HomeMy WebLinkAboutResolution 2015-29 - Approving Charitable Gambling - St ThomasCity of Corcoran
County of Hennepin
State of Minnesota
RESOLUTION NO. 2015 -29
Motion By: Keefe
Seconded By: LaFave
June 11, 2015
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 Charitable Gambling August 16, 2015 (One day license)
Catholic Church
VOTING AYE VOTING NAY
® Guenthner, Ken ❑ Guenthner, Ken
® Hank, Pat ❑ Hank, Pat
® Keefe, Mike ❑ Keefe, Mike
® LaFave, Tonya ❑ LaFave, Tonya
® Thomas, Ron ❑ Thomas, Ron
Whereupon, said Resolution is hereby declared adopted on this 11th day of June 2015.
ATTEST:
AL
anie Heinecke — City Clerk
(
Ken Guenthner -Mayor
Page 1 of 1
City Seal
MINNESOTA LAWFUL GAMBLING
LG220 Application for Exempt Permit
5/15
Page 1 of 2
An exempt permit may be issued to a nonprofit Application Fee (non - refundable)
organization that: I Applications are processed in the order received. If the application
• • conducts lawful gambling n five or fewer days, and is postmarked or received 30 days or more before the event, the
awards less than $50,000 n prizes during a calendar
year. application fee is $100; otherwise the fee is $150.
If total raffle prize value for the calendar year will be Due to the high volume of exempt applications, payment of
$1,500 or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite
your county by calling 651 -539 -1900. service, nor are telephone requests for expedited service accepted.
ORGANIZATION INFORMATION
Organization St. Thomas the Apostle Catholic Church Previous Gambling 27268
Name: Permit Number:
Minnesota Tax ID 7263917 Federal Employer ID 416133637
Number, if any: Number (FEIN), if any,
Address. County Road 10
City: Corcoran State: MN Zip: 55340 County: Hennepin
Name of Chief Executive Officer (CEO): Rev John Gallas
Daytime Phone: 763 420 2385 Email: frgallas @gmaii.com
NONPROFIT STATUS
Type of Nonprofit Organization (check one):
= Fraternal M Religious Veterans Other Nonprofit Organization
Attach a copy of one of the following showing proof of nonprofit status:
(DO NOT attach a sales tax exempt status or federal employer ID number, as they are not proof of nonprofit status.)
A current calendar year Certificate of Good Standing
Don't have a copy? Obtain this certificate from:
MN Secretary of State, Business Services Division Secretary of State webslte, phone numbers:
60 Empire Drive, Suite 100 www.sos.state.mn.us
St. Paul, MN 55103 651- 296 -2803, or toll free 1- 877 -551 -6767
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 toll free at 1 -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:
1. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling, and
2. the charter or letter from your parent organization recognizing your organization as a subordinate.
GAMBLING PREMISES INFORMATION
Name of premises where the gambling event will be conducted St. Thomas the Apostle Catholic Church
(for raffles, list the site where the drawing will take place):
Address (do not use P.O. box): 20000 County Road 10
City or Corcoran 55340 Hennepin
Township: Zip: County:
Date(s) of activity (for raffles, Aug. 16, 2015
indicate the date of the drawing):
Check each type of gambling activity that your organization will conduct:
✓Bingo* Paddlewheels* Pull -Tabs* = Tipboards*
✓Raffle (total value of raffle prizes awarded for the calendar year: $ )
* 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.mn.gov /gcb and click on
Distributors under LIST OF LICENSEES, or call 651 -539 -1900.
LG220 Application for Exempt Permit
5/15
Page 2 of 2
LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT (required before submitting application to
the Minnesota Gambling Control Board)
CITY APPROVAL
COUNTY APPROVAL
for a gambling premises
for a gambling premises
located within city limits
located in a township
The application is acknowledged with no waiting period.
_The application is acknowledged with no waiting period.
_The application is acknowledged with a 30 -day waiting
_The application is acknowledged with a 30 -day waiting
period, and allows the Board to Issue a permit after 30 days
period, and allows the Board to issue a permit after
(60 days for a 1st class city).
30 days.
_The application is denied.
_The application is denied.
Cy ry �'�� �
Print City Name:
Print County Name:
' n ture of City Personnel: -
Signature of County Personnel:
/S'd/!J /I
e: t -ti4 L Date:.'/1
Title: Date:
TOWNSHIP (if required by the 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
The city or county must sign before
deny an application, per Minn. Statutes, section 349.213.)
submitting application to the
Gambling Control Board.
Print Township Name:
Signature of Township Officer:
Title: Date:
CHIEF EXECUTIVE OFFICER'S SIGNATURE (required)
The information 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 the Board within 30 days of the event date.
Chief Executive Officer's Signature: Date:
(Signature must be CEO's signature; designee may not sign)
Print Name:
REQUIREMENTS
MAIL APPLICATION AND ATTACHMENTS
Complete a separate application for:
Mail application with:
• all gambling conducted on two or more consecutive days, or
a copy of your proof of nonprofit status, and
• all gambling conducted on one day.
— application fee (non -refundable). If the application is
Only ne application Is required if one or more raffle drawings are
Y PP 9
postmarked or received 30 days or more before the event,
conducted on the same day.
the application fee is $100; otherwise the fee is $150.
Financial report to be completed within 30 days after the
Make check payable to State of Minnesota.
gambling activity is done:
To: Gambling Control Board
A financial report form will be mailed with your permit. Complete
1711 West County Road B, Suite 300 South
and return the financial report form to the Gambling Control
Roseville, MN 55113
Board.
Questions?
Your organization must keep all exempt records and reports for
Call the Licensing Section of the Gambling Control Board at
3 -1/2 years (Minn. Statutes, section 349.166, subd. 2(f)).
651 -539 -1900.
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. All other information provided will
be private 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
members, Board staff whose work requires
access to the Information; Minnesota's Depart-
ment 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 Individuals 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.
This form will be made available in alternative format (i.e. large print, braille) upon request. i