04/27/1998 Council Packet - Laserfiche WebLink

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West LG 2100R PRINTED:O1 /12/98 STATE OF MINNESOTA IFOR BOARD USE ONLY GAMBLING CONTROL BOARD ORGANIZATION LICENSE RENEWAL APPLICATION LICENSE NUMBER:B -03017 EFFECTIVE DATE:07 /01/96 EXPIRATION DATE:06 /30/98 ORGANIZATION INFORMATION Fire Circle Pines Centennial Fighters Relief Assoc MN SALES & USE TAX PERMIT #: 2719874 7741 Lake Dr Lino Lakes MN 55014 COUNTY:Anoka PHONE NUMBER: 612 - 784 -7472 Desmond Englund 7081 Brian Dr Centerville MN 55038 CHIEF EXECUTIVE OFFICER INFORMATION DATE OF BIRTH: 09/01/40 PHONE NUMBER: 612 - 429 -5900 TREASURER INFORMATION 7080 Br.ca., t r DATE OF BIRTH: 06/01/39 Jerry Peterson CErttery Wt, IW/-i ��-S'� 3 PHONE NUMBER: 612 - 429 -0821 ORGANIZATIONS REGULARLY SCHEDULED MEETINGS ARE: 1st & 3rd Tues AT 6:30 PM NUMBER OF ACTIVE MEMBERS OVER THE AGE OF 18: 50 ACKNOWLEDGMENT I DECLARE THAT: • I HAVE READ THIS APPLICATION AND ALL INFORMATION SUBMITTED TO THE GAMBLING CONTROL BOARD; ALL INFORMATION IS TRUE, ACCURATE AND COMPLETE; •THE COMPENSATION SCHEDULE IS CURRENT AND ON FILE WITH THE BOARD; ▪ THE PROOF OF NONPROFIT STATUS FOR THE ORGANIZATION IS ON FILE WITH THE BOARD; OUR ORGANIZATION REMAINS IN GOOD STANDING AS A NONPROFIT CORPORATION WITH THE MINNESOTA SECRETARY OF STATE'S OFFICE AND /OR CONTINUES TO BE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INCOME TAX EXEMPT ORGANIZATION AND, IF APPLICABLE, OUR CHARTER REMAINS IN GOOD STANDING WITH OUR NATIONAL ORGANIZATION; ▪ THE INTERNAL CONTROLS ARE CURRENT AND ON FILE WITH THE BOARD; • ALL OTHER REQUIRED INFORMATION HAS BEEN FULLY DISCLOSED; • I AM THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION; • I ASSUME FULL RESPONSIBILITY FOR THE FAIR AND LAWFUL OPERATION OF ALL GAMBLING ACTIVITIES TO BE CONDUCTED; • I WILL FAMILIARIZE MYSELF WITH THE LAWS OF MINNESOTA GOVERNING LAWFUL GAMBLING AND RULES OF THE GAMBLING CONTROL BOARD AND AGREE, IF LICENSED, TO ABIDE BY THOSE LAWS AND RULES, INCLUDING AMENDMENTS TO THEM; •A MEMBERSHIP LIST OF THE ORGANIZATION WILL BE AVAILABLE WITHIN SEVEN DAYS AFTER IT IS REQUESTED BY THE GAMBLING CONTROL BOARD; •ANY CHANGES IN APPLICATION INFORMATION WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD AND THE LOCAL UNIT OF GOVERNMENT WITHIN 10 DAYS OF THE CHANGE; • A LICENSE TERMINATION PLAN WILL BE SUBMITTED TO THE GAMBLING CONTROL BOARD WITHIN 15 DAYS OF TERMINATION OF ALL PREMISES PERMIT(S); • THE GAMBLING MANAGER IS BONDED AND LICENSED AS REQUIRED BY MINNESOTA STATUTE; AND • I UNDERSTAND THAT FAILURE TO PROVIDE REQUIRED INFORMATION OR PROVIDING FALSE OR MISLEADING INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF THE LICENSE.