5.f) Gammelgarden Excluded or Exempt Lawful Gambling Permit-Running of the Meatballs Meeting Date: 6/19/2012
Agenda Item: �
� � �
City Council Agenda Report
City of Scandia
14727 209�' St. North
Scandia, MN 55073 (651) 433-2274
Action Requested: Approve the application of Gammelgarden Museum for an Excluded
or Exempt Lawful Gambling Permit to conduct a raffle.
Deadline/Timeline: The event is scheduled for September 8, 2012, immediately prior to
the Taco Daze parade.
Background: • The Gambling Ordinance (No. 100)requires a local permit to
conduct lawful gambling excluded or exempted from state
licensure requirements.
• The value of all prizes to be given is $2,500.00.
• The organization and the event appear to meet all the requirements
of the city's ordinance.
• As they did in 2011, the organization will sell chances on the
"Running of the Meatballs"which will occur on Oakhill Road
starting at Elim Church, down the hill (to the east.) Special golf
balls will be rolled down the hill and prizes awarded based on
when the balls cross a finish line.
• In 2011, the Scandia Marine Lions Club included this activity in
their Special Event Permit for the parade and the rest of their Taco
Daze events.
Recommendation: I recommend that the Council approve the permit.
Attachments/ • Application
Materials provided:
Contact(s): Dianne Johnson, 651 470-3724
Prepared by: Anne Hurlburt, Administrator
(gambling gammelgarden 2012)
Page 1 of 1
OS/25/12
AF�PLIG�TfON FQR EXGLUDED OR EXE�MPT
L��F�L ��f�BLl�C P�f��[[�"
��e: $��.ao
City� a� Scandia, lV�innesota
14727 203th Street North, Scandia, MN 55073
Phcsn�&S�f/433-22T4 Fax�5'f/433-�112 4"deb http:l/ww�w.ci.scandia.mn.u�
This application form is for use to request City approval of a local permit for lawful gambling required to be registered with
the Minnesota Gambling Control Board. In addition to this form, applicants shall submit to the City the original, signed and
completed application to the Gambling Control Board (forms LG220, Application for Exempt Permit, or LG 2406,
Application to Conduct Excluded Bingo)with copies of all required attachments.
'G. t�ame �nd addr��s of organizatian: �r..�`�,'vu�����.. �'-w_'-�"'�� �'�US��.��� .
���t�3C3�C"�Lih���r '.C"�. j J. ; �C� t�`.aX b�
����fl -r�� N' S��`7.�
Z. Nam� anc� addres� ai premises vret��r� ev�nt will occur�. (a copy of the rental or leasing arrangement,
if any, including renfal to be charged to the organizafion must be attached to fhis application.)
C�,4{C-t-t i�.�- �Ut-�iJ ,��,i����t�►`C�L��b/t- �"� .� t.1. `� �C�;'� �i J�/�
'^ � -''c=� �i����ti �-U fi`t��2_,� C�i�kU��+-�
3. D�te(s) of gambting occa�ion:
�r ��2.��-�-� , �..r'� � � �-o r �
4�. Estimated value o� pri��s to be avvard�c�: ��,��, �� t'l�f�i._. �,�- fG�-IS�+� �z-�-s
�'t���.�r'u� 'Dc-s N �'c � 37.
�. Names �nd addresses of afficers and person� accounting for receip�, expenses and
profits for th� event:
Name: �iRtiN���5�� � ��:�� �'t�.�v�Bz� Phone: ��l�����-3'��'�
Street Address: �����v��ih��-�� �pG�X 1'�J E-Mail: �.-��rA--n►�U�i�C��L°LQr►-i
City/ State:���S'T �-t�~t«� �'1� Zip: �����
Name: �;�7�- �4�r.�, 1���.� � [��.���..�,2 Phone: (��/����_�._/���
Street Address: �.�°3� -�(. �r SC �lfi�A-iL- �� E-Mail: �S��-D��r-(=���t�`�-��r
,
City/ State: �C"�t��1.�i� �'1 !� Zip: ���ZYj�
Name: ���;� V�1(��'�`E"�i�:�'t� � ?��(�_ I��(ar�Phone: �,,�'j,�q`�_��-_,.���'�
Street Address: -�-1��� �����►� �i, r,C�, E-Mail: �,����'_D£-��;L���,tF'�
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City/ State: ��-�� �I� f�� ���� .,����`
ACKNQY�(LEDGEMENTS: I hereby acknowledge and certify that the organization and the activity
for which fhis application applies will be conc4ucted in �ccordance with the all regulations and
requirements af Minnesata Statutes and the rules af the Minnesota Gambling Controi 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 organizatian has been in existence in the City of Scandia for at least three consecutive years
prior to the date of this application.
c) The organization has at least 15 active members.
d) This is the only arganization conducting exemptec� or excluded lawful gambting activities on the
premises.
e) This permit is valid anly for the occasion(s) for which it is issued.
6. Applic�nt Signature(�) Date:
�--�-,�-�.���._. � ��, �r�l�
, ��-�-� ��"e�
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Upon receipt of this application you will be notified in writing of the date on which the City Counci/will consider
the permit. The City Caunci(meets on the fhird Tuesday of each month. Applications must be recerved naf
less than 6 days prior to the meeting date. No application will be consider�d complete until the fee has been
paid. after Council action, the City Clerk wi11 sign and retum form LG220 or LG2408 to you.
Far City Us� Only
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Application Fee Received � t � �� � �$ ?�f�"'�
C�AY � �ZQ12
City Council Consideration (Date) C�''C��f-� ��
CITY OF SCA.NDIA
Approved Denied
City of Scandia, Application for Excluded or Exempt Lawful Gambling Permit
Page 2, 4/5/2012