5.e) Excluded Raffle Permit, Scandia Elementary Enrichment Foundation � x
Meeting Date: 721/2009
Agenda Item: � ,-- }
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City Councii 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"Roll in the
Money"raffle at the Scandia Softball Association Taco Daze games.
Deadline/ Timeline: The event is scheduled for Friday, September 11,2009
Background: • The Gambling Ordinance(No. 100)requires a local permit to
conduct lawful gambling excluded or exempted from state
licensure requirements.
• Raffle tickets will be sold for$1.00. The drawing is between
softball games on Friday Night at the Scandia Softball Field. The
winner wears double-sided tape and rolls in cash; whatever sticks
to the tape, the winner keeps. The maximum prize will be$300,
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
07/13/09
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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 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.pcb.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�rental to be charged to the organization must be attached to this application.)
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3. Dat of ga bling occasion• � ,._-. %" �c
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4. Estimated value prizes to e awarded: -
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5. Names and addresses of officers and persons a counting f r receipts, expe ses and
profits for the event: /
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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. Applicant Signature(s) Date:
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Upon receipt of this application you will be nofified 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 monfh. Applications must be
received not/ess than 5 days prior to the meeting date. No application will be considered complefe until the
fee has been paid. After Council action, you will receive a copy of this application signed by the City C/erk as
your official permit.
For City Use Only -
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Application Fee Received � ��� ��� ��`.��_ ; i�!�i�.� '
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City Council Consideration (Date) ��?Y OF St;�,ND�A �
Approved Denied
Signature, City Clerk
City of Scandia, Application for Excluded Raffle Permit
Page 2, 7/1/2009