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HomeMy WebLinkAboutMontana Department of Revenue (2) Alik Montana Department of Revenue ° Dan Bucks Brian Schweitzer Director Governor April 1, 2010 RE: Application for Corporate Structure Change of Montana Retail On- Premises Consumption Beer and Wine License No. 03- 044 - 9135 -301, MONTANA LIL'S CASINO OF LAUREL, 306 South 1 Avenue, Laurel, Yellowstone County, Montana The above referenced application was received at the Department of Revenue, Liquor Licensing. Notice is being provided to you to give you an opportunity to advise if the applicant and premises meet all the laws and ordinances your office is responsible for regulating. We will be happy to provide any additional information that is needed. Local laws are not enforced through the alcoholic beverage licensing process; however, if there are local laws affected by this application, compliance with those laws may influence the final determination to issue the license. If anv agency determines deficiencies exist that should be considered in the issuance of this license, please advise this office in writing by May 1, 2010. If we receive a determination of a local deficiency, the license application process cannot be completed until the issue is cleared up at the local level. In addition, if we receive a written protest against the issuance of this license, a public hearing will be scheduled. If you have any questions, please call (406) 444 -0713. Sincerely, Yi `" n r a i ' a d E b Tanya Stelzer Compliance Specialist 1 APR 2 2010 J Department of Revenue Liquor Licensing PO Box 1712 CITY OF LAUREL Helena MT 59624 -1712 —" - cc: Department of Labor & Industry Montana Beer and Wine Distributors Association Customer Service (406) 444 -6900 A TDD (406) 444 -2830 • www.mt.gov /revenue CERTIFICATE OF SERVICE certify that on this 1 day of April , 2010, a true and correct copy of the foregoing has been served by placing same in the United States mail, postage prepaid, and addressed as follows: LAUREL CITY COUNCIL PO BOX 10 LAUREL MT 59044 LAUREL CITY ATTORNEY PO BOX 10 LAUREL MT 59044 LAUREL POLICE CHIEF MIKE ATKINSON PO BOX 10 LAUREL MT 59044 LAUREL CITY BUILDING INSPECTOR PO BOX 10 LAUREL MT 59044 YELLOWSTONE COUNTY SANITARIAN BOX 35033 BILLINGS MT 59107 YELLOWSTONE COUNTY TREASURERS OFFICE P O BOX 35010 BILLINGS MT 59107 -5010 ADMINISTRATIVE ASSISTANT FIRE PREVENTION AND INVESTIGATION BUREAU 303 NORTH ROBERTS BOX 201415 HELENA MT 59620 -1417 Check the Appropriate Boxes to Designate the Purpose of this Application Alcoholic Beverage Designate the Type of License 0 New Alcoholic Beverage License Application of Your Application: ® Existing Alcoholic Beverage License; Transfer of Ownership Application ° On-Premises Beer ® Existing Alcoholic Beverage License; Corporate Structure Change ® On- Premises Beer/Wine Existing Alcoholic Beverage License; Transfer of Location Application El All-Beverage 0 QExisting Alcoholic Beverage License; Death of Licensee Restaurant Beer/Wine 0 Resort License Gambling An ownership interest in a licensed gambling operation may not transfer an interest in the operation to a stranger to the license until a new gambling license application reflecting the proposed transfer is submitted to the department and the department approves the transfer. An ownership interest in a licensed gambling operation may not be transferred to another owner or group of owners of an interest or interests in the same licensed gambling operation without submitting an amended gambling license application to the department and obtaining department approval. ® New Gambling ['New Gambling - No Alcoholic Beverage License is Required for Live Keno/Bingo. ['Amended Gambling License Application (Note: No fee is required for this application) °Existing Gambling License Change Among Existing °Existing Gambling License Deletion of Owner(s) Corporate Shareholder(s) DExisting Gambling Location Change Application °Existing Gambling License Change Among Existing 0 Existing Gambling License Type Change Application Partners or LLC /LLP Members ['Other (Explain) ��CEIVFn fay' Section ! MAR 0 9 2010 General Information GAMBLING CONTROL DIVISION Print or Type Name of Applicant LAUREL CASINO, INC. (Owning entity such as Sole Proprietor/Partnerships /Corp./LLC/LLP) Business/Trade Name MONTANA LIL'S CASINO OF LAUREL (An assumed business name must be filed with the Secretary of State and verification provided.) Mailing Address P0 BOX 6000, BUTTE, MT 59702 -6000 (P.O. Box or Street) Address of Premises to be licensed 306 1ST AVE. S. (Street, Suite No., Building No.) Ci LAUREL State MT Zip 59044 Business Phone ( 406 )62 &2591 Cell Phone ( ) Fax ( 406 ) 497 - 6706 Federal Tax I.D. Numbeall1111P Check if applied for but not yet received. Alcohol Beverage License Number 03 _044 _9135 _ 301 (N/A if not applicable) Are the premises for licensing located: I Within the boundaries of an incorporated city /town (Gambling Licensing.) [' Within a distance of five miles of an incorporated city /town (Alcoholic Beverage Licensing.) In Within an unincorporated city /town or outside the boundaries of and more than five miles distance from any city /town whether incorporated or unincorporated (Alcoholic Beverage Licensing.) LAUREL in County of YELLOWSTONE City Name County Name 2 C. Provide the information requested below for each: Check appropriate box (Use additional paper if necessary) O Individual /Sole Proprietor 0 Person(s) holding an option to purchase the business 0 General or 0 Limited Partnership or any interest in the business O Limited Liability Company (Member of...) 0 Other ® Officer of a Corporation 0 Check this box if ownership in the alcoholic beverage ® Director of a Corporation license is also held as Joint Tenants with Rights of Survivorship (JTROS) or Tenants in Common (TEN O Shareholder of a Corporation COM) and make certain each individual with rights of O Shareholder owning 5% or more of the stock of a survivorship or common are listed below. O publicly traded corporation 0 JTROS or 0 TEN COM O Person(s) and /or committee managing the gambling activity under a 26 U.S.C. 501 (cX3), (cX4),)(8) or (c) (19) organization Name (First, M.I., Last)SEE ATTACHED Title Date of Birth Social Security No. Number of Shares Address Percentage of Ownership Name (First, M.I., Last) Title Date of Birth Social Security No. Number of Shares Address Percentage of Ownership Name (First, M.I., Last) Title Date of Birth Social Security No. Number of Shares Address Percentage of Ownership Note: Each individual listed above must submit with this application a Personal /Criminal History Statement (Form 10) and a completed Fingerprint Card and fee. Use additional sheet of paper if necessary. I hereby request smoking exception and affirm that 60% of the revenue generated by this business will be from the sale of alcoholic beverages and /or gambling. 0Yes I do not request smoking exception. El No P D. Charitable, Religious, Veterans' or Fraternal Organization If the applicant is a charitable, religious, veterans' or fraternal organization, complete the following information. If not applicable indicate: ®N /A Date qualified for exemption under 26 U.S.C. 501 (cX3), (cX4), (cX8) or (c)(19): Month Day Year Date local charter issued or post organized: Month -s: Day Year Has national organization been in existence for a period of five years prior to January 1, 1949? 0 Yes 0 No Provide Address of National Headquarters: Street Address City State Zip A copy of your organization or post charter must accompany this application. Location of Gambling Premises: Street Address City _ State Zip How many days, per year, is gambling conducted at this location? Days 0' 4 RECEIVED BY PROPOSED MAR 0 8 2010 LAUREL CASINO, INC. fka Kalispell Casino, Inc. GAMBUNG WQNTRQ{, DIVISION DATE OF INCORPORATION: May 12, 1995 PLACE OF INCORPORATION: MONTANA DIRECTORS /OFFICERS OF LAUREL CASINO, INC. NAME TITLE ADDRESS PHONE Thomas F. Kenneally President 600 S. Main, Butte 497 -6700 Thomas P. Kenneally VP 600 S. Main, Butte 497 -6700 Mary Ann Kenneally Secretary 600 S. Main, Butte 497 -6700 Daniel J. Kenneally Director 600 S. Main, Butte 497 -6700 Kevin J. Kenneally Director 600 S. Main, Butte 497 -6700 Michael E. Kenneally Director 600 S. Main, Butte 497 -6700 SHAREHOLDERS OF LAUREL CASINO, INC. (.1% ownership) CLASS A SHARES NAM All: 1e; 1 , ' S Daniel J. Kenneally 4000 Hillside Dr., Butte 25.0 3 James M. Kenneally 121 Rampart, Butte 25.0 3 Kevin J. Kenneally 341 BJacktail Cyn Rd., Bu 25.0 3 Michael E. Kenneally 3355 Blacktail Loop, Butte 25.0 3 (99.9% ownership) CLASS C SHARES NAME ADDRESS FEIN SHARES % DANLA,LLC 600 S. MAIN 111111111111p 2497.5 25 Wholly owned by Danner Trust Butte, MT 59701 JOHNS, LLC 600 S. MAIN _11* 2497.5 25 Wholly owned by Johnson Trust Butte, MT 59701 KOPE, LLC 600 S. MAIN 2497.5 Wholly owned by Kinsey rust 25 y Butte, MT 59701 LUCAS, LLC 600 S. MAIN allum 2497.5 25 Wholly owned by Leonard Trust Butte, MT 59701 C. Is the premises within any defined zones: 1. Where the sale of alcoholic beverages is restricted by city or county zoning ordinance? DYes ® No • 2. Where gambling is restricted by city or county zoning ordinance? e ".(5 1,&5 I o G 4.41 o �+ ®Yes IM No D. Is the building ready for use for an alcoholic beverage business: © Yes ® No 1. Is this a newly constructed premises? DYes ®No If Yes, indicate an estimated date of occupancy 2. Is this a remodel of an existing premises? DYes ® No If Yes, indicate an estimated date of completion E. Submit a copy of the floor plan area to be licensed, using approximate dimensional measurements, including external dimensions and general layout — on an 8 -1/2" x 11" sheet of paper and number of tables and chairs indicated. If you are applying for a restaurant beer and wine license, be sure the floor plan has the service bar area clearly designated thereon. Note: On the floor plan you will need to clearly mark the areas where alcohol will be served, stored and consumed. The floor plan must contain outside dimensions, the name of the establishment, physical address, alcoholic beverage license number (if applicable) and date of submittal. 13 • RE • Section VII MAR 0 9 2010 GAMBUNG Declaration and Authorization CANTROL DIVISION APPLICANT'S FORMAL DECLARATION AND AUTHORIZATION FOR EXAMINATION AND RELEASE OF INFORMATION I LAUREL CASINO, INC. , hereby declare under the penalty of law and /or the revocation of any licenses granted pursuant hereto, that I am the applicant or duly authorized representative of the firm or corporation making this application and that I have examined the application, including any accompanying information, and that the responses provided herein are true, correct and complete. I understand if this application or attachment(s) contains false information, I am subject to the criminal penalties of Section 45-7 -202, 45-7 -203 and 45-7 -208, Montana Code Annotated, and /or revocation of any alcoholic beverage or gambling licenses granted pursuant to this application. I further authorize a full review, disclosure and release to any duly authorized officer, agent or employee of the Montana Department of Justice, Gambling Control Division, of any and all records concerning me that the Montana Department of Justice properly determines relate to my qualifications for gambling and /or liquor Iicensure, whether the records are of a public, private, or confidential nature. SIGNATURE `" ! Ver THOMAS P. KENNEALLY PRINT FULL NAME VICE PRESIDENT • TITLE/POSITION DATE 2/23/n This application must be completed in full, and all requested attachments must accompany it. Delay, denial or the return of the application will result if incomplete. Additional Information May Be Required During the Investigation of Your License Application. 18 • • RECEIVED BY MAR 09?OM 1 laurel MTLU. 3 GAMOUNGCONTROLDIVISION 14 banger 1-3 banger 1 -2 banger 1 4kple 5 drink stands 5 ple pieces 1ST Up Poker SG l N 44 c4 Ct 4 `�J.St^ Old Banes, �I /. PS 5 • Up tit, 00Eig,1 Up PS UDS .'I,; s IL 1::1 44 0 *V Lit 4 ' 4 c4 11. Entry Entry RT oaplay swx / \ Resaooms H H HI d III Cage 4 Oleo. „ f r-o ‘., 0 " '' f I . 5 e G .S 1 n O D �A %.) r 4 A lk o r -4--A via / 366 1st- / � l s / a U r-t-I 03 —044_ 9 1 3s -3 o