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1989_0109_packet
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1989_0109_packet
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a <br />har. tabiE�a Ganbllng Control Board <br />m N -475 rllggs- Midway, Bldg. <br />x. <br />ks <br />1821 University Aivel. <br />St. Raoul,, MN 55104-3383 <br />(61 )X42- oi5551 <br />GAMBLING LICENSE RENEWAL, APPLICATION <br />For Board <br />Paid <br />Check No. <br />D- <br />IL110ENSE, NUMBER A- 093311 -811 EFF'. DATE <br />114101188 <br />1 AMOUNT OF FEE: <br />1. Alpplicarnt —k Legal l Name of Organization <br />2. Street Address <br />I8' DAL MEN'S CLUB <br />2101 North Cale <br />Street <br />1 rimy„ 'State, Zip <br />County <br />5. Business Phone <br />Roseville, KK 55113 <br />(Ratlike y <br />612 489r <br />6. Name of Chief Executive Officer <br />7. Business Phone <br />IPijtt1 (Mattson( <br />( 612 ) _ <br />B. Name of Treasurer air Person Who Accounts for Revenues <br />9.13usiness Phone <br />Robert Iiio1al <br />61 ) <br />110. Mane of Gambling IManager <br />111. Bond Number <br />12. Business Phone <br />oinn lexter A <br />RP 12#44 <br />1 , (Name of Estabilishmient where Gambiling Will Take Place <br />14. County <br />15. No. of Active Members <br />(tens E1uII R'osev111s <br />Ramsel <br />128 <br />116. Lessor Name <br />17. Monthly Rent: <br />_........ .... _ ....................... <br />to <br />16. It Bingo will be conducted wwithi thiis license, (please specify days and times of Bingo. <br />Days Times N [days Times l Days Times <br />19. Has incense ewer been" Revoiked Date: Buaspend+ed Dale; Denied mate: <br />201. Have internal controls been submitted previously? :: Yes No ('lf "No." attach copy) <br />2"1. Has current lease been filed with thle board?' L] "Yes No (ilf "No,,, attach copy) <br />22. Has current sketch, been filed with the board? I 0 'Yes 0 No (if -No," attach copy) <br />GAMBLING SITE AUTHORIZATION <br />By my signature (below, Vocal law enfo rice rnent officers or aglents of the Board are hereby authorized to enter upon the site, at any time, gambling is <br />being coinducted. to observe the garnlbling, and to enforce the law for any, unauthorized game or practice. <br />BANK RECORDS AUTHORIZATION <br />By my signature Ibelo1w. the Board is hereby authorized to inspect time bank records of the General Gambling Bank Account whenever necessary to <br />ttiiltIl r uiremi nts� of curren t g arblirg rules and law. <br />OATH <br />I hereby declare that: <br />t l have, read this iapplicalion and all information suabmiitted to the Board: <br />2' All unformrnation suubmni'tted is true. accurate and complete; <br />. All other required int'ormatnon has been fullly disclosed <br />4 1 .gym the chef +executivee officer, of the organizatton <br />5 1 assume full responsibility for the fair and lawful operation of all activities to be conducted: <br />6 l wwnlllli familiarize, myself with the Ilaws, of" the State of M' innesota respecting <br />gambling, and rules' of the board l and agree, if licensed, to abide by these <br />laws and rules. including amnenldments thereto. <br />23. Official Legal INamie of Organization <br />ignatuure ('Chief Executive Officer) date Title <br />Ile?"•', <br />I Ihereby a acckinowlledgre receipt, of a copy of this application. By a ncknowrvledlgvng receipt. I admit hanviirng been served with notice that Ibis Pp lication will <br />be reviewed by the Charitable Gambling Control (Board and if' approved by the Boaroi. will become effective 60 days from the date of receipt (noted <br />below), unless a resolutiiorn of the focal governing body is passed which specifically disallows, such activity and a copy of that resolution is received b <br />(hie haritalblue Gambling Control Board within 601 days of the below noted date. y <br />24. aty/ ounty Nanrm D^ 0- �- - S'. If _ 1� (Local � overniing Body Township: if situ is located within a township, please complete items 24 <br />I _r iki 4 / and 5 <br />Signature of Pe#ni Relceiiviirlg Application: <br />0 <br />Title Date Received 1( is date be,g�ins 6iO daiy period) <br />1612 — 0i <br />Name of Person, Delivering Application to Local Governing Body: <br />25. Signature of Person Receiving Application <br />Towwrnship Name <br />CG-0002-2-02 (8159) White Copy —Board Canary— Applicant Pink —Local Governing Body <br />
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