HomeMy WebLinkAbout03-061
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~HILLS
CITY OF ARDEN HILLS
COUNTY OF RAMSEY
STATE OF MINNESOTA
RESOLUTION NO. 03-61
A RESOLUTION
APPROVING AN APPLICATION FOR AUTHORIZATION
OF AN EXEMPT GAMBLING PERMIT
FOR TRINITY LUTHERAN CHURCH
THEREFORE, BE IT RESOLVED that the City Council hereby approves the
application for authorization to conduct exempt gambling activities at Trinity Lutheran
Church at its annual Craft Fair event to be held Saturday, November I, 2003 with total
prizes not exceeding $2,500.00 for the 2003 calendar year.
ADOPTED by the City Council this 29th day of September, 2003.
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, verly l\plikowski, Mayor
ATTEST:
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Michelle Wolfe, dministrator
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Minnesota Lawful Gambling
LG240R Application to Conduct Excluded Raffle
(No fee)
06/03
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If your organization has been Iicensec;l or exempted in the ~urrent calendar year, you are not eligible to apply for excluded raffle.
Organization Information
Previous authorization number, jf any
ry of State or Internal Revenue Service)
Street
3..:1 t/ S-
City vi , I
tH2..trej/ N i 1/ S
Type of nonprofit organization (check one)
o Fraternal D Veteran
~ ReligiQus 0 Other nonprofit organization
Type of proof of nonprofit - attach a copy (see instructions):
D Certificate of Good Standing .- Minnesota Secretary of State's Office
~ Internal Revenue Service
D Affiliate of Parent nonprofit organization (charter)
Excluded Raffle Activi Information
Dale ofraffle drawing --L/--!--'---l-
Nameofthe person in charyeofraffle
Total marketvalueofraffleprizes $ (;)00. 6-0
(The value of all raffle prizes in a calendar year may not exceed $1500.)
Phonel Ij,r-f I </'i'l- SI+ iffp
Premises Where Excluded, Raffle Will Be Conducted
Name of Premises
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.::r$7/ L
The infonnation provided in this applica .
mplete and accurate to Ihe best of myknowledgc.
Chief executive officer's signatu
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Name {please print}
Phone number ~t.~~.3t.-rf
Oat. '1 /L2.JQd
ThisfonnW1] be made available in aIlemativefonnat O.e. targe prin~ Braille)
upon request The information requested on this form (and any
attachments) will be used by the Gambling Control Board (Board) to
detennine your qualifications to be involved in lawful gambling activities in
Minnesota. You have the right 10 refuse 10 supply the infOlmation requested;
however, it you refuse to supply this information, the Board may not be
able to detennine your qualifications and, as a consequence, may refuse
to issueyou an authorization. If you supply the infonnation requested, the
Board will be able to process your application.
Your name and your organization's name and address will be public
information when received by the Board, All the other information that you
provide win be private data about you until the Board issues your permit or
authorization. When the Board issues your authorization. all of the
infonnation that you have provided to the Board in the process of applying
for your authorization will become public. If the Board does not issue you
an authorization, all the information you have provided inthe process of
applying for an authorization remains private. with the exception of your
name and and your organization's name and address which win remain
public.
Private data about you are available only to the following: Board members;
staff of the Board whose workassignment requires thatthey have access
to the information; the Minnesota Department of Public Safety; the
Minnesota Attorney General; the Minnesota' Commissioners of
Administration. Finance, and Revenue; the Minnesota LegislativeAuditor,
national and international gambling regulatory agencies; anyone pursuant
to court order; other individuals and agendes thatare spedficaUy authorized
by state or federal law to have access to the information; individuals and
agendes for which law or legal order authorizes a new use or sharing of
infonnation after this Notice was given; and anyone with your oonsent
.
Mail Application and Attachment(s)
Send the completed application and a copy of your proof of nonprofit status at least 30 days prior to the activity date to:
Gambling Control Board
Suite 300 South
1711 West County Road B
Roseville, MN 55113