5.f) Application for Excluded Raffle Permit-Scandia Women's Softball Association Meeting Date: 2/21/2012
Agenda Item: �
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City Council Agenda Report
City of Scandia
14727 209`�' St.North
Scandia, MN 55073 (651)433-2274
Action Requested: Consider application of Scandia Women's Softball for an Excluded or
Exempt Lawful Gambling Permit to conduct Ham Bingo and Turkey
Bingo at the Scandia Community Center.
Deadline/Timeline: Ham Bingo is scheduled for March 30, 2012, Turkey Bingo on
November 16, 2012.
Background: • The Gambling Ordinance (No. 100)requires a local permit ta
conduct lawful gambling excluded or exempted from state
licensure requirements.
• The softball association's state Application to Conduct Excluded
Bingo requires approval by the city. Up to four events in a
calendar year may be covered in a single application.
• Prizes given will be 50-$10 hams (March)and 50-$10 turkeys
(November.)
• This event has been conducted in past years by this organization at
this location, with no incident or complaint.
• The organization and the event appear to meet a11 the requirements
of the city's ordinance.
Recommendation: I recommend that the Council approve the permit.
Attachments/ . Application
Materials provided:
Contact(s): Linda Capra, Scandia Women's Softball
651 464-0659
Prepared by: Anne Hurlburt, Administrator
(gambling permit womens softball bingo)
Page 1 of 1
02/09/12
APPLICATION FOR EXCLUDED RAFFLE PERMIT
Fee: $15.00
City of Scandia, Minnesota
14727 209th Street North,Scandia, MN 55073
Phone 651/433-2274 Fa�c 651/433-5112 Web http:Hwww.ci.scandia.mn.us
This application form is for use only to request City approval of a local permit for lawful gambling not required to be
registered with the Minnesota Gambling Control Board. An excluded raffle may be conducted by a nonprofit organization
if the total market or retail value of all raffle prizes awarded in a calendar year does not exceed$1500 and the
organization has not received an exempt permit in the current calendar year. All applicants for an excluded raffle permit
are encouraged to contact the Licensing Section of the Gambling Control Board at 651 639-4000, or www.qcb.state.mn.us
for more information and requirements for exempt and excludec! lawful gambling activities.
1. Name and address of organization: _ ,
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2. Name and address of premises where event will occur: (a copy of the rental orleasing arrangement,
if any, including rental to be charged to fhe organization must be attached to this application.)
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3. Date of gambling occasion:
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4. Estimated vaiue of prizes to be awarded: �� e �v � �� �
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5. Names and ad ses of officers a p so s accounting fo eceipts, expenses and
profits for the event:
Name: 1_ ����✓� �. va�vz �1 Phone: l�S I -� �y -�'��: ��
Street Address: 2 ��1 �� �� �- �-e�, ta�e � _ E-Maif: (��f�- G�/�' ���S'� . � a."-
City/State: �;��,�} L�,�-� r� ��'l'' S�D Z�� Zip: �.SCs���
Name: ��� rti� , ,� 4��,_, ' � ! Phone: �S 1 - �-I 3 3�� �� 1
Street Address: E-Mail:
City/ State: "1°`��1 c,�� t�.. �'�� �� Cl��.,� ��1�'� Zip: ��0�� �
Name: Phone:
Street Address: E-Mail:
City/ State: Z�P�
ACKNOWLEDGEMENTS: I hereby acknowledge and certify that the organization and the activity
for which this application applies will be conducted in accordance with the all regulations and
requirements of Minnesota Statutes and the rules of the Minnesota Gambling Control Board, and the
City of Scandia, including:
a) The organization is a non-profit organization with non-profit status from the IRS or the Minnesota
Secretary of State.
b) The total market or retail value of all raffle prizes awarded by this organization in a calendar year
does not exceed $1500 and the organization has not received an exempt permit in the current
calendar year.
c) The organization has been in existence in the City of Scandia for at least three consecutive years
prior to the date of this application.
d) The organization has at least 15 active members.
e) This is the only organization conducting exempted or excluded lawful gambling activities on the
premises.
fl This permit is valid only for the occasion for which it is issued.
6. Applicant Signature(s) Date:
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Upon receipt of this application you will be notified in w►iting of the date on which the City Council will consider
the permit. The City Council meets on the third Tuesday of each month. Applications must be received not
/ess than 5 days prior to the meeting date. No application will be consider�ed complete until the fee has been
paid. After Counci!action, you will receive a copy of this application signed by the City Clerk as your officia!
permit.
For City Use Only
� �� D � PAiD
Application Fee Received
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City Council Consideration (Date) .� �c�/�-`�d��i
CITY OF SCANDIA
Approved Denied
Signature, City Clerk
City of Scandia,Application for E�ccluded Raffle Permit
Page 2, 1/27/2012