5.e) Excluded Raffle Permit, Scandia Elementary Enrichment Foundation t i
Meeting Date: 7/20/2010
Agenda item: ��
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City Council Agenda Report
City of Scandia
14727 209`h St. North
Scandia, MN 55073 (651) 433-2274
Action Requested: Approve the application of Scandia Elementary Enrichment
Foundation for an Excluded Raffle Permit to conduct a raffle at the
Scandia Softball Association Taco Daze games.
Deadline/ Timeline: The event is scheduled for Friday, September 10, 2010
Background: • The Gambling Ordinance (No. 100)requires a local permit to
conduct lawful gambling excluded or exempted from state
licensure requirements.
• The maximum prize will be $500, donated by Security State Bank
of Marine. All proceeds go to the Scandia Elementary Enrichment
Foundation.
• The organization and the event appear to meet all the requirements
of the city's ordinance.
Recommendation: I recommend that the Council approve the permit.
Attachments/ • Application
Materials provided:
Contact(s): James Lindberg, 651 433-2265
Prepared by: Anne Hurlburt, Administrator
(gambling permit scandia elem enrich found)
Page 1 of 1
07/07/10
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APPLICATION FOR EXCLUDED RAFFLE PERMIT
Fee: $15.00
City of Scandia, Minnesota
14727 209th Street North, Scandia, MN 55073
Phone 651/433-2274 Fax 651/433-5112 Web http://www.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 totaf 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 excluded 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 or leasing arrangement,
if any, includin�c rental to be charged to the organization must be attached to this application.)
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3. Date of gambling occasion: (' ���/�
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4. Estimated value of prizes to be awar ed:
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5. Names and addresses of officers and persons accounting for receipts, expenses and
profits for the event:
Name: Q m,�,s ��_•�.1"�` Phone: �2 ��.
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Street Address: Z l�� S Q�,' �t �r•�, E-Mail:
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Name: rn �"�y ��7,(� '��''�_ Phone:
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Street Address: E-Mail:
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Name: Phone:
Street Address: E-Mail:
City/ State: Zip:
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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.
f) This permit is valid only for the occasion for which it is issued.
6. plicant Signature(s) Date:
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Upon receipt of fhis application you will be notified in writing of the date on which the City Council will consider
the permit. The City Council meets on the first and third Tuesday of each month. Applications must be
received not less than 5 days prior to the meeting date. No application will be considered complete until the
fee has been paid. After Council action, you wil!receive a copy of this application signed by the City Clerk as
your official permit.
For City Use Only
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Application Fee Receiveci ��� ��
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City Council Consideration (Date) CITY OF SCAND(A
Approved Denied
Signature, City Clerk
City of Scandia, Application for Excluded Raffle Permit
Page 2, 6/23/2010