02-12-1990 Council Packet - Laserfiche WebLink

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MtiriNGFEB 12 1990 fiTV ft;:list op licenses for council approval rOB Hcermo or February 12. 1990Renewal Application - Multiple Scl^osis^S^iety3380 Shoreline Drive t 4^ m Department of Revenue ■ Mail Station 3315 St. Paul, MN 55146-3315 (612) 297-5300 Gaming DivisionGAMBLING LICENSE RENEWAL APPLICATION For Board Use OnlyPaid Amt; _______Check No _______Date ___________1 Applicant - Legal Name ol Organization RUITIPLE SCIEROSIS SOC IIMEIPO " IDIITK STXII CHRPTEI 2 Street Address 23M Picollet3 City State Zip J ■» CountyPinntipoUs, RP 5SUI i Henntpin 5 Business Phone ( 612 ) 87M5H6. Name of Chief Executive Officer Uillird Hunger Jr 7 Business Phone ( 612 ) 871-lSII8 Name of Treasurer or Person Who Accounts for Revenues Eleinor Hovik 9 Business Phone ( 612 ) 871-lSM10 Name of Gambling Manager ff S Society Ueyne Novak 11 Bond Number 988Z2S8 12. Business Phone ( 612 ) 871-lSM13 Name of Establishment Where Gambling Will Tane Place Jitiie’s lounoe Havarre 14 County Henneoin 15 No of Active Members2IIH16 Lessor Name J 8 HoK:17 Monthly Rent;;6H 18 If Bingo will be conducted with this license please specify cays and times of Bmgo Davs Times Days Days Times 19 Has license ever been _ RevoKeo Date 20 Have internal controls been submitted previously'^ 21 Has currerit lease been filed with the board'^ 22 Has current sketch been filed with the board'’ Z Suspended Date ___________ 'ji^Yes Z No (If “No." attach copy) j^Yes Z No Ilf "No." attach copy) ^^Yes Z No fit "No." attach copy) ^ Denied Date GAMBLING SITE AUTHORIZATION By my signature below, local law enforcement officers or agents of thn Board are hereby authorized to enter upon the site, at any time, gambling is being conducted to observe the gambling and to enforce the law for any unauthorized game or practice BANK RECORDS AUTHORIZATION By my signature below, the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to fulfill requirements of current gambling rules and law OATH I hereby declare that 1 I have read this application and all information submitted to the Board 2 All information submitted is true, accurate and complete 3 All other required information has been fully disclosed. 4 I am tho rhfof oxecutsvc officer of Hit? uiyamzaiion; 5 I assume full responsibility for the fair and lawful operation of all activities to be conducted; 6 I will familiarize myself with the laws of the Slate of Minnesota respecting gambling and rules of ihe board and agree, if licensed, to abide by those laws and rules including amendments thereto 23 Official Legal Name of Organization Sclerroi'is £ock4%q hJotF-i-ix S4tLr ________ Title__ ^ ACKNOWLEDGEMENT OF NOTlCTBY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy of this application. By acknowledging receipt. i admit having been served with notice that this application will be reviewed by the Chantabie Gambling Control Board and if approved by the Board, will become effective 60 days from the date of receipt (noted below), unless a resolution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is received by 24^ily/County Name^ocai Governing Body)Township If sue •$ located withm a township, please complete items 24 and 25 Signaiur^f P^sbn deceiving Application 25 Signature of Person Receiving Application Title i Date Received (this date begins 60 day period)Title ol Perion Delivering Application iOTloco. '^n.- .iing Poov Township Name CG-00022-01 14/09)White Copv - Board Ciinarv - Apoi'Cant PinH-Local Governm