HomeMy WebLinkAboutResolution 2012-37 - Approve Charitable Gambling St Thomas ChurchCity of Corcoran
County of Hennepin
State of Minnesota
RESOLUTION NO. 2012 -37
Motion By: Milbrandt
Seconded By: Gmach
July 26, 2012
A RESOLUTION APPROVING CHARITABLE GAMBLING IN THE CITY OF
CORCORAN, MINNESOTA
BE IT RESOLVED, by the City Council of the City of Corcoran that the following Charitable
Gambling License is granted effective for the dates as indicated, to the following Licensee,
provided appropriate application and insurance documents are submitted and satisfactory
background check completed by the Corcoran Police Department,
LICENSEE LICENSE LICENSE EFFECTIVE DATE
St. Thomas The Apostle
VOTING AYE
® Guenthner, Ken
® Asleson, Rich
® Cossette, Tom
® Gmach, George
® Milbrandt, Rosalyn
Charitable Gambling August 19, 2012
VOTING NAY
❑ Guenthner, Ken
❑ Asleson, Rich
❑ Cossette, Tom
❑ Gmach, George
❑ Milbrandt, Rosalyn
Whereupon, said Resolution is hereby declared adopted on this 26th day of July 2012.
Kenneth Guenthner - Mayor
2 EST: ,
eanie Heinecke — City Clerk
Page I of I
City Seal
MINNESOTA LAWFUL GAMBLING
LG220 Application for Exempt Permit
6/12 Page 1 of 2
An exempt permit may be issued to a nonprofit organization that:
Application fee
- conducts lawful gambling on five or fewer days, and
If application posted or. received:
- awards less than $50,000 in prizes during a calendar year,
less than 30 days more tha 0 days
If total prize value for the year will be $1,500 or less, contact
before the event before the event
the licensing specialist assigned to your county.
$100 $50 f
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Organization name Previous gambling permit number
p
Minnesota tax ID number, if any Federal employer ID umber (FEIN), if any
I-- / .
Type of nonprofit organization. Check one.
ElFraternal WReligious Veterans Other
nonprofit organization
Mailing address City State Zip code County
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Name of chief executive officer [C O] Daytime phone number E -m it address
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Attach a copy of ONE of the following for proof of nonprofit status.
Nonprofit Articles of Incorporation OR a current Certificate of Good Standing.
Don't have a copy? This certificate must be obtained each year from:
Secretary of State, Business Services Div., 60 Empire Drive, Suite 100, St. Paul, MN 55103
Phone: 651 - 296 -2803
IRS income tax exemption [501(c)] letter in your organization's name.
Don't have a copy? To obtain a copy of your federal income tax exempt letter, have an organization officer contact
the IRS at 877 - 829 -5500.
IRS - Affiliate of national, statewide, or international parent nonprofit organization [charter]
If your organization falls under a parent organization, attach copies of both of the following:
a. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and
b. the charter or letter from your parent organization recognizing your organization as a subordinate.
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BLI NG
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Name of premisq ihpeere the gambling event will be conducted. For raffles, list the site where the drawing will take place.
es l f 1 _(
Address [do not use PO box] dity or township Zip code County
o caa Cca t) 0 i 6.d i-a e /I 1),e ai, ' "y
Dates] of activity. For raffles, indicate the date of the drawing.
Check each type f gambling activity that your organization will conduct.
Bingo* ___X_. Raffle Paddlewheels* Pull -tabs* Tipboards*
*Gambling equipment for bingo paper, paddlewheels, pull -tabs, and tipboards must be obtained from a distributor
licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo number selection devices
may be borrowed from another organization authorized to conduct bingo.
To find a licensed distributor, go to www.gcb.state.mn.us and click on Distributors under
the WHO'S WHO? LIST OF LICENSEES, or call 651- 639 -4000.
LG220 Application for Exempt Permit
CITY APPROVAL
for a gambling premises
located within city limits
Y—The application is acknowledged with no waiting period.
The application is acknowledged with a 30 day waiting
period, and allows the Board to issue a permit after 30 days
[60 days for a 1st class city].
_The application is denied.
Print city name"
Sig atur f city p`erso I,
Title I7't/ �( r Date1
6/12 Page 2 of 2
COUNTY APPROVAL
for a gambling premises
located in a township
The application is acknowledged with no waiting period.
The application is acknowledged with a 30 day waiting
period, and allows the Board to issue a permit after 30
days.
The application is denied.
Print county name
Signature of county personnel
Title
Date
TOWNSHIP -If required by county. On behalf of the township,
I acknowledge that the organization is applying for exempted
gambling activity within the township limits.
[A township has no statutory authority to approve or deny an
application, per Minnesota Statutes 349.166.]
Print township name
Signature of township officer
Title
Date
The inforration provided in this application is complete and accurate to the best of my knowledge. I acknowledge that the financial
report will be completed and returned to Board within 30 days of the event date.
,< r�
Chief executive officer's signature ate®`
Print name
Complete a separate application for:
- all gambling conducted on two or more consecutive days, or
- all gambling conducted on one day.
Only one application is required if one or more raffle
drawings are conducted on the same day.
Send application with:
a copy of your proof of nonprofit status, and
_ application fee. Make check payable to "State of Minnesota."
To: Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113
Data privacy notice: The information requested on this
form (and any attachments) will be used by the Gambling
Control Board (Board) to determine your organization's
qualifications to be involved in lawful gambling activities in
Minnesota. Your organization has the right to refuse to
supply the information; however, if your organization
refuses to supply this information, the Board may not be
able to determine your organization's qualifications and,
as a consequence, may refuse to issue a permit. If your
organization supplies the information requested, the Board
will be able to process the application. Your organization's
name and address will be public information when received
by the Board.
Financial report and recordkeeping required
A financial report form and instructions will be sent with your
permit, or use the online fill -in form available at
www.gcb.state.mn.us.
Within 30 days of the event date, complete and return
the financial report form to the Gambling Control Board.
Questions?
Call the Licensing Section of the Gambling Control Board
at 651- 639 -4000.
This form will be made available in alternative format (i.e. large print, Braille)
upon request.
All other information provided will be pri-
vate data about your organization until the
Board issues the permit. When the Board
issues the permit, all information provided
will become public. If the Board does not
issue a permit, all information provided
remains private, with the exception of your
organization's name and address which will
remain public. Private data about your
organization are available to: Board mem-
bers, Board staff whose work requires
access to the information; Minnesota's
Department of Public Safety; Attorney
General; Commissioners of Administration,
Minnesota Management & Budget, and
Revenue; legislative Auditor, national and
international gambling regulatory agencies;
anyone pursuant to court order; other indi-
viduals and agencies 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
written consent.