HomeMy WebLinkAboutResolution 23-047 CITY OF LINO LAKES
RESOLUTION NO. 23-47
LOCAL APPROVAL OF A LAWFUL GAMBLING PREMISES PERMIT
FOR FOREST LAKE AREA ATHLETIC ASSOCIATION
WHEREAS, the Lino Lakes City Council has received an application for a Premises Permit to
conduct lawful gambling from the Forest Lake Area Athletic Association at Fiesta Mexican Grill
&Bar at 7090 21'Avenue North, Lino Lakes, Minnesota.
WHEREAS, the Minnesota Gambling Control Board requires local approval by resolution of all
premises permits; and
WHEREAS,the City of Lino Lakes has conducted the required background investigation relative
to the Gambling Manager; and
WHEREAS, Forest Lake Area Athletic Associate is eligible for local approval of a gambling
Premises Permit pursuant to Chapter 611 of the Lino Lakes City Code relating to Lawful
Gambling;
NOW,THEREFORE,BE IT RESOLVED by the City Council of the City of Lino Lakes hereby
approves the request of the Forest Lake Area Athletic Association for a Premise Permit for
charitable gambling at Fiesta Mexican Grill&Bar located at 7090 21st Avenue North, Lino Lakes,
Minnesota.
Adopted by the Council of the City of Lino Lakes this 22nd day of May, 2023.
t*".et-42- 1
Rob afferty, ayor
Jolleen Chaika, City Clerk
MINNESOTA LAWFUL GAMBLING 6/15 Pagel of 2
LG214 Premises Permit Application Annual Fee $150 (NON-REFUNDABLE)
REQUIRED ATTACHMENTS TO LG214
1. If the premises is leased, attach a copy of your lease. Use LG215 Mail the application and required attachments to:
Lease for Lawful Gambling Activity. Minnesota Gambling Control Board
2. $150 annual premises permit fee, for each permit(non-refundable). 1711 West County Road B, Suite 300 South
Make check payable to "State of Minnesota." Roseville, MN 55113
Questions? Call 651-539-1900 and ask for Licensing.
ORGANIZATION INFORMATION
Organization Name: Forest Lake Area Athletic Assciation License Number: 04354
Chief Executive Officer(CEO) Allan Hauge Daytime Phone: 651-270-1229
Gambling Manager: Dana Arntzen Daytime Phone: 651-895-5015
GAMBLING PREMISES INFORMATION
Current name of site where gambling will be conducted: Fiesta Mexican Grill and Bar
List any previous names for this location:
Street address where premises is located: 7090 21st Ave N
(Do not use a P.O.box number or mailing address.;
City: OR Township: ( aunty: Zip Code:
Lino Lakes Ramsey 55038
Does your organization own the building where the gambling will be conducted?
Yes n No If no, attach LG215 Lease for Lawful Gambling Activity.
A lease is not required if only a raffle will be conducted.Is any other organization conducting gambling at this site? nYes I n I No n Don't know
Note: Bar bingo can only be conducted at a site where another form of lawful gambling is being conducted by the applying organi-
zation or another permitted organization. Electronic games can only be conducted at a site where paper pull-tabs are played.
Has your organization previously conducted gambling at this site? nYes fNo nDon't know
GAMBLING BANK ACCOUNT INFORMATION; MUST BE IN MINNESOTA
Bank Name: MidWestOne Bank Account Number: 4137741
Bank Street Address: 1650 Lake St S City: Forest Lake State: MN Zip Code: 55025
ALL TEMPORARY AND PERMANENT OFF-SITE STORAGE SPACES
Address (Do not use a P.O. box number): City: State: Zip Code:
Hallberg Mini Storage 682 Lake St N Forest Lake MN 55025
MN
MN
LG214 Premises Permit Application 6/15 Page 2 of 2
ACKNOWLEDGMENT BY LOCAL UNIT OF GOVERNMENT: APPROVAL BY RESOLUTION
CITY APPROVAL COUNTY APPROVAL
for a gambling premises for a gambling premises
located within city limits located in a township
City Name: Lino Lakes County Name:
Date Approved by City Council: MA-Al Zy, 2 Date Approved by County Board:
Resolution Number: 13,— 4:1 Resolution Number:
(If none, attach meeting minutes.) (If none, attach meeting minutes.)
Signature of City Personnel: Signature of County Personnel:
Title: G C'14"-VIO"'" Date Signed: '127-12✓ Title: Date Signed:
TOWNSHIP NAME:
Complete below only if required by the county.
Local unit of government On behalf of the township, I acknowledge that the organization is
must sign. applying to conduct gambling activity within the township limits.
(A township has no statutory authority to approve or deny an
application, per Minnesota Statutes 349.213, Subd. 2.)
Print Township Name:
Signature of Township Officer:
Title: Date Signed:
ACKNOWLEDGMENT AND OATH
1. I hereby consent that local law enforcement officers, 6. I assume full responsibility for the fair and lawful operation of
the Board or its agents, and the commissioners of all activities to be conducted.
revenue or public safety and their agents may enter
and inspect the premises. 7. I will familiarize myself with the laws of Minnesota governing
lawful gambling and rules of the Board and agree, if licensed,
2. The Board and its agents, and the commissioners of to abide by those laws and rules, including amendments to
revenue and public safety and their agents, are them.
authorized to inspect the bank records of the gambling
account whenever necessary to fulfill requirements of 8. Any changes in application information will be submitted to the
current gambling rules and law. Board no later than ten days after the change has taken
effect.
3. I have read this application and all information
submitted to the Board is true, accurate, and complete. 9. I understand that failure to provide required information or
providing false or misleading information may result in the
4. All required information has been fully disclosed. denial or revocation of the license.
5. I am the chief executive officer of the ganization. 10. I understand the fee is non-refundable regardless of license
approval/denial.
06.'04-A
Signature of Chief Executive Officer(designee may not sign) Date
Data privacy notice:The information requested on this information when received by the Board. Minnesota's Department of Public Safety,
form (and any attachments)will be used by the All other information provided will be Attorney General,Commissioners of
Gambling Control Board (Board)to determine your private data about your organization until Administration, Minnesota Management&
organization's qualifications to be involved in lawful the Board issues the permit. When the Budget,and Revenue; Legislative Auditor,
gambling activities in Minnesota.Your organization has Board issues the permit,all information national and international gambling
the right to refuse to supply the information; however, provided will become public. If the Board regulatory agencies; anyone pursuant to
if your organization refuses to supply this information, does not issue a permit,all information court order; other individuals and agencies
the Board may not be able to determine your provided remains private, with the specifically authorized by state or federal law
organization's qualifications and,as a consequence, exception of your organization's name and to have access to the information; individuals
may refuse to issue a permit. If your organization address which will remain public. Private and agencies for which law or legal order
supplies the information requested,the Board will be data about your organization are available authorizes a new use or sharing of
able to process your organization's application. Your to: Board members, Board staff whose information after this notice was given; and
organization's name and address will be public work requires access to the information; anyone with your written consent.
This form will be made available in alternative format, i.e. large print, braille, upon request.
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