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5F, A Motion to Acknowledge the Application of Catholic United Financial for an Exempt Permit to Conduct a Raffle with the Date of the Drawing being March 14, 2013, with No Waiting Period
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5F, A Motion to Acknowledge the Application of Catholic United Financial for an Exempt Permit to Conduct a Raffle with the Date of the Drawing being March 14, 2013, with No Waiting Period
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LG220 Application for Exempt Permit 6/12 Page 2 of 2 <br /> LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT <br /> CITY APPROVAL COUNTY APPROVAL <br /> for a gambling premises for a gambling premises <br /> located within city limits located in a township <br /> The application is acknowledged with no waiting period. The application is acknowledged with no waiting period. <br /> _The application is acknowledged with a 30 day waiting The application is acknowledged with a 30 day waiting <br /> period, and allows the Board to issue a permit after 30 days period, and allows the Board to issue a permit after 30 <br /> [60 days for a 1st class city]. days. <br /> _The application is denied. The application is denied. <br /> Print city name Print county name <br /> Signature of city personnel Signature of county personnel <br /> Title Date Title Date <br /> TOWNSHIP-If required by county. On behalf of the township, <br /> I acknowledge that the organization is applying for exempted <br /> gambling activity within the township limits. <br /> [A township has no statutory authority to approve or deny an <br /> Local unit of government must sign application, per Minnesota Statutes 349.166.] <br /> Print township name <br /> Signature of township officer <br /> Title Date <br /> CHIEF EXECUTIVE OFFICER'S SIGNATURE <br /> The information provided in this application is complete and accurate to the best of my knowledge. I acknowledge that the financial <br /> report will be completed and returned to e d within 3 days of the event date. q <br /> Chief executive officer's signature Date <br /> Print name Bonnie Westberg <br /> REQUIREMENTS Reset form <br /> Complete a separate application for: Financial report and recordkeeping required <br /> - all gambling conducted on two or more consecutive days, or A financial report form and instructions will be sent with your <br /> - all gambling conducted on one day. permit, or use the online fill-in form available at <br /> Only one application is required if one or more raffle www.gcb.state.mn.us. <br /> drawings are conducted on the same day. <br /> Within 30 days of the event date, complete and return <br /> Send application with: the financial report form to the Gambling Control Board. <br /> _a copy of your proof of nonprofit status, and <br /> application fee. Make check payable to "State of Minnesota." Questions? <br /> Call the Licensing Section of the Gambling Control Board <br /> To: Gambling Control Board at 651-639-4000. <br /> 1711 West County Road B, Suite 300 South This form will be made available in alternative format(i.e.large print,Braille) <br /> Roseville, MN 55113 upon request. <br /> Data privacy notice: The information requested on this All other information provided will be pri- General; Commissioners of Administration, <br /> form(and any attachments)will be used by the Gambling vate data about your organization until the Minnesota Management&Budget,and <br /> Control Board (Board)to determine your organization's Board issues the permit. When the Board Revenue; Legislative Auditor, national and <br /> qualifications to be involved in lawful gambling activities in issues the permit,all information provided international gambling regulatory agencies; <br /> Minnesota. Your organization has the right to refuse to will become public. If the Board does not anyone pursuant to court order;other indi- <br /> supply the information; however, if your organization issue a permit,all information provided viduals and agencies specifically authorized <br /> refuses to supply this information,the Board may not be remains private,with the exception of your by state or federal law to have access to <br /> able to determine your organization's qualifications and, organization's name and address which will the information; individuals and agencies <br /> as a consequence,may refuse to issue a permit. If your remain public. Private data about your for which law or legal order authorizes a <br /> organization supplies the information requested, the Board organization are available to: Board mem- new use or sharing of information after this <br /> will be able to process the application. Your organization's bers, Board staff whose work requires notice was given; and anyone with your <br /> name and address will be public information when received access to the information; Minnesota's written consent. <br /> by the Board. Department of Public Safety;Attorney <br />
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