HomeMy WebLinkAbout20100405 - VI-17HASTINGS FIRE DEPARTMENT
RELIEF ASSOCIATION
Alan E. Storlie, President
115 West 5~' Street
Hastings, MN 55033-1815
Business Office (651} 480-6150
Fax (651} 480-6170
TO: Mayor Hicks
Council Members
FROM: Hastings Fire Department Relief Association
DATE: March 29, 2010
SUBJECT: Request for approval of One-Day Liquor License Application and Charitable
Gambling Application for 70t1i Annual Booya.
The Hastings Fire Department Relief Association is requesting Council approval for cone-day
liquor license, to allow for the sale of Beer at the Columbian Hall, South Highway 61, during our
70~~' Annual Booya, to beheld on Sunday, September 12, 2010. We also request that you waive
the customary fee. In addition, we are requesting approval to allow charitable gambling at the
above-mentioned site /event.
Attached you will find an application for atemporary on-sale liquor license and an application
for charitable gambling. These items will need to be signed, upon your approval, and retui~ed to
us so that we may forward them to the appropriate State agencies.
Thank you far your consideration of this matter. If you should have any questions, please feel
free to contact James Gelhar, Raymond Knoll, or Christopher Paulson at 651-480-615D.
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Page 1 of 2 2110
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LG220 Application for Exempt Permit Application fee for each event
lfa [ication ostmarkedorreceived:
An exempt permit may be issued to a nonprofit organization That: less than 30 days more than 30 days
- conducts lawful gambling an five or fewer days, and before the event before the event
-awards less than $50,000 in prizes during a calendar year. $100 $50
ORGANIZATION INFORMATION Check# $
Organization name Previous gambling permit number
Hastings Fire Department Relief Association X-19043-09-001
Type of nonprofit organization. Check one.
Fraternal ~ Religious ~ Veterans ~ Ofher nonprofit organization
Mailing address City State Zip Gode County
115 West 5th Street Hastings MN 55033-18'15 Dakota
Name of chief executive officer {CEO) Daytime phone number Email address
Alan E. Storlie 657-480-6150
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 Cood Standing.
Don't have a copy? This certificate must be obtained each year from:
Secretary of State, Business Services Div., 180 State Office Building, 5t. Paul, MN 55955 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 IR5 at 877-829-5500.
IR5 - Affiliato of national, statewide, or international parent nonprofit organization {chartor)
If your organization falls under a parent organization, attach copies of both of the following:
a. IR5 letter showing your parent organization is a nonprofit 501 (c) organization with a group ruling, and
b. the charter ar 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 nonproft status from the IRS, no attachment is required.
GAMBLING PREMISES INFORMATION
Name of premises where gambling activity wi11 be conducted (for raffles, list the site where the drawing will take place}
Columbian Hal[
Address (do not use PO box) City Zip Code County
Highway 61 South Hastings 55033 Dakota
Date(s) of activity (for raffles, indicate the date of the drawing)
09/12/2010 to 0 911 2120 1 0
Check the box or boxes that indicate the typo of gambling activity your organization will conduct:
Bingo" ®Raffles ®Paddlewheels' ®Pul]-Tabs# ®Tipboards*
* Gambling equipment for pull-tabs, bingo paper, tipboards, and
Also complete
paddlewheels must be obtained from a distributor licensed by the
Gambling Control Board. EXCEPTION: Bingo hard cards and bingo Page 2 of this form.
number selection devices may be borrowed from another organization
authorized to conduct bingo. Pr[nt Form:
To find a licensed distributor, go to www.gcb.state.mn,us and click on List Reset,Forrn:
of Licensed Distributors, or call 6S1-b39-407b.
LG220 Application €ar Exempt Perrrtit
Page 2 of 2 1!1 t}
LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT
If the gambling premises is within city limits, If the gambling premises is located in a township, a
a city official must check the action that the city is county offcial must check the action that the county is taking
taking on this application and sign the application. on this application and sign the application.
A township official is not required to sign the application,
rThe 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 period, and allows the Board to issue a permit after 30
days (60 days fora 1st class city). days.
The application is denied. The application is denied.
Hastings Print county name
Print city name On behalf of the county, 1 acknowledge Phis application.
On behalf of the city, !acknowledge tfris application. Signature of county official receiving application
officio! receiving application
nature of cit
Si
g
y
Title Date ! 1
(Optional) TOWfVSHlP: On behalf of khe township, I
Title Date I 1 acknowledge that the organizatien is applying for exempted gambling
activity within township limits. [A township has no statutory authority
to approve or deny an application [Minnesota Siaiuie 343.166)]
Print township name
Signature of township official acknowledging application
Title Date 1 I
CHIEF EXECUTIVE OFFICER'S SIGNATURE
The information provided in this application is complofc and accurate to the best of my knowledge. 1 acknowledge that the
financial report will be completed and ret d a the Board ftti 30 d s of the date of our gambling activity.
Chief executive officer's signature ~ -' Date ~ ~~ ~!!~/Q
Complete a separate application far each gambing activity: Financial report and recordkeeping required
- one day of gambling activity, A financial report form and instructions will be sent with
-two or more consecutive days of gambling activity, your permit, or use the online fill-in farm available at
-each day a raffle drawing is held www.gcb.staie.mn.us_ Within 30 days of the activity date,
Send application with: complete and return the financial report form to the
- a copy of your proof of nonprofit status, and Gambling Control Board.
-application fee for each event. 4uestions?
Make check payable to "State of Minnesota." Gall the licensing Section of the Gambling Control
To: Gambling Control Board Board at 651-639-4076.
1711 West County Road B, Suite 300 South - _
° 'I'nnt f=orm _ ", Reset Farm
Roseville, MlV 55113
This form wit[ be made available in alternative
format {i.e. large print, Braille) upon request.
data privacy notice:The information requested
on this forrn {and any attachments) will be used
by the Gambling Control Board {Board) to
determine your organization's qualifcations to
be involved in lawful gambling activities in
Minnesota. Your organization has the right to
refuse to supply the information requested;
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 you supply the information requested,
the Board wit] be able to process your
organization's application. Your organization's
name and address will be public information
when received by the Board. All other
information provided will be private daka until
tho 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 in#ormation provided remains private
with the exception of 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 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 individuals and agencies
specifically authorized by state or federal law to
have access to the in€ormation; individuals and
agencies for which law or legal order authorizes
a new use or sharing of information after this
hfoiice was given; and anyone with your written
consent.
t~ ~f ill I r~ r~ ~~
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A' ~- -
Certificate of Good Standing
I, Mark Ritchie, Secretary of State of Minnesota, do
certify that: The corporation listed below is a corporation
formed under the laws of Minnesota; that the corporation was
formed by the filing of Articles of Incorporation with the
Office of the Secretary of State on the date listed below, that
the corporation is governed by the chapter of Minnesota Statutes
listed below; and that this corporation is authorized to do
b~.~s:iriess as a corporation at the time this certificate is
issued.
Name: The Hastings Fire Department Fel.ief Association
Date Formed: 02/Ol/~924
Chapter Governed By: 317A
This certificate has been issued on 03/25/10.
L~~ ~
Secretary a# State.
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Minnesota Department of Public Safety
ALCOHOL AND GAMBLING ENFORCEMENT DNISION
444 Cedar Street Suite 222, St. Pau] MN 55101-5133
(651) 201-7507 Fax {651) 297-5259 TTY (651} 282-6555
WWW,DPS.STATE.MN.US
APPLICATION AND PERMIT
FORA 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
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NAME OF ORGANIZATION DATE ORGANIZED TAX EXEMPT NUMBER
Hastin s Fire De artment Relief Assn. 02 O1 1 2 41-6D
STREET ADDRESS CITY STATE ZIP CODE
115 West 5th Street ~ Hastings MN .55033-1515
NAME OF PERSON MAKING APPLICATION BUSINESS PHONE HOME PHONE
Alan ~. Storlie, President {651-480-615D ~i51~-437-1508
DATES LIQUOR WILL BE SOLD
09 / 12/2010 TYPE OF ORGANIZATION
L B H ~ BLE RELI I THER N NPR FITXXX
ORGANIZATION OFFICER'S NAME ADDRIaSS
Dale R. Schoeppner, Vice-President 115 West 5th Street Hastings, MN 55033-1815
ORGANIZATION OFFICER'S NAME ADDRESS
Christopher T. Paulson, SecrataYy 115 West.Sth Street Hastings, MINI. 55D33-1815
ORGANIZATION OFFICER'S NAME ADDRESS
3a~nes C. Gelhar, Treasurer 115 Tnlest 5th Street Hastings, MN 55D33-1815
Location license will be used. If an outdoor area, desct•ibe
Columbian Hall, Highway 6I South, Hastings, MN 55033
Will the applicant cont~•act for intoxicating liquor service? If so, give the name and address of the liquor licensee providing; the sewice.
1V/A
Will the applicant carry liquor liability insm'ance? If so, please provide the carrier's name and amount of coverage.
MN Liquor Liability Assigned Risk 5,0 / 1DD / 10
__
APPROVAL
APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING
ENFORCEMENT
CITY/COUNTY DATE APPROVED
CITY FEE AMOUNT LICENSE DATES
DATE FEE PAID
SIGNAT[IRT' CITY CLH,RK OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCCi4IENT
ivu i~;: Suamit tn~s torm to me city or county 3U tlays prior to event. h'orward apptication signed by city and/or county to the address
above. If the application is approved the Alcohol and Gambling Enforcement Division will rehcrn this application to be used as the License for the event
PS-0979 (t21D9}
CITY OF HASTINGS
DAKOTA COUNTY, MINNESOTA
RESOLUTION NO. 04- -10
RESOLUTION APPROVING THE APPLICATION BY
THE HASTINGS FIRE RELIEF ASSOCIATION
TO CONDUCT A RAFFLE AND
FOR A TEMPORARY ON-SALE LIQUOR LICENSE
WHEREAS
, Hastings Fire Department Relief Association has presented an
application to the City of Hastings to conduct gambling and for a temporary on-sale
liquor license on September 12, 2010 at the KC Hall, South Highway 61; and;
WHEREAS
, the Minnesota Gambling Control Board Minnesota Alcohol
Enforcement Division requires resolutions be passed to approve the requests; and
WHEREAS
, an application for an exempt permit gambling license and an
application for a temporary on-sale liquor license have been presented; and
WHEREAS
, the Hastings Fire Department Relief Association has requested that
the City’s license fee be waived as a part of this approval.
NOW, THEREFORE, BE IT RESOLVED
by the City Council of the City of
Hastings that the Mayor and City Clerk are authorized and directed to sign this resolution
and forward to the appropriate agencies, showing the approval of these applications.
Ayes:
Nays:
Absent:
th
Whereupon said resolution was declared duly passed and adopted on the 5 day
of April 2010.
_______________________
Paul J. Hicks, Mayor
ATTEST:
__________________________
Melanie Mesko Lee,/City Clerk
(SEAL)