91-040A
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4/17/91
RESOLUTION NO.
40A-91
A RESOLUTION APPROVING GAMBLING LICENSE
WHEREAS, the Shorewood City Code, Chapter 301, provides for the
licensing of certain gambling activities in the City; and
WH ERE AS, said code prescribes certain restrictions concerning
eligibility for such licensing and application, whereby the licensee will
save the City harmless for all claims arising out of the granting of such'
license; and
WH ERE AS, the following applicant has met the eligibility
requirement for such license and has agreed to all terms and conditions of
the agreement contained in the license.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Shorewood as follows:
1. That a license for the conduct of gambling as specified in
the terms and conditions of the license, be issued for a term of one year,
from 22 Apri 1 , 1991, to 31 December , 1991, to the following
applicant:
Applicant Name
Address
American Legion, Post #259
24450 Smithtown Road
Shorewood, MN 55331
ADOPTED BY THE CITY COUNCIL OF THE
22nd day of April, 1991.
CITY OF SHOREWOOD this
ijMt5I4,;;ft~
Barbara JPi'rancel, Mayor
~'J1TES ....... r? /l~&~
"~{.,..J ' F
radley ,,/ Nielsen
Acting ity Administrator/Clerk
Roll Call Vote:
A yes -
Nays -
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Premise Permit Application, Form LG214
Attachments, Instructions
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Signature(s) required
When an application is delivered by an organization
to th.e local governing body, the local governing body
must acknowledge receipt of the application by
. signing and dating the application.
City or County
If the gambling premises is located within city limits
the application must be signed by the city.
.Ifthe gambling premises is located outside city
limits the application must be signed by BOTH ~he
county and the township.
Township .
The township must complete this section if the
gambling premises is not located within city limits.
. Indicate whether the township is organized,
unorganized, or unincorporated. The township must
acknowledge the application, however, it
has no disapproval authority.
If the township is unincorporated, the county must
indicate in this section that the township is not
incOrporated.
Name of person delivering application to local
governing body
Fill in the name of the persQn who delivers the
application to the local governing body for signature.
Applications received without proper signatures will
not be processed until those signatures have been
obtained.
RESOLUTION REQUIRED
The local governing body (city or county) must
approve or deny each premise permit application.
A copy of the resolution approving the premise permit
application must be attached to the application
when submitting the application to the Gambling
Control Division.
The resolution must be dated within 60 days of the
. date of submissioriof the application to the Gambling
Control Division.
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1. Aopllcatlo!)
Be sure that part one, two, and three of the prem-
ise permit application, formLG214,arecompleted.
2. W9.
If the gambling premisEts is leased, attach a copy of
the Lawful Gambling Lease, F()rmLG202.
3. Sketch '
Attach a copy of the ske,tchof the gambling premises
with dimensions and ~quarefootage of the leased
areas.
4. Permit Fee
Attach a check forthe appropriate license fee.
Class A - $200
Class B - $125
Class C- $1 qo
Class D - $7~
The check should be maqe payable to the:
'"State of Mlhnesota"
5.. Resolution 01 apprpval
Each gambUng premises permit must be approved
(or denied) by the local governing body. A copy of
the resolution which ShOWS approval of the applica-
tion must be attached to the application.
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Applications must be submitted by the date of the
previous month's Gambling Control Board meeting In
order to be considered by the date of the next
month's board meeting.
To obtain further information on application
deadlines, contact the Gambling Control Division
office at 6121639~400Q.
NOTE: Applications should be completed as soon
as possible. Waiting until "deadlines" may result in
delays for pro~SSingandissuing premise permits.
Page 3
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Minnesota Lawful Gambling
Premise Permit Application - Part 1
FOR BOARD USE ONLY
FEE
CHECK
INIT1ALS
DATE
~ LG214
(11/141llO)
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Legal Name ot Organization II (;) """'-d
~L-A;€c;NeG' L-LO P~I?- rOSr ;2~ '(
Business Address of Organization - Street or P. 0 Box (Do not use address of gambling manager)
;Z I.t L( rO ..5~1/ T II 70 tAJ IV ;<. b 1
City State
i;X erE L:5 /0 R- JI..'IAl 1
Name ot chief execu~re officer (cannot be gambling manager)
A LLI E ~\ k' R-C/JI36 ~ G-
Address:otchierexecutive officer - Street or P. O. Box
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City Slate Zip Code Coun,t~
E; i C.e L-S I 0 t'2 IVL 10 c; ") ""3 i \ N-4\ /1 eJ)t JJ
Zip Code County
.s:..r.3 3 /)-/ EAlrJ {; P / ,A)
Title .
LCi'V1ft1 I1/J b ~12-
Business phone number
rklJ) 1.(7'1-3 9?;l.
Business phone number
(G{~) I:.{ \J.6 -&9?1
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Class of Premise Permit
~ Class A - Bingo, Raffles, Paddlewheels, Tipboards, Pull-tabs
o Class B - Raffles, Paddlewheels, Tipboards, Pull-tabs
o Class C - Bingo only
.0 Class D - Raffles only
Bingo Occasions
If class A or C. fill in days and beginning and ending hours of bingo occasions:
No more than seven bingo occasions may be conducted by an orltanization per week.
Fee
$200
$125
$100
$75
The class of premise permit
must be reflected by class of
the organization license.
Day
Beginning/Ending Hours
Day
Beginning/Ending Hours
Day Beginning /Ending Hours
to
to
to
to
to
to
to
Status of Premise Pennit - check one:
o New premise - Fill in base organization premise permit number
IZI Renewal of existing premise permit - Fill in comolete premise permit number A - 0 C,,1..2 0 - 00 I
o Previously expired premise permit - Fill in comolete premise permit number
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LG2.14
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Minnesota Lawful Gambling
Premise Permit Application - Part 2
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Name of establishment where gambling will be conducted
C-Lt4 !2-fE;0C.S f.Lcf'ttR- PO$t .2rCJ
Is the premises located within city limits? ~ yes 0 no
Street Address (do not use a post office box number)
,;l t; 7",\0 .5M 171176 w,J "J!b,
City and County where gambling premises is located OR Township and County where gambling premises is located if outside of
I
city limits
Name and Address of Legal Owner of Premises
City
)-/I;NNGP IrJ
State
Zip Code
.:5/-10 R.fE Woe b
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Does the organization own the building where the g~bling will be conducted? ~ YES 0 NO .
NOTE: Organizations may not pay themselves rent if they own the building or have a holding company. A letter must be sub-
mitted showing rent payments as zero from gambling funds if the organization's holding company owns the premises. The
letter must be signed by the chief executive officer.)
If NO, attach the following:
* a copy of the lease with terms for one year.
* a copy of a sketch of the floor plan with dimensions. showing what portion is being leased.
A lease and sketch are not required for Class D applicantions.
. Rent:
For gambling with bingo $
Total square footage leased
For gambling without bingo $
Total square footage leased
Address of storage space of gambling equipment
Address City State Zip code
,.:2./.;L;sO ,5";'I110'/700..)^-) Rbi g:I/C(;!i-<i~/(. It-l1v. -.\...('3.3" i
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(each permitted gambling premises must have a separate checking account)
Bank Name Bank Account Number
JJDf. uj(-;iST 13 filJ;! 0/ c / '-(77
Bank Address ' City State Zip Code
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Name, address, and title of persons authorized to sign checks and make deposits and withdrawals.
Name
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Address Title
.30 LJoolJL/4vJ/J f) VI I c:){CE0c()/,2-/ ;t1tJ( ,j-r.:331 &;-?/lrf/,J&t1-f6(?../
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LG214
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Minnesota Lawful Gambling
Premise Permit Application - Part 3
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GambUng Site Authorization
I hearby consent that local law enforcement officers, the board or agents of the board, or the commissioner of revenue or
public safety, or agents of the commissioners, may enter the premises to enforce the law.
Bank Records Information
The board is authorized to inspect the bank records of the gambling account whenever necessary to fulfill
requirements of current gambling rules and law.
I declare that:
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I have read this application and all information submitted to the board;
All information is true, accurate and complete;
All other required information has been fully disclosed;
I am the chief executive officer of the organization;
I assume full responsibility for the fair and lawful gambling and rules of the board and agree, if licensed.
to abide by those laws and rules, including amendments to them;
A membership list of the organization will be available within seven days after it is requested by the board;
Any changes in application information will be submitted to the board and local government within 10
days of the change; and
A termination plan will be submitted to the board within 15 days of the termination of all premise permits.
Failure to provide required information or providing false information may result in the denial or revocation of the
license.
Signawre orchief executive officer .~ Date
Lli~ "tA {~/~~/ /,
1. The city *must sign if the gambling premises is located within city limits.
2. The county **AND township** must sign if the gambling premises is located within a township.
3. The local government (city or county) must pass a resolution specifically approving or denying the application.
4. A copy of the resolution approving the application must be attached to the application.
5. Applications which are denied by the local governing body should not be submitted to the Gambling Control Division.
Township: By signature below, the township acknowledges that the organization is applying for a premises permit within
township limits.
Clty* or County**
Township**
~<~
Township Name
Signature of person receiving application
Date Received
Is township: 0 Organized 0 Unorganized 0 Unincorporated
Refer to the instructions for the required attachments Mail to:
Department of Gaming
Gambling Control Division
Rosewood Plaza South, 3rd Floor
1711 W. County Road B
Roseville, MN 55113