HomeMy WebLinkAboutItem 4B, Flaherty's Charitable Gambling License
Request for Council Action
.
Prepared By: Noah Simon
Council Meeting Date: May 27,2008
Adopt Resolution 2008-028, approving the charitable gambling license request
submitted by the 621 Foundation, to conduct charitable gambling (pull tabs,
tipboards, paddlewheel, bar bingo and meat raffles) at Flaherty's Arden Bowl for a
period of two years.
Budgeted Amount:
$0.00
Actual Amount:
$0.00
Funding Source:
Recommendation:
1. Adopt Resolution 2008-028, approving the charitable gambling license request submitted by the 621
Foundation, to conduct charitable gambling (pull tabs, tipboards, paddlewheel, bar bingo and meat
raffles) at Flaherty's Arden Bowl for a period of two years.
Documents:
1 . Resolution 2008-028
2. Memo dated May 27'" From Noah Simon to the City Council
3. 621 Foundation Application
~
/]'\~ HILLS
MEMORANDUM
DATE:
May 27, 2008
TO:
City Councilmembers
FROM:
Noah A. Simon, Assistant City Administrator
Ronald J. Moorse, City Administrator
SUBJECT:
Charitable Gambling License
Requested Action
Adopt Resolution 2008-028, approving the charitable gambling license request submitted by the
621 Foundation, to conduct charitable gambling (pull tabs, tipboards, paddlewheeI, bar bingo and
meat raffles) at Flaherty's Arden Bowl for a period of two years.
Backl!round
The City has received a charitable gambling license application from the 621 Foundation and all
required forms, paperwork and the application fee.
~
~HILLS
CITY OF ARDEN HILLS
COUNTY OF RAMSEY
STATE OF MINNESOTA
RESOLUTION NO. 2008-028
A RESOLUTION APPROVING A CHARITABLE GAMBLING LICENSE FOR THE 621
FOUNDATION TO CONDUCT CHARITABLE GAMBLING (PULLTABS,
TIPBOARDS, PADDLEWHEEL, BAR BINGO AND MEAT RAFFLES) AT
FLAHERTY'S ARDEN BOWL
NOW THEREFORE, BE IT RESOLVED by the City Council of the City of Arden
Hills, Minnesota, that the City agrees to approve a Charitable Gambling License for two
years, to the 621 Foundation to conduct bar bingo and meat raffles at Flaherty's Arden
Bowl, 1273 West County Road E, Arden Hills, Minnesota, 55113.
ADOPTED BY THE CITY COUNCIL OF THE CITY OF ARDEN HILLS THIS
27th DAY OF MAY.
Stanley D. Harpstead, Mayor
ATTEST:
Ronald J. Moorse, qty Administrator
~
~HlLLS
City of Arden Hills
1245 West Highway 96
Arden Hills, Minnesota 55112
Phone: 651.792.7800
Fax: 651.634.5137
www.ci.arden-hills.mn.us
License No. GAMOB- ()
Receipt No.
Amount Paid $150.00
Date Recvd.
Ins. Celt.
Total Fee Paid
2008 Charitable Gambling Premise Permit-
Application Form
(Terms of the License: 2 Year Agreement)
Information (allfields are required)
Business Name:
rod-I mUIl~bY-J
IBox 1~d6'=>'6" J VJf...? B0.:'Jh-Im. ()'\t'\ LZfS It;;l, I
_D ~.S3~J:\-a ~~'S:_~~..k?.ILY\:L_.___.____.___. ..__..........__
~-$-~.1)~1Ecs____.
.tQ 51::1_ ~:235b__. Business Fax(Q21-=Y~I=~ I ~Q
sJrk~ &YloYJ(.:k:'Cl~S. ~~Address: h~ldb;,lndxb~"Q~
3j:"-~-'1ls.BS
Property Address:
Nature of Business:
Local Contact:
Business Phone:
Email Addres~:
F ederallD#:
Premise Permit and Investigation Fee
$150.00
Please submit the foUowinl! forms with your application:
*2007 Income and Loss Statement
*Projected 2008 Receipts/Prizes
*Form LG200B Organization Officers Affidavit
*FolTIl LG214 Premise Permit Application
*Form LG200R A preprinted renewal from the Gambling Control Board (if this is a renewal)
*Fonn LG215 Lease for Lawful Gambling Activity
*Copy of Lease Agreement
*Insurance certificate
(All organizations pennitted to conduct lawful gambling within the City of Arden Hills shall contribute 10% (ten percent) of their
net profits derived from gambling activities within the City to a special fund to be administered by the City Council for lawful
purposes. Payments to the fund shaH he calculated for quarterly periods ending on the last days of March, June, September and
December. Quarterly installment payments shall be submitted togelher with verifiable supporting documentation no later than the
twentieth day of the month following the end of the quarterly period.)
Anthorized Signature 3 l~ ~~
Dale 5-ld- 0 8
Minnesota Lawful Gambling
LG214 Premises Permit Application
Annual Fee $150 6/07 Page 1 of2
FOR BOARD USE ONLY
. Check #
$
Licensenumber 0'-\ ;;1.4\
Organization name ~ d \ ~o'-\,-..d 1>.\\0"'-'
Chief executive officer (CEO)
Daytime phone b S' - (:;~;1-? bE:.S
Name of establishment where gambling will be conducted f=" I \;\~'Q;Q_~.s. C\qQ~", 1t,C:>'-l)\
Street address where premises is located 1';l"T3. \..U. <::"0. ~d.. ~
(Do not use a P.O. box number or mailing address)
City Township County Zip code
I_~~~~~--~~~~---~~---------------------------------~~~~~~______________~~_~~~_____
Does your organization own the building where the gambling wi.!1 be conducted?
Yes XNo If no, attach LG215 Lease for Lawful Gambling Activity
Bank name
Bank account number
~~~~~~~__~~_~~~~_________________L~~~~~~___________________________
Bank street address City
I'S()\ \..A.). ~D. '<.cl ~ ~';olW\\\Q
All Temporary a fbff-$HeSt
(for gambling equipmeri't'an I.ated t&this site?:
Address (Do not use a P.O. box number)
__R~L__?~ '5~tS-+ ,W
Bin~o Occasions ([hi::lJ.ll:lin.!fbarbingo)
Enter day and beginning/ending hours of bingo occasions (indicate A.M. or P.M.). An occasion may not exceed 8 hours.
1m
-~~Q~-
-[.Q-~----
::rh_L,l-f~__
Beainnina/Endina Hours
_____f,d, 3D _ to _'1.L~_CZ___
____~L~Q_ to __-q; 3Q__
_____~ '3_~ to 3-,~-Q---
1m
Beainnina/Endina Hours
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
to
OA' I ...
no-+- 'S(A..{"~ w~ D+h'tf n"fj h-r () vJl:-. POSS, bI;1
()J&J. or- ThU'\s" f'I\'l:Q...k (,C1.~\tS ch.d\r?1 l))'?,) )'lOT
Su.Cf D+- c\. "~'r"" Ij~t..
LG214 Premises Permit Application
Data Privacy
The information requested on this form (and any attachments)
will be used by the Gambling Control Board (Board) to
determine your qualifications to be involved in lawful gambling
activities in Minnesota, and to assist the Board in conducting a
background investigation of you. You have the right to refuse
to supply the information requested; however, if you refuse to
supply this information, the Board may not be able to
determine your qualifications and, as a consequence, may
refuse to issue you a premises permit. If you supply the
information requested, the Board will be able to process your
application.
Your name and address will be public information when
received by the Board. All other information you provide will
be private data until the Board issues your premises permit.
6107
Page 2 of 2
When the Board issues your premises permit, all permit infonnation
provided will become public. If the Board does not issue you a
premises permit, all the information provided remains private, with
the exception of your name and address that will remain public.
Private data about you are available to: Board members; Board
staff whose work requires access to the information; Minnesota's
Department of Public Safety; Attorney General; Commissioners of
Administration, Finance, and Revenue; LegislativeAtJditor; national
and international gambling regulatory agencies; anyone pursuant to
court order; other individuals and agencies that are specifically
authorized by state or federal law to have access to the
information; individuals and agencies for which law or legal order
authorizes a new use or sharing of Information after this notice
was given; and anyone with your consent.
1. I hereby consent that local law enforcement officers, the Board or its agents, and the commissioners of revenue or
public safety and their agents may enter the premises to inspect it and enforce the law.
2. The Board and its agents, and the commissioners of revenue and public safety and their agents are authorized to
inspect the bank records of the gambling account whenever necessary to 'fulfill requirements of current gambling
rules and law.
3. I have read this application and all information submitted to the Board is true, accurate, and complete.
4. All required information has been fully disclosed.
5. I am the chief executive officer of the organization.
6. I assume full responsibility for the fair and lawful operation of all activities to be conducted.
7. I will familiarize myself with the laws of Minnesota governing lawful gambling and rules of the Board and agree, if
licensed, to abide by those laws and rules, including amendments to them.
8. Any changes in application information will be submitted to the Board no later than 10 days after the change has
taken effect.
9. I understand that failure to provide required information or providing false or misleading information may result in
the denial or revocation of the license.
__~ 'rnc~
Signature of Chief Executive Officer (designee may not sign)
Pri nt name __<2.~_~_~_'-<i___~:-_~_~':'~":_'i__________________________
~3o)
Date
DE
Monthly Reguhitory Fee
If you receive a premises permit for this site,
there is a monthly regulatory fee of 0.1% (.001)
of gross receipts from lawful gambling
conducted at the site. The fee is reported on the
G1 Lawful Gambling Monthly Summary and Tax
Return and paid with the monthly tax report.
1. LG214 Premises Permit Application
2. If the premises is leased, attach a copy of your lease.
Use LG215 Lease for Lawful Gambling Activity.
3. Attach a resolution from the local unit of government that
shows approval of your application:
if the premises is within a city, attach city approval, or
if the premises is within a township, attach county
approval.
4. $150 annual premises permit fee, for each permit.
Make check payable to "State of Minnesota."
Mail to:
Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113
Questions?
Call the Licensing Section of the Gambling
Control Board at 651-639-4000.
This form will be made available in alternative
format (Le. large print, Braille) upon request.
Minnesota Lawful Gambling
LG215 Lease for Lawful Gamblin
6/07
Page 1 of 2
Check applicable item:
$- 1. Lease for new application. Submit with new premises permit application.
___2. Renewed lease. Submit with premises permit renewal.
___3. New owner. Effective date ____L_"__I____ Submit new or amended lease within 10 days after new lessor assumes ownership.
4. Amended lease
. Check the change(s} in the lease: ___Rent ___Premises name ___Booth/bar __Activity change __Other
. Date that changes will be effectiv8_____I____I_____
. Both parties must initial and date all changes.
. Submit changes at least 10 days before the effective date of the change.
Organization name License number Daytime phone
Cod-\ ~~o..\t';',",- Cl4'd.41 "'5\- (,?'~-W"
--~-~-'----_._----------_._----_._----- -~~-
Nameofleased premises Street address City
i: h~1.n~~___L~~J?, W~ Qo'_~c:I. ~___ ~~'" \~~~'S
Name of legal owner of premises! Business/street address City
E~~-h~s~~ i B~tSress C~~C-
owner, write in "SAME") l
~~ 'L S .;;).ry\'L
;[~h~.dk,:bh':all',ClQ:iY'i~i,~,$,~6at}~'iIl-:,ij~..~~,iijM:<[J::~~fn;:: ',\ ~:![~~~ii~~~li~i~f~f~4,j[&;i ll:}f%~~\4I~i~1~11~t~?~~4~4f~~~*~~*ft
XPull-tabs _Pull-tabs with dispensing device )lTipboards :X-Paddlewheel _Paddlewheel with table _Bingo )lBar bingo
PU. n.tab.....Ti"i:l6at.di.and.Palil!:lj~j,iI,}j6.t<fl~iif:"~~+:wlN'Y,~~~;iZ.1!i\i3~~ifl~\i~~~~~.~ii~~~l.~
c-.... ....".",. .,~",. ..,n. . ",n,n. .... _,.'.,' ....,'~.,'_..,"",...,)""'~i'hii!l~~t"..~4!i!Qh~i"""",,,'.^^^~Y:!~nf~~~1i1i!~V,^,4YJf"H0~ 0-,,,,s.,,,.J,,,,,,^,,,,o.
Booth operation - sales of gambling equipment by an employee Bar operation M sales of gambling equipment within a leased
(or volunteer) of a licensed organization within a separate enclosure premises by an employee of the lessor from a common area where
that is dIstinct from areas where food and beverages are sold. food and beverages are also sold.
State
Zip
Daytime phone
MN
"'C:;II~
i Zip Daytime phone
~E=.. 'S.:; n..,
Zip
Daytime phone
State
State
~c
'L
'So-rn<i:...
Doe:'s~" . '" .
L ~ _ .......-'- ~.~'irQ~,;#~~'dqt~'#~;p~r\~~ioV';'~~\,
If you answered yes to the question above, rent limits are
based on the following combinations of operation:
Booth operation
Booth operation and pull~tab dispensing device
Booth operation and bar operation
Booth operation, bar operation, and pUll-tab dispensing device
If you answered no to the question above, rent limits are
based on the following combinations of operation:
Bar operation
Bar operation with pull-tab dispensing device
Puil-tab dispensing device only
The maximum rent allowed may not exceed $1,750 in total
per month for all organizations at this premises.
The maximum rent allowed may not exceed $2,500 in total
per month for all organizations at this premises.
COMPLETE ONE OPTION:
Option A: 0 to 10% ofthe-9ross profits per month.
Percentage to be paid 10 %
COMPLETE ONE OPTION:
Option A: 0 to 20% of the gross profits per month.
Percentage to be paid %
Option B: When gross profits are $4,000 or less per month, $0 to Option B: When gross profits are $1,000 or less per month, $0
$400 per month may be paid. Amount to be paid $ to $200 per month may be paid. Amount to be paid $
Option c: $0 to $400 per month on the first $4,000 of gross
proAt. Amount to be paid $
Plus, 0% to 10% of the gross profits may be paid per month on
gross profits over $4,000. Percentage to be paid _%
Bil19gRent
Option D: 0 to 10% of the gross profits per month from all lawful
gambling activities held during bingo occasions, excluding bar bingo.
Percentage to be paid ___ %
Option C: $0 to $200 per month on the first $1,000 of gross
profits. Amount to be paid $
Plus, 0% to 20% of the gross profits may be paid per month on
gross profits over $1,0'00., Percentage to be paid %
Option E: A rate based on a cost per square foot, not to exceed
110% of a comparable cost per square foot for leased space, as
approved by the director of the Gambling Control Board. No rent may be
paid for bar bingo. Rate to be paid $ per square foot.
The lessor must attach documentation, verified by the organization, to
confirm the comparable rate and all applicable costs to be paid by the
organization to the lessor.
For any new bingo activity not previously
included ina Premises Permit Application,
attach a separate sheet of paper listing the
days and hours that bingo will be conducted.
LG215 Lease for Lawful Gambling Activity
6/07
Page 2 of 2
Lease Term
The term of this lease agreement will be concurrent with the
premises permit issued by the Gambling Control Board (Board).
Management of Gambling Prohibited
The owner of the premises or the lessor will not manage the
conduct of gambling at the premises.
Participation as Players Prohibited
The lesso~ the lessor's immediate family, and any agents or
gambling employees of the lessor will not participate as players
in the conduct of lawful gambling on the premises.
Illegal Gambling
. The lessor is aware of the prohibition against illegal gambling
in Minnesota Statutes 609.75, and the penalties for illegal
gambling violations in Minnesota Rules 7865.0220, Subpart 3.
In addition, the Board may authorize the organization to
withhold rent for a period of up to 90 days if the Board
determines that illegal gambling occurred on the premises and
that the lessor or its employees participated in the illegal
gambling or knew of the gambling and did not take prompt
action to stop the gambling. Continued tenancy of the
organization is authorized without payment of rent during the
time period determined by the Board for violations of this
provision, as authorized by Minnesota Statutes 349.18,
Subdivi~on l(a),
. To the best of the lessor's knowledge, the lessor affirms that
any and all games or devices located on the premises are not
being used, and are not capable of being used, in a manner
that violates the prohibitions against illegal gambling in
Minnesota Statutes 609.75.
. Notwithstanding Minnesota Rules 7865.0220, Subpart 3, an
organization must continue making rent payments under
the terms of this lease, if the organization or its agents are
found to be solely responsible for any illegal gambling,
conducted at this site, that is prohibited by Minnesota Rules
7861.0260, Subpart 1, item H or Minnesota Statutes 609.75,
unless the organization's agents responsible for the illegal
gambling activity are also agents or employees of the lessor.
. The lessor must not modify or terminate the lease in whole or
in part because the organization reported, to a state or local
law enforcement authority or the Board, the conduct of illegal
gambling activity at this site in which the organization did not
participate.
Other Prohibitions
. The lessor will not impose restrictions on the organization with respect
to providers (distributors) of gambling-related equipment and services
or in the use of net profits for lawful purposes.
. The lessor, any person residing in the same household as the lesso~
the lessors immediate family, and any agents or employees of the
lessor wlll not require the' organization to perfonn any action that
would violate statute or rule. The lessor must not modify or terminate
this lease in whole or in part due to the lessors violation of this
provision. If there is a dispute as to whether a violation occurred, the
lease will remain in effect pending a final determination by the
Compliance Review Group (CRG) of the Gambling Controi Board. The
lessor agrees to arbitration when a violation of this pro'vision is
alleged. The arbitrator shall be the CRG.
Access to permitted premises
The Board and its agents, the commissioners of revenue and public
safety and their agents, and law enforcement personnel have access to
the pennitted premises at any reasonable time during the business hours
of the lessor. The organization has access to the permitted premises
during any time reasonable and when necessary for the conduct of
lawful gambling on the premises.
lessor records
The lessor must maintain a record of all money received from the
organization, and make the record available to the Board and its agents,
and the commissioners of revenue and public safety and their agents
upon demand. The record must be maintained for 3~ 1/2 years.
Rent all-inclusive
Amounts pC3.id as rent by the organization to the lessor are all-indusive.
No other services or expenses provided or contracted by the lessor may
be paid by the organization, induding but not limited to trash removal,
janitorial and cleaning services, snow removal, lawn services, electricity,
heat, security, security monitoring, storage, other utilities or selVices,
and in the case of bar operations, cash shortages.
Any other expenditures made by an organization that is related to a
leased premises must be approved by the director of the Gambling
Control Board. Rent payments may not be made to an individual.
Changes in lease
If the lease is amended with no change in ownership, the organization
will submit the amended lease to the Board at least 10 days before the
effective date of the change. If a change in ownership occurs, the
organization will submit an amended lease to the Board within 10 days
after the new lessor has assumed ownership.
Acknowledgment of Lease Terms I affirm that this lease is the total and only agreement between the lessor and the
organization, and that all obligations and agreements are contained in or attached to this lease and are subject to the approval of
the director of the Gambling Control Board.
Other terms
E\~~ <;>I>.'l..""- ""-~ "'...........:......\,e
\...\.;)~~'""-- loo\.c::,\\CR., "".....'c"'" ~ ~
'<:l'a <!,.\\J\~
~ ~\l-.
"""bD 0.
~t u,,,,,..,,
~"'O.XU. O~
re of organiza~ o~cia@:s.s~d3 '1 Date
'''~ :;r~IJ.-D5
--------------------------------------------------------
Print name and title of lessee
Q.. e..r~ Id (VI_":~_~_~:+=_-~~~--
Lessee's business address
Questions? Contact the Licensing Section, Gambling Control Board, at 651-639~4000. This publication will be made available in
alternative format (i.e. large print, Braille) upon request. The information requested on this form will become public information when
received by the Board, and used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities.
Minnesota Lawful Gambling 7/07
LG200B Organization Officers Affidavit .
Affidavit of Qualification of Officers for an Organization Ucense and Consent Statement pursuant to Mlnneso~ statutes
Organizalionname c., 'J... ) F. I.J/),dcd-I ~ '" License number 0 If;;;J.4 I
Businessaddres~X"~ nf,J B(\'~~_Cily/ZiPCode h'ln $ / I ~
(may not be the address oflhe gambling manager, trea ufer, accountant, or leased s.le address)
Check the position: X_Chief executive officer
Effective date of officer change E_-,_L2-'-J2J!__
Officer's first name
@lVr", Ie!.
I Middle name
Lo..~~o:.:(,..
Treasurer
last name
{l'/l\c.C.o..uk'1
A--.re
Maiden or previous name
(qa.s .:re-~rqM
City A-rd e.-. IL II s
f
Socialsecurilynumber -'!]k- -_ /{L- 9!jjL Dateofbirth_
t.H- 3H5
Home address
Officer's daytime phone number --b151 .-
State rn rJ Zip code S 5 II Z-
1J--/23-3h
I affirm that the infonnation stated above is accurate
and lhat
I have never been convicted of a felony or gross
misdemeanor involving theft or fraud.
J have never been convicted of a crime- involving
gambling.
I have never had a license issued by the -board or
director permanently revoked for violation of law or
board rule.
In addition, I understand, agree, and hereby irrevocably
consent that suits and actions relating to the subject
matter of the organization license application, or acts
or omissions arising from such application, may be
commenced against my organization and I will accept
the service of process for my organization in any court
of competent jurisdiction in Minnesota by servke on
the Minnesota Secretary of State of any summons,
Signature,~ e:L __dY7c.. Q
Fax to 651-639-4032
or mail to:
Gambling Control Board
1711 W County Road B, #300 South
Roseville, MN 55113
process, or pleading. authorized by Minnesota laws.
By signature of this document the undersigned
authorizes the Department of Public Safety to conduct a
criminal background check or review and to share the
results with the Gambling Control Board.
Failure to provide required infonnation or providing false
or misleading information may result in the denial or
revocation of the license.
If this form is being submitted for a change in the chief
executive officer, the chief executive officer also affirms
that I am the chief executive officer of the organization;
I assume full responsibility for Ihe fair and lawful
operation of all activities to be conducted; and I will
familiarize myself with Minnesota laws governing _lawful
gambling and rules of the Board, and agree to abide by
those laws and rules, including amendments to them.
Date 5: -f 2- - 08
QUQstions: Call the Ucenslng Section of the Gambling Control Board al651-639-4000.
This form will be made available in alternative format {i.e. large print. Brame) Upon request
The information requested on this fann. with the exception of your social security number,
will become public information when received by the Board. and wilJ be used to detennine
your compliance With Minnesota statutes and rules governing lawful gambling activities.
05/14/2008 14:50 FAX 6514827876 CKSM
MAY-14-a00B 14:S9 FROM;GOLDUE~ FIN~NCIAL ~e696287
~ 002/002
TO:lb:>l<t=c:r.",",
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.
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$ond lIIumbl!lr41QQ1731 ...
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Gambling Manager's Bond
KNOW ALL MBN BY THBlm PDSENTS; tbll-t we, Sn.4AQ Deters B5 p:ril1cipal
mid ~ 'River 1:mIurBftC' C...........v I cOlpomtWn lIuthcriMcl to da b1.1smess ill ~ Stl\~
ofMi=IlB01a, 18 Surety, ail! hllldlll.C1:B=1y bound untcJ "'!IS Q Gol,! In tho sum not to
exce.ei:l TllI1_'U>anoan~ ~11d. ",tIlIOD ($1 o.ooo.om, lot paymmt of which, wellllJlcl truly to
bll mGc, WI biDd O\U'll~VOll ald our legll.l tllprllSOlltativlll, joitlfly and scvm:ally, by tbcSIl
prUaI1t.
TIm CONDITION of the above mmltloned obll.gatian is sueh that WHEREAS
said Prlncil'al bas beml. c!I!lsI.gEIat1ld Qllmbllng MlDlager and is requirlld to siVll tbia bond
by vlttUc ofMSA ~49.17,
NOW THml'EPORB,lf said Prlnoipfllshall fei.tbfijUy pam=- bisIber duties IS
Gllllb!lns"Mmagel'. then tbi! obligation to be void; othwNlsa to r=m.m i.Il.1iill. fO~1l me!
eot.
!bis be" XC!l)' be canceled by flattil River WSUl'IUI111l C01:II....,,'II by glWlg wrltteIl.
J:loticllll by Certi:liecl. Mall. addressed to the PrlDd.pBl. and the Oblisec. that Tbirty (30)
clays after the mfli1ing of said notices by Cetlitilld. MIIIl; thls boDcl shall be mill end void
aaltO my liallilit)' for ~ra committed s.fl:er that date. .
HO\"'/C\'ef, ibis bend shalJ. remain m fil1I. i'brce IlI)d effect for lUlY IUlC1 all COVl!fI'ld.
acts oommitted up to ~ dllie of CB.IIIlI!lUatioXl. ali provided by MSA 349.17.
Da.ted. thia~ dB:)' of~. WI!
SuslmDeters
.
iJ.v:
'~~.x;t=:~n~.-L
. lA.'ltOp;ley-)'j),-Fect, Tamara L. Bbiw;l.m: .
, .
'.
. ,
__.~14/2008 14:50 FAX 8514827878
CKSM
P!:l .. ..
3570 Lexington Avenue North - Suite 300
St. Paul, Minnesota 55126-8077
6511482-1698 fax 651/482-7976
Cornell
Kahler
ShidclI &
Mail',
PLLP
Certified publio
AooDWltantll
FAX tRANSMITTAL JNFORMATION
FAX PHONE NUMBER: (651) 482.7876
. THe INFORMATION CONTAINeD IN THIS FACSIMILE MESSAGE IS P~MLEGeo
AND CONFIDENTIAL INFORMATION INTENDf!D FOR THE use OF THE ADDRESSEe
usmD BELOW AND NO ONE EL.SE. IF you ARe NOT THE INTeNDED
REClPlliNT OR THE EMPLOYEe OR AGENT ReSPONSIBLE TO DELIVER THIS
MliSSAGE TO THE INTENDED RECIPIENT, Pl-EASE DO NOT use THIS
TRANSMISSION IN ANY WAY, SUT CONTACT THE $ENDf!R BY TELEPHONE.
DATE OF TRANSMllTAL:
05/14 lC~
TO: ~ll. l-\.~ S,.........:.-..
.FROM: ~~ ~~\
THIS IS PAGE -1-. OF 'd--.
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CAlL IMMEDIATELY IF THERE ARE PROBLEMS IN RECEIVING THIS TRANSMISSION
TELEPHONE: (6111) 482.1698
1'01
~1'ItNmI1~o;kol
05/12/2008 11 :33 FAX 6514827876
CK3M
IiiJ 002/005
621 FOUNDATION
ESTIMATED PROJECTED INCOME
12 MONTH PERIOD
GROSS
MEAT RAFFLES $36,000.00
BAR BINGO $104,000.00
PULL TAB $30.000.00
TOTAL GROSS $170,000.00
PRiZeS
MEAT RAFFLES $18,000,00
BAR BINGO $72,800.00
PULLTABS $24900,00
TOTAL PRIZES $115,700.00
NET RECEIPTS $54,300.00
05/12/2008 11 :33 FAX 8514827878
~
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GAMBLING BANK ACCOUNT
INVENTORY
REFUND RECEIVABLE
ASSETS
TOTAL ASSETS
LIABILITIES
ACCOUNTS PAYABLE
TOTAL LIABILITIES
FUND BALANCE
CKSM
621 FOUNDATION
LAWFUL GAMBLING OPERATION
ASSETS & LIABILITIES
AS OF APRIL 30, 2008
(REGULATORY BASIS)
ASSETS
$
13,886.07
447.26
695.74
LIABILITIES AND FUND BALANCE
$
(336.22)
FUND BALANCE
CURRENT EARNINGS
LAWFUL PURPOSE EXPENDITURES
15,342.04
72,25/4,43
(72,271,18)
FUND BALANCE
TOTAL LIABILITIES AND FUND BALANCE
< SEE ACCOUNTANTS' COMPILATION REPORT ~
~ 003/005
$
15,029.07
$
(336.22)
15,365.29
$
15,029.07
PAGE 1
05/12/2008 1133 FAX 8514827876
CK3M
621 FOUNDATION
LAWFUL GAMBLING OPERATION
REVENUE, EXPENSES AND LAWFUL PURPOSE EXPENDITURES
FOR THE ONE AND TEN MONTHS ENDED APRIL 3D, 2008
(REGULATORY BASIS)
J
Ii!! 004/005
+____ PERIOD TO DATE ---+ +---- YEAR TO DATE -----+
ACTUAL ACTUAL
BINGO INCOME
BINGO RECEIPTS
BINGO PRIZES
$
,00
.00
NET BINGO INCOME
,00
PULLTAB INCOME
PULLTAB RECEIPTS
PULLTAB PRIZES
.00
.00
NET PULLTAB INCOME
.00
PADDLEWHEEL INCOME
PADDLEWHEEL RECEIPTS
PADDLEWHEEL PRIZES
.00
.00
NET PADDLEWHEEL INCOME
.00
RAFFLE INCOME
RAFFLE RECEIPTS
.00
J
NET GAMING REVENUE
.00
ALLOWABLE EXPENSES
COST OF GAMES PLAYED
COMPENSATION & pIR TAX
ADVERTISING
LEGAL AND ACCOUNTING
GAMBLING SUPPLIES
MAINTENANCE OF EQUIPMENT
RENT
UTILITIES
GAMBLING MANAGER'S BOND
CASH (OVER)SHORT
.00
8,388.89
.00
812.58
2,043.21
.00
.00
.00
.00
.00
TOTAL ALLOW EXPENSES
11,244.68
CURRENT EARNINGS
$
(11,244.66)
.00 \ $ 959,472.50 100.00 %
.00 (719,199.00) (74.96)
.00
240,273.50 25.04
.00
.00
283,800.00 100.00
(205,041.00) (72.25)
78,759.00 27,75
.00
.00
.00
10,740.00 100.00
(6,802.00) (63.33)
3,938.00 36.67
.00
.00
2,735.00 100.00
.00
325,705.50
.00
.00
.00
,00
.00
.00
.00
.00
.00
.00
23,627 .49
130,721.48
893.44
14,342.87
21,417.85
46.67
53,794.80
7,193.27
150,00
1,223.20
253,411.07
.00
.00 % $
72,294.43
( CONTINUED
'~
< SEE ACCOUNTANTS' COMPILATION REPORT>
100.00
7.25
40.13
.27
4.40
6.58
.01
16.52
2.21
.05
.38
77.80
22.20 %
PAGE 2
05/12/2008 11 :33 FAX 8514827878
CKSM
621 FOUNDATION
LAWFUL GAMBLING OPERATION
REVENUE, EXPENSE AND LAWFUL PURPOSE EXPENDITURES
FOR THE ONE AND TEN MONTHS ENDED APRIL 30, 2008
(REGULATORY BASIS)
....J
~ 005/005
+----PERIOD TO DATE----+ +-----YEAR TO DATE-----+
ACTUAL ACTUAL
CURRENT EARNINGS
$
(11,244.68)
.00 % $
72,294.43
TAXES AND LICENSES
8.5% STATE TAX
1.7% STATE TAX
REGULATORY FEE
STATE TAX REFUND
LOCAL GOV'T TAXES
TOTAL TAXES/LICENSES
.00
.00
.00
.00
622.34
.00
.00
.00
.00
.00
20,990.45
6,526.18
1,256.75
(3,857.16)
7,354.96
32,271.18
622.34
.00
AVAILABLE FOR ORGANIZATION
(11,867,02)
40,023.25
.00
BOARD APPROVED EXPENDITURES
TOTAL BOARD APPROVED EXPEND
.00
.00
.00
(11,867.02)
.00
40,023.25
AVAILABLE FOR CONTRIBUTION
C. 'ITABLE CONTRIBUTIONS
~RIOR MONTHS EXPENDITURES
621 FOUNDATION
.00
10,000.00
,00
.00
30,000.00
10,000,00
TOTAL CONTRIBUTIONS
10,000.00
40,000.00
,00
.00
.00
23.25
15,342.04
PROFIT CARRYOVER
BEGINNING PROFIT CARRYOVER
(21,867.02)
.00
(21,867.02)
.00 % $
15,365.29
ENDING PROFIT CARRYOVER
$
< SEE ACCOUNTANTS' COMPILATION REPORT>
~
22.20 %
6.44
2.00
.39
(1.1B)
2.26
9.91
12.29
.00
12.29
9.21
3.07
12.28
.01
4.71
4,72 %
PAGE 3