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CCP 02-13-2006
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CCP 02-13-2006
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<br />l--. <br />Gambling Manager Requirements:-- <br />. 1. An a~~ual g~mbling manager license fee of $100 is required. <br /> <br />Gambling Manager Authorization <br />Current License Term 4/1/2004 <br /> <br />- BOOrd- use- o;,jy ': <br /> <br />GM-01485-001 <br />to 3/31/2006 <br /> <br />. <br /> <br />Elizabeth Louise Matson <br />2774 Dellwood Ave, Roseville, MN 55113 <br />(651)633-0156 <br /> <br />Bond: Old Republic Surety Co <br />RPS 579134 <br />Last Education: 11/19/2004 <br /> <br />Check this box if the person listed a bove will not be Note: A new person may not <br />renewing as gambling manager. Enclose a separate " assume or act as gambling <br />LG212 application for the new applicant. Effective / manager until licensed by the <br />date will run concurrent with the organization's license. Gambling Control Board. <br /> <br />1M <br />e:=J <br /> <br />Gambling Manager Affidavit and Consent Statement <br /> <br />1. I have never been convicted of a felony or a crime <br />involving gambling. <br />2. I have never committed a violation of law or Board rule <br />that resulted in the revocation of a license issued by the <br />Board within five years before the date of the license <br />application. <br />3. I have never been convicted of a criminal violation <br />involving fraud, theft, tax evasion, misrepresentation, or <br />gambling. <br />4. I have never been convicted of (i) assault, (ii) a criminal <br />violation involving the use of a firearm, or (iii) making <br />terroristic threats. <br />5. I have never been, or am I now, connected with or <br />engaged in an illegal business. <br />6. I have never had a sales and use tax permit revoked by <br />the commissioner of revenue within the past two years. <br />7. I have never, after demand, failed to file tax returns <br />required by the commissioner of revenue. <br />S. I do not owe $500 or more in delinquent taxes as defined <br />in section 270.72. <br />9. I have been an active member of the organization for at <br />least two years at the time of our organization's initial license <br />application, or have been an active member for at least the <br />most recent six months prior to the effective date of our <br />organization's license renewal. <br />10. I am not a gambling manager or an assistant gambling <br />manager for another organization. <br />11. I am not a lessor, a member of the lessor's immediate <br />family or a person residing in the same household as the <br />lessor, or an employee of a lessor of a premises where this <br />organization has a permit issued from the Board to conduct <br />lawful gambling. <br />12. I am not involved directly or indirectiy as a bingo hall <br />owner, manufacturer, or distributor. <br /> <br />13. I am not the chief executive officer of this organization. <br />14. I am not the treasurer of this organization. <br />15. I was not an officer of an organization at a time when an <br />offense occurred which caused that organization's license to be <br />revoked. <br /> <br />Background Check. By signature of this document, the <br />undersigned authorizes the Departments of Public Safety and <br />Revenue to conduct a criminal and tax background check or review <br />and to share the results with the Gambling Control Board. Further, <br />I understand, agree, and hereby irrevocably consent that suits and <br />actions relating to the subject matter of this gambling manager <br />license application, or acts or omissions arising from such <br />application, may be commenced against me.or my organization and <br />I will accept the service of process in any court of competent <br />jurisdiction in Minnesota by service on the Minnesota Secretary of <br />State of any summons, process, or pleading authorized by the laws <br />of Minnesota. <br />Failure to provide required information or providing false or <br />misleading information may result in the denial or revocation of the <br />license. <br />Changes in the information submitted in this application will be <br />submitted in writing no later than 10 days after the change has <br />taken effect. <br /> <br />. <br /> <br /> <br />. <br />
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