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To: Mayor Hicks and City Councilmembers
From: Adeline Schroeder, Deputy City Cierk
Date: January ~2, 2010
Re: Application far Temporary Liquor License and Raffle-Saint
Elizabeth Ann Seton .School
Recommended .City Council Action: -
Approve the attached xess~lution~appxovng a temporary liquor license and a raffle for St.
Elizabeth Ann Setae School. Requestao-be effective on Apri1.30; 2010.:
Background:
Saint El~za~iath Ann Seton:`School has'paid the required; fees of`$20:0,~.
If Council s}ould approve this application; the attached resolution will `be sent. to the
Alcohol and Gambling Enforcement I~ivisian showing the City's approval
Should you have any concerns or questions; please e1o not hesitate to contact me.
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CITY OF HASTINGS
DAKOTA COUNTY, MINNESOTA
RESOLUTION NO. O1- -10
RESOLUTION APPROVING THE APPLICATION BY
ELIZABETH ANN SETON SCHOOL
FOR A TEMPORARY ON-SALE LIQUOR LICENSE AND RAFFLE
WHEREAS, St. Elizabeth Ann Seton has presented an application to the Cit<- of Hastings for a
temporar<- one day on-sale liquor license and raffle for Apri130, 2010 at St. Elizabeth Ann Seton School, 600
Tvler Street; and;
WHEREAS, the Minnesota Alcohol and Gambling Enforcement Di~-ision requires a resolution be
passed to appro~-e the request; and
WHEREAS, an application for a temporar<- on-sale liquor license and raffle has been presented; and
WHEREAS, St. Elizabeth Ann Seton has paid the required fees of $20.00.
NOW, THEREFORE, BE IT RESOLVED by the Cit<- Council of the Cit<- of Hastings that the Mayor
and Cit<- Clerk are authorized and directed to sign this resolution and forward to the appropriate agency, showing
the appro~-a1 of this application.
Ares:
Nay s:
Absent:
Whereupon said resolution was declared duly passed and adopted on the 19th day of Januar<- 2010.
Paul J. Hicks, MayoN
ATTEST:
Melanie Mesko Lee, City CZeNk
(SEAL)
~~
of ~
Minnesota Deparhnent of Public Safety
ALCOHOL AND GAMBLING ENFORCEMENT DIV~S~ON
444 Cedar Street Suite 222, St. Paul MN 55101-5133
(651) 201-7507 Fax (651) 297-5259 TTY (b51) 282-6555
W W W.DPS.STATE.MN.US
APPLICATION AND PERMIT
FOR A I TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
.{^~ ' :-;
;t
n
~~ ..~~:
NAME OF ORGANIZATION DATE ORGANIZED TAX EXEMPT NUMBER
~~ E~Ir2a~~~ ~~e ~ ~ ,SC~pr.~ j ay~55
STREET ADDRESS
4[~ ~' ~~ f ~- CITY
~ Sf~ ~ S STATE
M N ZIP CODE
~5v3 ~~
NAME OF PERSON G APPLICATION BUSINESS PHONE HOME PHONE L~ r
HATES LIQUOR WII.LBE SOLD ~ fi J ~~t-7'] ~~ ~ TYPE OF ORGANIZATION
RIT L U
ORGANIZATION OFFICER'S NAME
~, ~z~t ~uimbe~~- ADDRESS
(~ ~o ~ ~ f~,~ e
~- - ~~~ ~~s Cs~~~1~
ORGANIZATION OFFICER'S NAME ADDRESS
1
ORGANIZATION OFFICER'S NAME ADDRESS
Location license will be used. If an outdoor area, describe
... 5~ ~ so ~.~ ~a. l i
Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service,
N4
Will the applicant carry l~uo jliability insurance7~ If so, please provide the carrier's name and amount of coverage.
APPR®VAL
APPLICATION MUST BE APPROVED BY CITY OR COUNTY ~EF`ORE SUBMITTING T® ALC0130L & GAMBLING
ENFORCEMENT
CITY/COUNTY
CITY FEE AMOUNT
DATE FEE PAID
DATE APPROVED
LICENSE DATES
SIGNATURI: CITY CLERK OR COiJN'I`Y OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLINGENFORCEMENT
NOTE: Submit this form to the city ar county 3Q days prior to event. Forward application signed by city andlor county to the address
above. If the application is apprflved the Alcohol and Gambiing Enforcement Division viii return this appllcation to be aced as the License for the event
~1
PS-09079(12109)
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Page'! of 2 7!(]9
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LG220 Application for Exempt Permit
Application fee
Ifa lication osimarkedorreceived:
An exempt permit may be issued to a nonproft organization that:
- conducts lawful gambling on five or fewer days, and less than 30 days
before the event mare than 30 days
before the event
-awards less than $5D,000 in prizes during a calendar year. $'f 00 $SO
ORGANIZATION INFORMATION Check# ~
Organization name ` Previous gambling permit number
~~ ~~1~~~ :~~ ~ JGVIC)C~~ U
Type of nonprofit organization. Check one.
Fraternal Religious ~ Veterans ~ Other nonprofit organization
Mailing address City State Zip Code County
T ~ S ~- ~ ~ S M. N ~So~ 3 ~~.~~
Name of chief ex cutive officer (CEO) Daytime p one number Email address
~4 ~ WI ~~~~ G~~f- ~(~~~-3L ~K ~ ~m~~-~~~P.~isH . LPG
Attach a copy of ONE of the following for proof of nonprofit status. Check one.
Do not attach a sales tax exempt status or federal ID employer numbers as they are not proof of nonprofit status.
^ Nonprofit Articles of Incorporation OR a current Certificate of Good Standing.
Don't have a copy? This oerkificate must be obtained each year from:
Secretary of State, Business Services Div., 18D State Office Building, St. Paul, MN 55155 Phone: 651-296-2803
1RS 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 off ter
contact fhe 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.
IRS -proof previously submitted to Gambling Control Board
If you previously submitted proof of nvnproflf skafus from the 1RS, no attachment is required.
GAMBLING PREMISES fNFORMATION
Name of premises where gambling activity will be conducted (for raffles, list the site where the drawing will take place)
~~~ isuthc - 5~ n Cl~c~~rcG~
Address {do not use PO box) City Zip Code County
Date{s} of activity (for raffles, indicate the date of the drawing)
r~~ S 34'x"! , ~-p 1 ~
heck fhe box or boxes that indicate fhe type of gambling activity your organization will conduct:
Bingo* baffles ~ Paddlewheels* ~ Pull-Tabs' ~Tipboards"
* Gambling equipmenfi for pull-tabs, bingo paper, tipboards, and
paddlewheels must be obtained from a distributor licensed by the Also complete
Gambling Control Board. IXCfPTlON; Bingo hard cards and bingo Page 2 of this form.
number selection devices may be borrowed from another organization
authorized to conduct bingo. -Print Form
To find a licensed distributor, go to www.gcb.state.mn.usond click on List R
F
eset
orm
of Licensed Distributors, or tali 651-639-4076.
LG220 Application for Exempt Permit
Page 2 of 2 7149
~ LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT ~
if the gambling premises is within city limits,
a city ofFcial must check the action that the city is
taking on this application and sign the application
The application is acknowledged with no waiting period.
The application is acknowledged with a 3D day waiting
period, and allows the Board to issue a permit after 30
days (SD days fora 1st class city).
The application is denied.
Print city name
Qn behalfofthe city, t acknowledge this application.
If the gambling premises is located in a township, a
county afficaal must check the action that the county is taking
on this application and sign the application.
A township official is not required to sign the application.
The application is acknowledged with no waiting period.
The application is acknowledged wifh a 3D day wolfing
period, and allows the Board to issue a permit after 30
days.
The application is denied.
Print county name
On behalf of the county, l acknowledge this application.
Signature of county official receiving application
Signature of city official receiving application
Title Date
Title Date ! 1
(Optional) TOWNSHIP: On behalf of tho township, I
acknowledge that the organization is applying for exempted gambling
activity within township limits. jA township has no statutory authority
to approve or deny an application [Minnesota Statute 3a9.168j]
Print township name
Signature of township official acknowledging application
Title Date ! 1
~ CHIEF EXECUTIVE OFFICER'S SIGNATURE
The information provided in this application is complete and accurate to the best of my knowledge. 1 acknowledge that the
financial report will be trornplefed and retur~tedtto the BQar~ within 30 days of~he date of our gambling activity.
Chief executive officer`s signatu
Complete a separate application for each gambing activity:
- one day of gambling activity,
-Iwo or more consecutive days of gambling activity,
-each day a rafFle drawing is held
Send application with:
- a copy of your proof of nonprofit status, and
-application fee for each event.
Make check payable to "State of Minnesota."
To: Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, M1V 55113
Date ~-j~-Jj~
Financial report and recordkeeping required
A financial report form and instructions wiA be sent with
your permit, or use the online fill-inform available at
www.gcb,state.mn.us. Within 30 days of the activity date,
complete and return the financial repor# form to the
Gambling Control Board.
Questions?
Call the Licensing Section of the Gambling Control
Board at 659-639-4076.
Print Form Reset Form
Data privacy. This form will be made available
in alternative format (i.e. Large print, Braille)
upon request. The information requested on
this form (and any attachmenisj wilt be used by
the Gambling Control Board (Board) to
determine your qualifications #o be involved in
lawful gambling activities in Minnesota. 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 permit.
]f you supply the information requested,
the Board will be able to process your
application. Your name and and your
organization's name and address will be pubAc
informaton when received by the Board_ A!t
the other information you provide will be private
data unfit the Board issues your pemrit. When
the Board issues your permit, alt of the
information provided to the Board will become
public. if the Board does not issue a permit, alt
information provided remains private, with the
exception of your name and your organization's
name and address which will remain public.
Private data are available to: Board members,
Board staff whose work requires access to the
information; Minnesota's ^epartment of Public
Safety; Attorney General; Commtssloners of
Administration, Finance, and t2evenue;
Legistaiive Auditor, national and intemationat
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