CCP 02-12-1990 - Laserfiche WebLink

Home Browse Search

Record No. 9644 ,<ff;tr!~~:~;,%y-<.. Department of Revenue - Gaming Division Fc.r Board Use Only !~~~2\ Mail Station 3315 . ,.~..~::?).~! 51. Paul, MN 55146-3315 Paid Amt: \p".Rj,,,iI (612) 297.5300 Check No. ',~"",t.J~,~,.,'s.':> Date: . GAMBLING L1eENSE RENEWAL APPLICATION L1CENBE NUMBER: H29\3-661 I EFF. DATE: 85/81/89 I AMOUNT OF FEE: 128U6 1. ApplicDnt- Legal Name of Organization 2. Street Address SWEET ~OElINES EDEN PRAIRIE CITY OF lAKES 153S7 Village Woods Dr 3. City, S~ale, Zip 4. County 5. Business Phone Eden Prairie, IN 5530 Hennepin (612 ) 937-8752 6. Name of Chief Executive Officer 7. Business Phone Joan Grootoassink (612)831-6644 8. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phone Jo Kramer (612 )333-0111 10, Name of Gambling Manager 11. Bond Number 12. Business Phone Phyllis Smith Sli73261 (612 ) 116-3711 13. Name of Establishment Where Gambling Will Take Place 14. County 15. No. of Active Members lrden Hills Hall lrden Hills Ramsey -91" /;.:; CJ 16. Lessor Name 17. Monthly Rent: Ashland Kgt ~5.).oo 18. If Bingo will be conducted with this license, please specify days and times of Bingo. Q..~y.~ Times I Qeys Times I Days Times '-J..1.:...d_.\'"\es~'U.h 7:, S P r>1 <): 15 PfT) WW"~$d""1 19. Has license ever been: o Revoked Date: D Suspended Date: o Denied Date: 20. Have internal controls been submitted proviously? ~ Yes o No (If "No," attach copy) 21. Has CL:rrent lease been filed with the board? [J Yes e&: No (If "No," attach copy) 22. Has CL;rrent sketch been file.":: wi.h ttle board? ;] Yes 1:8.' No (If "No," attach copy) -e GAMBLING SITE AUTHORIZATION By my sigilature below, local law'enforcement officers or agents of the Board are hereby authorized to enter upon the site, at any time, gamblin] is being conducted, to observe the gambling and to enforce the law for any unauthorized game or practice. BANK RECORDS AUTHORIZA nON By my sig,lature below, the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to fulfill requirements of current gambling rules and law. G.HH I hereby declare that: 1. I have read this application and all information submitted to the Board; 2. All information submitted is true, accurate and complete; 3. All other required information has been fully disclosed; 4. J am the chief executive officer of the organization; 5. 1 aSSUflle full responsibility for the fair and lawful operation of all activities to be conducted; 6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the board and agree, if licensed, to abide by those laws and rules, including amendments thereto. Sigflature (Chief Exec Title , ( ,4'1-.;:, .#"1l " ACKNO I'EDGEMENT OF NOTIC BY LOCAL GOVERNING ODY I hereby acknowledge receipt of a copy of this aptMfcation. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Gambling Control Board and if approved by the Board, will become effective 60 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of the below noted date. 24. H~C?u~lYJa1 }tci0>erning Body) Township: If site is located within a township, please complete items 24 and 25: Signature of Person Receiving Application: 25. Signature of Person Receiving Application Title: Township Name CG-00022.01 (4/89) While Copy-Board Canary-Applicant Pink-Local Governing Body