Item 3.7 Approval of LG220 Application for Rogers High School Graduation Night Supporters Inc.F
Oltsego
MINNESOTA
DEPARTMENT INFORMATION
Request for
City Council Action
ORIGINATING DEPARTMENT
REQUESTOR:
MEETING DATE:
Administration
City Clerk Etzel
February 22, 2021
PRESENTER(s)
REVIEWED BY:
ITEM #:
Consent
City Administrator/Finance Director Flaherty
3.7 LG220 Application
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MEETS:
THE CITY OF OTSEGO:
Graduation Night Supporters, Inc.
Is a strong organization that is committed to leading the community through innovative
communication.
IS A PUBLIC HEARING REQUIRED?
Has proactively expanded infrastructure to responsibly provide core services.
No
Is committed to delivery of quality emergency service responsive to community needs and
expectations in a cost-effective manner.
X
Is a social community with diverse housing, service options, and employment opportunities.
An exempt permit may be issued to a nonprofit organization who:
Is a distinctive, connected community known for its beauty and natural surroundings.
AGENDA ITEM DETAILS
RECOMMENDATION:
City staff is recommending that the City Council approve an LG220 Application for the Rogers High School
Graduation Night Supporters, Inc.
ARE YOU SEEKING APPROVAL OF A CONTRACT?
IS A PUBLIC HEARING REQUIRED?
No
No
BACKGROUND/JUSTIFICATION:
City staff received an application from the Rogers High School Graduation Night Supporters, Inc. for a raffle
& bingo to be held April 8, 2021 at the Rockwoods Event Center located at 9100 Quaday Avenue NE.
An exempt permit may be issued to a nonprofit organization who:
• Conducts lawful gambling on five or fewer days, and
• Awards less than $50,000 in prizes during a calendar year.
SUPPORTING DOCUMENTS ATTACHED:
• LG220 Application for Exempt Permit
• Minnesota Secretary of State Business Record Details
POSSIBLE MOTION
PLEASE WORD MOTION AS YOU WOULD LIKE ITTO APPEAR IN THE MINUTES:
Motion to approve an LG220 Application for Exempt Permit for the Rogers High School Graduation Night
Supporters, Inc. to be held April 8, 2021 at the Rockwoods Event Center and authorizes the City Clerk to
sign.
BUDGET INFORMATION
FUNDING: BUDGETED:
N/A I N/A
MINNESOTA LAWFUL GAMBLING
LG220 Application for Exempt Permit
11/17
Page 1 of 2
An exempt permit may be issued to a nonprofit Application Fee (non-refundable)
organization that: Applications are processed in the order received. If the application
conducts lawful gambling on five or fewer days, and is postmarked or received 30 days or more before the event, the
awards less than $50,000 in prizes during a calendar application fee is $100; otherwise the fee is $150.
year.
If total raffle prize value for the calendar year will be Due to the high volume of exempt applications, payment of
$1,500 or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite
your county by calling 651-539-1900. service, nor are telephone requests for expedited service accepted.
ORGANIZATION INFORMATION
Organization Previous Gambling
Name: Rogers High School Graduation Night SUpporters, Inc Permit Number:
Minnesota Tax ID Federal Employer ID
Number, if any: 5473679 Number (FEIN), if any: 82-3744366
Mailing Address: 25203 Mardale Dr
City: Rogers State: MN Zip; 55374 County: Hennepin
Name of Chief Executive Officer (CEO): Stacy Gleason
CEO Daytime Phone: 612-251-4579 CEO Email: rhsgradparty202l@gmail.com
(permit will be emailed to this email address unless otherwise indicated below)
Email permit to (if other than the CEO): kstrombeckl3@gmail.com
NONPROFIT STATUS
Type of Nonprofit Organization (check one):
= Fraternal = Religious Veterans Other Nonprofit Organization
Attach a copy of one of the following showing proof of nonprofit status:
(DO NOT attach a sales tax exempt status or federal employer ID number, as they are not proof of nonprofit status.)
A current calendar year Certificate of Good Standing
Don't have a copy? Obtain this certificate from:
MN Secretary of State, Business Services Division Secretary of State website, phone numbers:
60 Empire Drive, Suite 100 www.sos.state.mn.us
St. Paul, MN 55103 651-296-2803, or toll free 1-877-551-6767
F-1IRS 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 toll free at 1-877-829-5500.
❑ 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:
1. IRS letter showing your parent organization is a nonprofit 501(c) organization with a group ruling; and
2. the charter or letter from your parent organization recognizing your organization as a subordinate.
GAMBLING PREMISES INFORMATION
Name of premises where the gambling event will be conducted
(for raffles, list the site where the drawing will take place): Rockwoods Event Center
Physical Address (do not use P.O. box): 9100 Quaday Ave NE
Check one:
City: Otsego Zip: 55330 County: Wright
FITownship: Zip: County:
Date(s) of activity (for raffles, indicate the date of the drawing): April 8 2021
Check each type of gambling activity that your organization will conduct:
Bingo E-1 Paddlewheels = Pull -Tabs = Tipboards E7J Raffle
Gambling equipment for bingo paper, bingo boards, raffle boards, paddlewheels, pull -tabs, and tipboards must be obtained
from a distributor licensed by the Minnesota Gambling Control Board. EXCEPTION: Bingo hard cards and bingo ball selection
devices may be borrowed from another organization authorized to conduct bingo. To find a licensed distributor, go to
www.mn.gov/gcb and click on Distributors under the List of Licensees tab, or call 651-539-1900.
11/17
LG220 Application for Exempt Permit Page 2of2
CITY APPROVAL
for a gambling premises
located within city limits
The application is acknowledged with no waiting period.
The application is acknowledged with a 30 -day waiting
period, and allows the Board to issue a permit after 30 days
(60 days for a 1st class city).
The application is denied.
Print City Name: Otse
Signature of City Personnel:
Title
COUNTY APPROVAL
for a gambling premises
located in a township
he application is acknowledged with no waiting period.
he application is acknowledged with a 30 -day waiting
period, and allows the Board to issue a permit after
30 days.
Ohe application is denied.
Print County Name:
Signature of County Personnel:
Date: I Title:
The city or county must sign before
submitting application to the
Gambling Control Board.
Date:
TOWNSHIP (if required by the county)
On behalf of the township, I acknowledge that the organization
is applying for exempted gambling activity within the township
limits. (A township has no statutory authority to approve or
deny an application, per Minn. Statutes, section 349.213.)
Print Township Name:
Signature of Township Officer:
Title:
Date:
CHIEF EXECUTIVE OFFICER'S SiGNAI URC (requ read
The information provided in this application is complete and accurate to the best of my knowledge. I acknowledge that the financial
report will be completed and returned to the Board within 30 days of the event date.
Chief Executive Officer's Signature:
Date:
(Signature must be CEO's signature; designee may not sign)
Print Name:
Complete a separate application for:
. all gambling conducted on two or more consecutive days; or
• all gambling conducted on one day.
Only one application is required if one or more raffle drawings are
conducted on the same day.
Financial report to be completed within 30 days after the
gambling activity is done:
A financial report form will be mailed with your permit. Complete
and return the financial report form to the Gambling Control
Board.
Your organization must keep all exempt records and reports for
3-1/2 years (Minn. Statutes, section 349.166, subd. 2(f)).
Mail application with:
a copy of your proof of nonprofit status; and
application fee (non-refundable). If the application is
postmarked or received 30 days or more before the event,
the application fee is $100; otherwise the fee is $150.
Make check payable to State of Minnesota.
To: Minnesota Gambling Control Board
1711 West County Road B, Suite 300 South
Roseville, MN 55113
Questions?
Call the Licensing Section of the Gambling Control Board at
651-539-1900.
Data privacy notice: The information requested
application. Your organization's name and
ment of Public Safety; Attorney Generai;
on this form (and any attachments) will be used
address will be public information when received
Commissioners of Administration, Minnesota
by the Gambling Control Board (Board) to
by the Board. All other information provided will
Management & Budget, and Revenue; Legislative
determine your organization's qualifications to
be private data about your organization until the
Auditor, national and International gambling
be involved in lawful gambling activities in
Board Issues the permit. When the Board issues
regulatory agencies; anyone pursuant to court
Minnesota. Your organization has the right to
the permit, all information provided will become
order; other individuals and agencies specifically
refuse to supply the information; however, if
public. If the Board does not issue a permit, all
authorized by state or federal law to have access
your organization refuses to supply this
information provided remains private, with the
to the information; individuals and agencies for
Information, the Board may not be able to
exception of your organization's name and
which law or legal order authorizes a new use or
determine your organization's qualifications and,
address which will remain public. Private data
sharing of Information after this notice was
as a consequence, may refuse to issue a permit.
about your organization are available to Board
given; and anyone with your written consent.
If your organization supplies the information
members, Board staff whose work requires
requested, the Board will be able to process the
access to the information; Minnesota's Depart -
This form will be made available in alternative format (i.e. large print, braille) upon request.
An equal opportunity employer
Business Record Details >>
Minnesota Business Name
ROGERS HIGH SCHOOL GRADUATION NIGHT SUPPORTERS, INC.
Business Type
Nonprofit Corporation (Domestic)
File Number
984415300025
Filing Date
12/7/2017
Renewal Due Date
12/31/2021
Registered Agent(s)
DEANN SCHREIFELS
Filing History
Filing History
MN Statute
317A
Home Jurisdiction
Minnesota
Status
Active/ In Good Standing
Registered Office Address
22775 TIFFANY TRAIL
ROGERS, MN 55374
USA
President
Kelly Braun
13783 Bluewing Drive
Rogers, Minnesota 55374-5537
United States
Select the item(s) you would like to order: Order Selected Copies
® Filing Date Filing Effective Date
® 12/7/2017 Original Filing- Nonprofit Corporation (Domestic)
(Business Name: ROGERS HIGH SCHOOL
GRADUATION NIGHT SUPPORTERS, INC.)