05-24-1995 Council Agenda - Laserfiche WebLink

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STATE OF MINNESOTA GAMBLING CONTROL BOARD BINGO HALL LICENSE APPLICATION - LG 300 PRINTED: 03/08/95 PART 2 OF 2 LICENSE NUMBER: BH -040 NAME OF BINGO HALL The Market Place OATH I affirm that none of the persons listed in this application: (a) have ever been convicted of a felony; (b) have ever been convicted of a crime involving gambling; (c) have ever been convicted of assault, a criminal violation involving the use of a firearm, or making terroristic threats; (d) have ever been connected with or engaged in an illegal business; (e) owe delinquent taxes in excess of $500 as defined in Minnesota Statutes section 270.72; (f) have ever had a sales and use tax permit revoked by the Commissioner of Revenue within the past two years; (g) failed to file after demand, tax returns required by the Minnesota Commissioner of Revenue. I affirm that none of the individuals listed, or a person holding a financial or managerial interest in the bingo hall or affiliate thereof is /are not: (a) a licensed distributor or affiliate of a distributor under section 349.161; (b) a licensed manufacturer or affiliate of a manufacturer under section 349.163; or (c) a wholesale distributor or an affiliate of a wholesale distributor of alcoholic beverages. I further affirm that the bingo hall licensee, person(s) holding a financial or managerial interest in the bingo hall, or any affiliate(s) will not: (1) provide any staff to conduct or assist in the conduct of bingo or any other form of lawful gambling on the premises; (2) acquire, provide inventory control for, or report the use of any gambling equipment used by an organization that conducts lawful gambling on the premises; (3) prepare any reports required by part 7861.0120, subp. 3, for an organization conducting lawful gambling on the premises; (4) provide accounting services to an organization conducting lawful gambling on the premises; (5) solicit, suggest, encourage, or make any expenditure of gross receipts of an organization from lawful gambling; (6) charge any fee to a person without which the person could not play bingo or participate in another form of lawful gambling on the premises; (7) provide assistance or participate in the conduct of lawful gambling on the premises; or (8) permit more than 21 bingo occasions to be conducted on the premises in any week. I declare that this application is correct and complete to the best of my knowledge and belief. I will familiarize myself with the laws of the state of Minnesota and rules of the Board governing gambling and agree, if licensed, to abide by those laws and rules, including amendments to them. Changes in the information submitted in this application will be submitted to the Board and local unit of government within ten days after the change occurs. The Chief Executive Officer of the bingo hall must ai iyteAAppplication, confirming the oath. E > Subscribed and sworn to before me this 12 day of (�(yrL� 19 9 LJ Q5 D 00, //l.- l�I.f *t CS�66,0 2 R 4 Nota}kyy Public 6 w i« E i 1 3 J CO z My commission expires 0 " Page 27 Signature of the Chief Executive Officer i%c/c.J / Date Signed 5 %ar