Professional Documents
Culture Documents
Lurisa Wallen - Washington State Gambling Commission - Muckleshoot Indian Tribe
Lurisa Wallen - Washington State Gambling Commission - Muckleshoot Indian Tribe
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Suffix
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Birth
of Birth
Date of 9/7/1967
License/ IO#
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Gender Female v
Email Address
Address Line
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354T H PL
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©
©
1889
jeanettew
jeanettew 12/10/2021
12/10/2021
WASHINGTON STATE
WASHINGTON STATE GAMBLING
GAMBLING COMMISSION
COMMISSION
LOCATION:
LOCATION: 4565
4565 7th Avenue SE, Lacey
Lacey WA 98503
98503
MAILING ADDRESS:
MAILING P.O ..Box 42400,
ADDRESS: P.O. WA 98504-2400
42400, Olympia WA 98504-2400
TELEPHONE:
TELEPHONE: 360 86-3440 /I FAX
360-486-3440 FAX NUMBER:
NUMBER: 360-486-3631
360-486-3631
TOLL-FREE: 1-800-345-2529
TOLL-FREE: 1-800-345-2529 / TDD: 360-486-3637
TDD: 360-486-3637
WEB
WEB SITE:
SITE: www.wsgc.wa.gov
www.wsgc.wa.gov
CLASS III
CLASS TRANSFER / ADD
Ill TRANSFER EMPLOYER
ADD EMPLOYER
______***IMPORTANT READ BACK PAGE
* IMPORTANT READ PAGE**
* * ____________________________
(Mark (3
(Mark 1&1 appropriate
appropriate boxes.) TYPE
boxes.) ___________________T OF
YPE
O F APPLICATION
APPLICATION _____________________ FEE:
F $61.00
EE: $61.00
T ~
Transfer-
.
rans,er.
O Tribal Employer (69) to a Licensed Card Room (68)
Tribal Employer (69) to a Licensed Card Room (68)
~Tribal Employer (69) to Tribal
Tribal Employer (69) to Tribal
Employer (69)
. Employer (69)
O Licensed
Licensed Card Room (68) to Tribal
Tribal Employer
Employer (69) [ j C l alass Subcontractor Tribal
s s C / Subcontractor Tnbal Employee
Employee (69C)
(69C) to
Class
Class C /I Subcontractor
Subcontractor Tribal
Tribal Employee
Employee (69C)
1.
1. Name
Name ofof / \ /1 I .,,
Applicant:
Applicant: !~1 ~ ,1( ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I
/ , _ , Last Name
LastName
iHVl.5L ________ . _________ _1 ~
FirstName
First Name · Ml Ml
Name
/- - Teleph:__._ _ _.j
, lldurn_-+-w L ·___
· __, (f&;v ~ -· a
/ City
i z+iffzn
~
1 V7 -1-f2._fY:i._'f2.0/
phone
Telephone
i-kW W 4
/
4. First
FirstDayofWork:
Day of Work: | J$ ,,L'l~u OZ..L__, Expiration Date: L{t_,,, ?cz'__ _111.....&2 ~ I
Applicant License#: l.@_1.J-1 i/ '7 7 C-_
Since your last
5. Since last application,
application, have you been charged
charged with a crime,
crime, paid
paid a fine, been arrested, jailed, convicted, gone through
diversion
diversion orr placed
placed on
on probation?
probation?
O Yes pfoo o IfIf yes, please please attach
attach a statement
statement of explanation.
of explanation.
OATH
OATH OF
OF APPLICANT
APPLICANT
I declare
declare under
under penalty
penalty of
of perjury, under
under the laws ofof the state of of Washington,
Washington, that that all information
information provided
provided in this
this application
application is
true and complete
true complete to thethe best
best of
of my knowledge.
knowledge. I understand
understand that that untruthful,
untruthfu~. misleading,
misleading, or incomplete
incomplete answers
answers whether
through
through misrepresentation,
misrepresentation, concealment,
concealment, inadvertence,
inadvertence, or mistake,
mistake, are cause for for denial
denfal of
of an initial application or revocation of
of
any gambling
gambling licenses
licenses currently
currently held and will bebe disclosed
disclosed to my employer.
employer. I agreeagree to
to notify Washington State Gambling
notify the Washington Gambling
Commission
Commission should
should any information
information required
required on this
this application
application and I
and I or on my my Personal I
Personal I Criminal
Criminal History
History Statement
Statement change
become inaccurate
or become inaccurate in any way.
way. I understand
understand that
that ifif I fail to make
make such notification,
notification, itit may
may constitute
constitute grounds
grounds for
for denial,
suspension
suspension or or revocation
revocation of
of my
my license.
license. I further
further understand
understand that that ifif any
any criminal
criminal or civil actions
actions are filed against
against me (except
(except as
declared
declared in Section
Section 5 above),
above), I must
must inform
inform the
the Commission
Commission and my employer. employer. See WACs WACs 230-03-050, 230-03-055,
230-06-080, ?30-06-085. I will read the training
230-06-080, and 230-06-085. training document
document provided
provided by my my card room
room employer
employer within thirty days from
from my
first date of emplo ment and kee myself current of all rules and regulations.
Signature y. , j,
First. Middle. Last
Business Office
Business Office Use
Use Only:
Only:
Code: 21
Code: 211-1\..if\c__
1-|. Date: |l________|
J, Date: _ _ lJ/ /' |l ~_ _ __ 7 ,,
fI 102______________
1
______|, Amt$!_
Amt: $|
$|. Lo _!_,.oo
LC ' 1
|.00 Val#:
Vai #: T f 41 1\ T.T
1
GC4-192 (Rev.
GC4-192 (Rev. 10/1
10/11)
1 )""""" " “ Our
u Mission:
ission Protect
rotectlhthe Pubn
Public bby Ensuring
nsurin that
har Gambling
amblin is Lega
Legal and Honest
ndHone
Val#
Vai #
297598 10/10/2 019
10/10/2019
WALLEN, LURISA L
1902 (69-47705)
AUBURN
jeanettet 10/11/2019
I WASHINGTON
W A S H I N G T O N STATE GGAM BLING
A M1B COMMISSION
LING C OMMISSION
LOCATION: 4565 7th 7th Avenue
Avenue SE, Lacey WA 98503
MAILING ADDRESS: P.O. Box 42400, Olympia W WA
A 98504-2400
TELEPHONE: 360-486-3440 - FAX NUMBER: 360-486-3631
360-486-3631
TOLL-FREE: 1-800-345-2529 - TDD: 360-486-3637 E -D
WEB
W www.wsgc.wa .gov
E B SITE: www.wsqc.wa.gov
CLASS III INDIAN GAMING EMPLOYEE CERTIFICATION OCT 0O9~ 20I9
2019
** ** * ** CAUTION * ** * ** ., '
:.>
F e e s will
Fees will n ot b
not bee rrefunded
efunded a f t e r iissuance
after ssuance o
off a ttemporary
emporary c e r t i f i c a t i o n . _ 11
certification.
Failure to complete all information
information and requirements may cause delays or or denial ofof your application.
***SPECIAL INSTRUCTlo'NS * *
* SPECIAL INSTRUCTIONS / -7
♦• Please type
type or
or print
print all answers.
answers. Do Do not
not use pencil.
pencil. J I ' / C
♦• Submit
Submit a current
current photograph
photograph (no smallersmaller than 2" x 3", nor
nor larger
larger than 3" x 5")
5")-- ensure
ensure the photograph
photograph is a full facial
facial view. Write
Write
your
your name
name andand social
social security
security number
number on the back of the picture.
back of picture.
♦• All new
new applicant
applicant employees
employees are ai-e required
required to provide
provide proof
proof of identity.
identity. Please
Please provide of o~ ll\f~ f f l ~documents:
provide a copy of documents: a
valid driver's
driver's license,
license, a tribal
tribal identification
identification card, a state
state identification
identification card,
card, or
or a valid passport. Iflfybu~
you nave
ave any
aty questions,
questions, you may
may
contact your
contact your Customer
Customer Service
Service Specialist Individual's Unit
Specialist in the Individual’s Unit at 1-800-345-2529.
— APPLICANT INFORMATION~
APPLICANT INFORMATION oeT 16 !81!
OCT 10 2019-----------
1.
1. Last Name: II ;
LastName: /~:<2: L f :C.: 0: WSGC:/JJICENSING_J
i WSGC/LICENSINGi —I
L.J.A.J t: i :S: C{ :
First Name: 1 : : : : : I Ml: I L1
Maiden
Maiden I/ 1• } r. I .I . fl J_ 72 j" I
Alias Name: ~.J.......LJ-:e :0 : I : L,,:l'.1: f :--c:e..: f: f :0 :n:o:
ID:
Social Security#: I .~ Lj: ZJ-1-1.J-1.J-1 / :q :0 :2d B:rthdate: IC2 : C/ J/l--1'.LJ-2J/I /
H o m e Address: II / :Ul: 4 ·.LZ..: :2:
Home :.5: £: _J-3.JE: 'i:-rl? :P la c.?: : :
r Stree~x Number
i-11·//: /51...iJJ
/1J ~
r:n: : : : City
i'A
~
Jr,) , iq . P- ,Q _!l_b
---1-JLLJ Zip
County:
County: | L.b',_f~:(J
'-+---:-?J
,__.._
: ~-~~~~~-~~~--'-~'----'
Telephone:
Telephone: Home: |I H I H Work: |I H 1-~
I ~-~~~
Cell: L~ 0 :3 1-1$:l t/:
Cell: |3lZ9l3|-| y;'7l-l 0\ /\O\B\
71-112...!:/J D..fi1
2. Have you ever been issued a license
2. license/I permit
permit to work in
in a gambling
gambling activity? IF YES , complete the following
IF YES, following: :
County: I ikJQJ.fl
| I::t:-:
Sl I I I I I I I I I ! I I I I I I I State : |I Q \
State: 0 :£
Date: From |1/
/ ;: Z>|/|
0 111 O0:\ // 1/|
111 2-1 Z. 0 : Z?~_.iJ
7 I To I (2 :
\Q\ f J/J:lJ!1.J11 A0 : f / 91 |/| O\ ! \ \
A--- . - I .
44. N
Name of Tribal
a m e of Tribal Employer:
Employer:
N
Name of Subcontractor: I~~-~~-~~-~~-~~-~~-~~-~~-~~-~~-~~-~
a m e of I I I I I I I I I I I I I I I I I I I I I I
t- Position Title:
Title : TT:a I; k :Q. a ~ Dect1.-i-k-.r1
,__,:_____,_/_,._:--'-:-__._:__.:_.,_..,____,____,_---'-___,
! I I I I I ! ! I I I
D Pre-Certification
Pre-Certification - Tribal license issued,
issued , include
include the results and preliminary TGA determination.
D Class CC I/ Subcontractor (69C)
_____________________________ _ _______________________________________________________ ______
Business
B Office Use Only:
u s i n e s s Office Only:
ate: |I
J
Code: 211-|/(/?t
~ QpPate:
211-J..LQ_ | |J// 1I J| ! |_!_J _ _ _! ___I Amt: $l I-00
GC4-177-abr
GC4-1 (Rev. 4/14)
77-abr (Rev. 4/14) Our Mission:
Our Mission: Protect
Protect the Public
Public by
by Ensuring
Ensuring that
that Gambling
Gambling is Legal
Legal and
and Honest
Honest Page 11 of
Page of 2
4
CRIMINAL
HAVE YOU
YQU EVER
EYER (as a JUVENILE
11.. Forfeited
Forfeited bail
Been arrested
2. Been
JUVENILE or
bail or
or paid
or an ADULT):
paid a fine
arrested or charged
ADULT):
fine over
over $25?
charged with a crime?
crime?
5.Are
5. Are you subject to any warrants
failure to appear
failure appear charges?
warrants
charges?
□□ Yes
Yes
'
?c HISTORY ~
Been convicted
3. Been convicted or jailed? 6. Had aa gambling
gambling license
license denied
-~ o
STATEMENT Sc -
Been placed on probation
4. Been probation oror community
community service? revoked?
suspended or revoked?
You must answer "YES" ifif any of the above have occurred, even even ifif charges
charges were dismissed, deferred,
were dismissed, deferred, or
- changed. Explain
changed. each charge
Explain each charge fully below
below and attach
attach additional
additional sheets
sheets as needed. False False or incomplete
incomplete
information may
information may result
result in denial
denial / revocation
revocation// administrative
administrative closure of your application.
application . The following traffic
violations
violations may be excluded from your explanation: speeding, signal, signal, sign, seatbelt, and and right-of-way.
right-of-way.
Date
Date
Disposition and
and Date
Date
Charge
Charge City
City County
County State
State Disposition
Charged
Charged
~
' .,. __
■ all l""l""'A ,...,, i!'r-,...\.11,..,.,-
IVIILI 11-\" I ;:,c:" V lvC: : D Yes D(No / Dates Served: Fmm: IU . / Type
Type of
of Discharge:
Discharge:
qOATH
q--OATH OF APPLICANT
penalty of perjury,
I declare under penalty perjury, under
under the laws of the state of Washington
Washington,, that all the
the answers and statements
statements are true
true,,
correct and complete.
correct complete. I understand
understand that
that untruthful
untruthful or misleading answers areare cause for denial
denial of mmyy application and / or
revocation ofof any
any certification
certification granted. II agree to notify the Tribal I/ State Gaming
Gaming Agency ifif any
any information required on this
application and/I or my Personal
application and Personal/I Criminal
Criminal History Statement, changes
changes oror becomes inaccurate
inaccurate in
in anyway.
any way. II understand
understand that
that ifif I
notification, it may constitute
fail to make such notification, constitute grounds for denial,
denial , suspension or revocation of m myy temporary or permanent
state certification. I further
further understand that the State Gaming Agency (Washington State Gambling Commission) may revoke,
Gambling Commission)
suspend or deny a state certification for any reason(s) it deems to be in the public
public interest under
under the provisions
provisions of Chapter 9.46
of the Revised (C
of C dp of ,Washington
Washington.
Signature of
Authorizing Tribal Agent: Date: | / |£ |/| 0 Z? } I |
Name of Tribe:|
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111111 IIIII IIII II Ill IIIIII IIII IIII Ill
CLASS:
C L A S S : C - Any single vehicle with a GVWR of not more than 26,000 pounds with the
proper endorsements. Any emergency vehicle operated by a firefighter.
This card belongs to the Social Security Administration and you must
return it if
if we ask for it.
If you find
If find a card that isn’t
isn't yours, please return it to:
Social Security Administration
P.O. Box 33008, Baltimore, MD 21290-3008
WALLEN LURISSA
WR/SSA $320.00
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OF STATE
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Column1 Type Subject Object Title Start End
315109 IndividualToPremises WALLEN, LURISA L TR-00005MUCKLESHOOT INDIAN TRIBE;AUBURN Class I I I Em12/15/2021
283581
309879
IndividualToPremises
IndividualToPremises
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WALLEN, LURISA L
TR-00005MUCKLESHOOT INDIAN TRIBE;AUBURN
TR-00021SNOQUALMIE TRIBE;SNOQUALMIE
Class I I I Em10/10/2019 08/01/2020
Class I I I Em07/01/2021 12/13/2021
License No
69-47705
69-47705
69-47705
Column1 Last First Middle Suffix Category Start Date End Date
161937 BLAND LURISA LEA Also Known As 10/10/2019
161936 CARTER LURISA LEA Also Known As 10/10/2019
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STATE OF WASHINGTON
GAMBLING COMMISSION
“Protect the Public by Ensuring that Gambling is Legal and Honest”
Marena Cross
Muckleshoot Indian Tribe
Tribal Gaming Commission
2700 Auburn Way S
Auburn WA 98002
In accordance with the provisions of Section 5(K) of the Tribal-State Compact for Class
III Gaming between the Muckleshoot Indian Tribe and the state of Washington, the
following Class III Gaming employees are granted certification.
Sincerely,
Jeanette Trac
Jeanette Trac
Licensing Specialist
Washington State Gambling Commission
Licensing Operations Division
(360) 486-3531
Jeanette.trac@wsgc.wa.gov
cc: file
P.O. Box 42400 Olympia, Washington 98504-2400 (360)486-3440 (800)345-2529 FAX (360) 486-3631
From: Anderson, Julie (GMB) <julie.anderson@wsgc.wa.gov>
Sent: Wednesday, August 11, 2021 8:17:33 AM
To: Anderson, Julie (GMB) <julie.anderson@wsgc.wa.gov>; Conway, Steve
<steve.conway@leg.wa.gov>; Conway, Steve (GMB) <steveconway@harbornet.com>;
Gilmour, Peter (GMB) <peter.gilmour@leg.wa.gov>; Haifley, Brian
<Brian.Haifley@leg.wa.gov>; Holy, Jeff <jeff.holy@leg.wa.gov>; Julia Patterson (GMB)
<jpatt3kids@gmail.com>; Kloba, Shelley <shelley.kloba@leg.wa.gov>; Lelli, Kimberlie
<kimberlie.lelli@leg.wa.gov>; Levy, Alicia (GMB) <alicia.levy@wsgc.wa.gov>;
Rasavage, William <Will.Rasavage@leg.wa.gov>; Reeves, Kristine (GMB)
<kristine.reeves@wsgc.wa.gov>; Sizemore, Bud (GMB) <budsize@gmail.com>;
Sizemore, Bud (GMB) <bud.sizemore@wsgc.wa.gov>; Vick, Brandon
<brandon.vick@leg.wa.gov>
CC: GMB DL CAT <CAT@wsgc.wa.gov>
Subject: Commission Meeting Materials for tomorrow
Attachments: August Commission Packet.pdf
Good morning,
Attached is the commission packet for tomorrow’s meeting. Please let me know if you have any
questions.
The meeting will begin at 9:30 Click here to join the meeting.
Julie
Julie Anderson
Executive Assistant
Washington State Gambling Commission
PO Box 42400
Olympia, WA 98504-2400
(360) 486-3453 desk
(360) 280-3937 cell
julie.anderson@wsgc.wa.gov
G
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