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Return to: Charitable Gambling Control Board <br />1821 University Avenue - Rm. N475 <br />St. Paul, MN 55104 -3383 <br />Phone: 612/642 -0555 <br />ONE DAY OFF -SITE <br />LAWFUL GAMBLING APPLICATION <br />• A licensed organization may, upon approval of this application, conduct gambling on a <br />premises other than a licensed site one day per calendar year for not more than 12 hours. <br />• If there are fewer than 60 days between the date that the city /county signs the <br />application and the date of the off -site gambling, include a waiver from the city /county <br />waiving its 60 -day disapproval period. <br />• Print clearly or type. Attach a copy of the lease for the off -site premises. <br />• After review, the application will be returned to the organization with approval or <br />denial indicated below. <br />Organization <br />Church St. Jerome Church <br />License No. <br />A _ 01122 — 001 <br />Address (street or P.O. box number) <br />380 E. Roselawn Ave. <br />City <br />Ijaplewood <br />n•In <br />State <br />Zip Code <br />55117 <br />Phone No. <br />(612 771 1209 <br />OFF -SITE INFORMATION <br />1. Name of premises where off -site lawful gambling will be conducted <br />Venetian Inn <br />2. Addre f off -site remises <br />2 � dice St. <br />City or township <br />Little Canada <br />State <br />Mn <br />Zip Code <br />55113 <br />3. Date of one -day event <br />April 22, 1990 <br />4. Has your organization conducted off -site gambling this year? DYES ENO <br />If YES, give date of event <br />5. Attach a lease for the one day off -site lawful gambling. <br />6. Name of chief executive officer (please print) <br />Rev. Kenneth Ludescher <br />S,/i� natur�% <br />G(�xr. `y4,h,p -, <br />ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY <br />I hereby acknowledge having been served with notice that this application will be reviewed by the Charitable <br />Gambling Control Board and, if approved, will become effective 60 days from the date of receipt <br />(noted below) unless a resolution of the local governing body is passed that specifically disallows such <br />activity and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of <br />the below noted date. The city or county may choose to waive the 60 -day acknowledgement period by resolution. <br />Attach the written waiver to this request. <br />7. Name of city or county (local governing body) <br />8. Signature of person receiving application <br />Title <br />Date received <br />If site is located within a township, items 9 and 10 must be completed in addition to the county signature. <br />9. Name of township <br />10. Signature of person receiving application <br />Title <br />FOR BOARD USE ONLY <br />Approved ( Denied <br />Exec <br />Cha• <br />Page 22 <br />Date <br />d <br />