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Home My WebLink About20090420 - VI-14HASTINGS FIRE DEPARTMENT RELIEF ASSOCIATION Alan E. Storlie, President 115 West 5~' Street Hastings, NIN 55033-1815 Business Office (6S 1) 480-6150 Fax (651) 480-6170 TO: Mayor Hicks Council Members FROM: Hastings Fire Department Relief Association DATE: May 4, 2009 SUBJECT: Request for approval of One-Day Liquor License Application and Charitable Gambling Application far 69~' Annual Booya. The Hastings Fire Department Relief Association is requesting Council approval for aone-day liquor license, to allow for the sale of Beer at the Columbian Hall, South Highway 61, during our 69~' Annual Booya, to be held on Sunday, September 13, 2009. 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 a temporary on-sale liquor license and an application for charitable gambling. These items will need to be signed, upon your approval, and returned to us so that we may forward them to the appropriate State agencies. Thank you for your assistance in this matter. If you should have any questions, please feel free to contact James Gelhar, Ray Knoll, or Christopher Paulson at 651-480-6150. Minnesota Lawful Gambling LG220 Application for Exempt Permit An exempt permit may be issued to a nonprofit organization that: -conducts lawful gambling on five or fewer days, and -awards less than $50,000 in prizes during a calendar year. Page 1 of 2 9lU8 Fee is $50 for each event For Board Use Only Check # ORGANIZATION INFORMATION Organization name Previous gambling permit number Hastings Fire Department Relief Association X-19043-08-001 Type of nonprofit organization. Check one. Fraternal ~ Religious ~ Veterans ~ Other nonprofit organization Mailing address City State Zip Code County 115 West 5th Street Hastings MN 55033-1815 Dakota Name of chief executive officer (CEO) Daytime phone number Email address Alan E. Storlie 651-480-6150 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 Good Standing. Don't have a copy? This certificate must be obtained each year from: Secretary of State, Business Services Div., 180 State Office Building, St. Paul, MN 55155 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 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 nonprofit status from the IRS, no attachment is required. GAMBLING: PREMISES INFORMATION Name of premises where gambling activity will be conducted (for raffles, IisYthe site where the drawing will take place) Columbian Hall Address (do not use PO box) City Zip Code County Highway 61 South Hastings 55033 Dakota Date(s) of activity (for raffes, indicate the date of the drawing) 09/13/2009 to 09/13/2009 heck the box or boxes that indicate the type of gambling activity your organization will conduct: Bingo* ®Raffies ®Paddlewheels* ®Pull-Tabs* ®Tipboards*. * Gambling equipment for pull-tabs, bingo paper, tipboards, and paddlewheels must be obtained from a distributor licensed by the Also complete 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. Fill-in & Print Form To find a licensed distributor, go to www.gcbstate.mn.us and click on List Reset Form of Licensed Distributors, or call 651-639-4076. LG220 Application for Exempt Permit Page 2 of 2 9/08 LOCAL UNIT OF GOVERNMENT ACKNOW LEDGMENT If the gambling premises is within city limits, If the gambling premises is located in a township, a a city official must check (X) the action that the city is county official must check (X) the action that the county is taking on this application and sign the application. taking on this application and sign the application. A township official is not required to sign the application (unless required by the county). _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 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. ~~~~ , 9~S" Print city name A.i Print county name On behalf of the city, 1 acknowledge this application. On behalf of the county, I acknowledge this application. Signature of county official receiving application Signature of city official receiving application Title Date / / ~ (Optional) TOWNSHIP: On behalf of thetownship,I ,~/~ >~ Title (~`/ z ~L~~ Date / / acknowledge that the organization is applying for exempted gambling activity within township limits. [A township has no statutory authority to approve or deny an application [Minnesota Statute 349.166)] Print township name Signature of township official acknowledging application Title Date / / CHIEF EXECUTNE 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 completed and returned to the Soarcf within 30 days of the date of our gambling activity. Chief executive officer's signature Date Complete a separate application for each gambing activity: Financial report and record keeping - one day of gambling activity, required -two or more consecutive days of gambling activity, A financial report form and instructions will be -each day a raffle drawing is held sent with your permit. Within 30 days of the activity date, complete and return the financial Send application with: a copy of your proof of nonprofit status, report form to the Gambling Control Board. and $50 application fee for each event. Make check payable to "State of Minnesota." Questions? Call the Licensing Section of the Gambling To: Gambling Control Board Control Board at 651-639-4076. 1711 West County Road B, Suite 300 South Roseville MN 55113 Fill-in & Print Form Reset Form , Data privacy. This form will be made available in aRematlve format (i.e. large print, Braille} upon request. The information requested on this form (and any attachments) will be used by the Gambling Control Board (Board) to determine your qualfications to 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 qualfications and, as a consequence, may refuse to issue you a permit. If you suppy the information requested, the Board will be able to process your application. Your name and and your organ'~za6on's name and address will be public information when received by the Board. All the other irdormafwn you provide will be private data until the Board issues your permit. When the Board issues your permit, all of the information provided to the Board will become public. If the Board does not issue a permk, all information provided remains private, wRh the exception of your name and your organizatan'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, Finance, and Revenue; Legislative Auditor, national and international gambling regulatory agencies; anyone pursuant to court order; other individuals and agencies that are spec'rf'~cally authorized by state or federal law to have arxess to the information; individuals and agencies for which law or legal order author¢es a new use or sharing of information after this Notice was given; and anyone with your consent. ate of Minnes ~~' °t~ SECRETARY OF STATE 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 business as a corporation at the time this certificate is issued. Name: The Hastings Fire Department Relief Association Date Formed: 02/01/1924 Chapter Governed By: 317A This certificate has been issued on 04/09/09. G%~2~~~ ~ Secretary of State. ,y~ ~ oa Minnesota Department of Public Safety ALCOHOL AND GAMBLING ENFORCEMENT DIVISION 444 Cedar Street Suite 133, St. Paul MN 55101-5133 (651) 201-7507 Fax (651) 297-5259 TTY (651) 282-6555 W W W.DPS. STATE.MN.US APPLICATION AND PERMIT FOR A I TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE TYPF. OR PR1NT INFORMATION ~`-1 • ~f -;' '"•, - NAME OF ORGANIZATION DATE ORGANIZID TAX EXEMPT NUMBER Hastings Fire Department Relief As sn. 02./01/1924 41-6030634 STREET ADDRESS CITY STATE ZIP CODE 115 West 5th Street Hastings MN 55033-1815 NAME OF PERSON MAKING APPLICATION BUSINESS PHONE HOME PHONE Alan E. Storlie President 1651)480-6150 ~ 1~4 -1 DATES LIQUOR WILL BE SOLD 09 / 13 / 2009 TYPE OF ORGANIZATION GTO S O I XXX ORGAI~IIZATION OFFICER'S NAME ADDRESS William R. Mesaros, Vice-President . 115 West 5th Street Hastings, MN 55033-181 ORGANIZATION OFFICER'S NAME ADDRESS Christopher T. Paulson, Secretary 115 West 5th Street Hastings, MN 55033-181 ORGANIZATION OFFICER'S NAME ADDRESS James C. Gelhar, Treasurer 115 West 5th Street Hastin s, MN 55033-181 Location license. will be used. If an outdoor area, describe Columbian Hall, Highway 61 South, Hastings, MN 55033 Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. N/A Will the applicant carry liquor liability insurance? If so, please provide the carrier's name and amount of coverage. MN Liquor Liability Assigned Risk 50 / 100 / 10 APPROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMPI°rING TO ALCOHOL & GAMBLING ENFORCEMENT CITY/COUNTY DATE APPROVED CITY FEE AMOUNT LICENSE DATES DATE FEE PAID SIGNATURE CTTY CLERK OR COUNTY OFFICIAL APPROVED DII2ECTOR ALCOHOL AND GAMBLING ENFORCEMENT NOTE: Submit this form to the city or county 30 days prior to event Forward application signed by city and/or county to the address above. U the application is approved the Alcohol and Gambling Enforcement Division will return this application to be used as the License for the event 1?5-09079 (05/06)