9c.v /fro Lt,)o.,•1:,0 /7 'l. - YY(ct:e ida,.j, hr'c,a it cttL7 '7fl� -h. 19. Has license ever been: A, e 0 Revoked Date: 20. Have internal controls been submitted previously? 21. Has current lease been filed with the board? 22. Has current sketch been filed with the board? Days Times .00,j ∎ c, -r{Jue5clf ti Ir. clay /C • - / • /5- , 0 Suspended Date: ❑ Denied Date. 18.Yes ❑ No (If "No," attach copy) 21 Yes ❑ No (If "No," attach copy) c3', Yes ❑ No (If "No," attach copy) 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; 8. 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, including amendments thereto. 23. Official Legal Name of prganization t aK C1GV,isSo Uu: w '1%cttre 1L. Sig (Chief xecutive Officer) Date Title 9 ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy of this app ication. By acknowledging receipt, I admit having been serve with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the Board, will become effective tiff from the date of receipt (opted below), unless a resolution of the local governing b dy is passed which specifically disallows such activi an a copy of that resolution is received by the Charitable Gambling Control Board within ays of the below noted date. 24. City /County Name (Local Governing Body) ' CTTY OF LTTTI F 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 ,. Ty� tom" Date Received (this date beg ins , ay period) RK 4/5/89 I�JI/ Title: plawi f Person Delivering pplication.to ocal Governing Body: �i / , 4) tic - .4i✓ Township Name CG- 00022 -01 (5/87) PageCopy-Board Canary- Applicant Pink -Local Governing Body F' 9