Agenda Packets - 2021/11/22 - Laserfiche WebLink

Home Browse Search

11111121, 7:21 AM Revize Online Forms Location(s) of current lawful gambling operation(s) Beef'O'Brady's-Andover, Andover Lanes -Andover, Oak Roads Grill & Bar -Oak Grove Have you ever been denied a license or had one suspended or revoked?? If yes, please explain. No CHIEF EXECUTIVE OFFICER INFORMATION First Name MI Last Name Jason J Strasser Home Address City State Zip Code 1191 142nd Ave. Andover MN 55304 Date of Birth * Email Phone jhstras@comcast.net 763-528-8907 Format: MM/DD/YYYY Valid Email Required TREASURER INFORMATION Company (if outside organization) * First Name MI * Last Name Patrick H Wheeler Address City State Zip Code 2033 151st Lane NW Andover MN 55304 Date of Birth * Email patrickwhe@lubetech.com Format: MM/DD/YYYY Valid Email Required GAMBLING MANAGER INFORMATION Phone 612-581-7913 * First Name MI * Last Name Marcie K DeMaio Home Address City State Zip Code 3792 124th Lane Coon Rapids MN 55433 Date of Birth Format: MM/DD/YYYY * Email mdemaio87@outlook.com Valid Email Required Phone 763-227-1600 PRIVACY NOTICE: I understand the information provided in this application may be considered private or confidential data. I further understand that I may not be required by law to provide such information. The purpose of providing such information is to aid the City in its determination on said application. I acknowledge that providing, or failing to provide, such information may affect the City's determination on said application. I understand this information will be made available to the City of Mounds View, its City Council, agents and representatives, as well as the Minnesota Department of Revenue, the Internal Revenue Service, or any other person or entity authorized by law to receive said information. I release the City of Mounds View from any and all liability for its receipt and use of data received pursuant to this application. https://moundsviewmn.rja.revize.com/reports/179446 2/3