Item 3.9 LG220 Application for Rogers Otsego Softball Associationot CIe F o
MINNESOTA
DEPARTMENT INFORMATION
Request for
City Council Action
ORIGINATING DEPARTMENT
REQUESTOR:
MEETING DATE:
Administration
City Clerk Etzel
February 8, 2021
PRESENTER(s)
REVIEWED BY:
ITEM #:
Consent
City Administrator/Finance Director Flaherty
3.9
STRATEGIC VISION
MEETS:
THE CITY OF OTSEGO:
Is a strong organization that is committed to leading the community through innovative
communication.
Has proactively expanded infrastructure to responsibly provide core services.
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.
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 Otsego
Softball Association.
ARE YOU SEEKING APPROVAL OF A CONTRACT?
IS A PUBLIC HEARING REQUIRED?
No
No
BACKGROUND/J USTIFICATION:
City staff received an application from the Rogers Otsego Softball Association for a raffle to be held June
13, 2021 at the ROSA Training Facility located at 5650 Queens 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
• IRS 501(c) (3) letter
POSSIBLE MOTION
PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES:
Motion to approve an LG220 Application for Exempt Permit for the Rogers Otsego Softball Association to
be held June 13, 2021 at the ROSA Training Facility and authorizes the City Clerk to sign.
BUDGET INFORMATION
FUNDING: BUDGETED:
N/A I N/A
a
�
�i
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
$ total or less, contact the Licensing Specialist assigned to additional fees prior to 30 days before your event will not expedite
your county by calling 651-5394900, service, nor are telephone requests for expedited service accepted.
ORGANIZATION INFORMATION
Organization"Z`Previous Gambling
w0',D f-l{�'? _
Name: Permit Number:
[�
Minnesota Tax ID Federal Employer ID
Number, if any: Number (FEIN), if any: ((��
Mailing Address:
City: CZ C& State: r //Zip: � County: 1N1�1 c 1
Name of Chief Executive Officerr /(CEO);
CEO Daytime Phone. ��1 7 J% ` f a r CEO Email: C"`r✓ ] �`^ C�
(permit will be emalled to this emall address unless otherwise Indicated below)
Email permit to (if other than the CEO): Lff,
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
IRS 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 � aIL4 � � /e_ ' d �-
(for raffles, list the site where the drawing will take place): '-`J �-►
Physical Address (do not use P.O, box):
(O �7 O V.Q� 4V�Yv
Check one:
3'City:2c Zip:
❑JU County:
Township: zip: County:
Date(s) of activity (for raffles, Indicate the date of the drawing): I2,) t�2 1 ltv� gpV`^'
Check each type of gambling activity that your organization will conduct:
Bingo Paddlewheels F1 Pull -Tabs F] Tipboards 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.
LG220 Application for Exempt Permit
11/17
Page 2 of 2
LOCAL UNIT OF GOVERNMENT ACKNOWLEDGMENT (required before submitting application to
the Minnesota Gambling Control Board)
CITY APPROVAL
for a gambling premises
located within city limits
HThe 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;
Signature of City Personnel:
Title; �, t Vt�h1 — Date;
The city or county must sign before
submitting application to the
Gambling Control Board.
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.
❑T'he application is denied.
Print County Name;
Signature of County Personnel:
Title
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;
CHIEF EXECUTIVE OFFICER'S SIGNATURE (required)
Date;
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 th you, within 30 day f the event date.
Chief Executive Officer's Signature: T Date; I Z7
l(9 n (ure- must b CEO 's sig ure; d lgnee may not sign)
Print Name:
REQUIREMENTS MAIL APPLICATION AND ATTACHMENTS
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))
Data privacy notice: The Information requested
by the Gambling Control Board (Board) to
determine your organlzatlon's qualifications to
be involved in lawful gambling activities In
Minnesota. Your organizatlon has the right to
refuse to supply the information; however, if
your organization refuses to supply this
Informatlon, the Board may not be able to
determine your organization's qualifications and,
as a consequence, may refuse to Issue a permit,
If your organization supplies the Information
requested, the Board will be able to arocess the
on this form (and any attachments) will be used
Mall Oplication with:
j�'copy of your proof of nonprofit status; and
V 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 Boa
rd at
651-539-1900,
application. Your organization
's name and
address will be public information
by the Board. All other information provided will
be private data about your organization until the
Board Issues the permit. When the Board Issues
the permit, all Information provided will become
public. If the Board does not Issue a permit, all
Information provided remains private, with the
exceptlon of your organization's name and
address which will remain public. Private data
about your organization are available to Board
members, Board staff whose work requires
access to the information; Minnesota's Depart -
when received
ment of Public sarety; attorney genera
Commissioners of Administration, Minnesota
Legislative
Management &Budget, and Revenue;
Auditor, national and International gambling
regulatory agencies; anyone pursuant to court
order; other Individuals and agencies specifically
authorized by state or federal law to have access
to the information; Individuals and agencies for
which law or legal order authorizes a new use or
sharing of Information after this notice was
given; and anyone with your written consent,
This form will be made available in alternative format (Le. large print, braille) upon request.
An equal opportunity employer
if
I
P`
INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date: A P K 2 5 201b
ROGERS OTSEGO SOFTBALT, ASSOCIATION
PO BOX 506
ELK RIVER, MN 55330
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
62-0866633
DLN:
17053312336017
Contact Person:
FAITH E CUMMINS ID## 31534
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
December 31
Public Charity Status:
509(a)(2)
Form 990/990-EZ/990-N Required:
Yes
Effective Date of Exemption:
February 21, 2017
Contribution Deductibility:
Yes
Addendum Applies$
No
We're pleased to tell you we determined you're exempt from federal income tax
under Internal Revenue Code (IRC) Section 501(c)(3), Donors can deduct
Contributions they make to you under IRC Section 170. You're also qualified
to receive tax deductible bequests, devises, transfers or gifts under
Section 2055, 2106, or 2522, This letter could help resolve questions on your
exempt status. Please keep it for your records.
Organizations exempt under IRC Section 501(c)(3) are further Classified as
either public Charities or private foundations. We determined you're a public
charity under the IRC Section listed at the top of this letter.
If we indicated at the top of this letter that you're required to file Form
990/990-EZ/990-N, our records show you're required tc file an annual
information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N,
the e-Postcard), If you don't file a required return or notice for three
consecutive years, your exempt status will be automatically revoked.
If we indicated at the top of this letter that an addendum applies, the
enclosed addendum is an integral part of this letter,
For important information about your responsibilities as a tax-exempt
organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar
to view Publication 4221-PC, Compliance. Guide for 501(c)(3) Pub1iC Charities,
which describes your recordkeeping, reporting, and disclosure requirements.
Letter 947
-a-
ROGERS OTSEGO SOFTBALL ASSOCIATION
We sent a copy of this letter to your representative as indicated in your
power of attorney.
Sincerely,
Director, Exempt Organizations
Rulings and Agreements
Letter 947