90-30 WNITE - CITY CLERK
PINK - FINANCE COUQCII �/,^/�
CANARV - DEPARTMENT G I TY � OF SA I NT PAU L File NO. • Q '- � �
BLUE - MAVOR
� �__,__ �Cou,.ncil Re olution
Presented By _�it�„��"�CY� ! �'='"�%�i�''�' �' � � �
Referre�To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #26862) for renewal of a State Class C
Gambling License by Church of St. Adalbert Rosary Society at
1079 Rice Street, be and the same is hereby approved/e�ri�eeF-
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
�� a Dimond
Goswitz [n Favor
witz
R tman Long B
e�net Maccabee � Against Y
�� � Rettmdtl
Thune �AN t� 19� Form App ved by City Att ey
Adopted by Counc�llSOri Date '
Certified Pas e ouncil ret
BY Z —! _
By
JAN 5 1990 Approved by Mayor for Submission to Council
t#pproved b 'Vla�vor: Date __
By �'���c�-6'� $y
PUBi�SNED ���� 1 319 90
' _ __ . .. , 1�1,,,..�'D,
DEPARTM[NTlOFFI(�JC6UNCIl DATE INITIATED
Fi nance/ i cense GREEN SHEET No. 5 7. 9 3
CONTACT PERSON 8 PHONE INI71ALl DATE INITIAUDATE
DEPARTMENT QIqECTOR �qTY OpUNpL
Chri Sti n ROZek-298-5056 W,�� GTY ATTORNEY �CITY CLERK
MUST 8E ON OOUNpL AQENOA BY D E) �pOUTINO �BUOOET DIRECTOR �FIN.6 MOT.SERVICES DIR.
12-28-8� �AAAYOR(OR ASSISTANn � •'�
TOTAL#�OF 81GNATURE PA ES (CLIP ALL LOCATIONB FOR SIGNATURE)
ACTION REOUESTED:
Approval f an application for renewal of a State Class C Gambling License. ����� �
Notificat'on Date: 12-11-89 Hearin Date: � �
RECOMMENW►TION8:MP►�N)o►� (R) C01lNGL RCH REPORT OPTIONAL
_PLANNINCi COMMIBSION GWL SERVI�COMMI�ION µ�YBT PFIONE NO.
_(�COAAMITTEE '
_STAFF C06AMENT6:
_DISTRICT WURT
SUPPORT8 WHICH COUNqL OBJE 7
INI7IATINO PR08LEM,ISSUE,OPPORTU (Who.Wh�t,WMn,Whsro,Wh»;
Dolores T ojan on behalf of. Church of St. Adalbert Rosary Society
requests ity Council appraval of their application for renewal of
a State C ass C Gambling License at 1079 Rice Street. Proceeds from
the gambi ng sessions are used for religious and educational purposes. .
AOVMITAf�E3 IF APPROVED:
If Council approval is given, Church of St. Adalbert Rosary Society
will continue operating bingo sessions at 1079 Rice ,Street.
DISADVANTA(�E81F APPROVED:
�ouncil Kesearch Center
�tC 1� �989 �
DISADVANT/U�E81F NOT APPROVED:
p�C271989
�ITY CLERK
TOTAL AMOUNT OF TRANSACTION = COST/REVENUE SNOOETFD(qRCLE ONE) YE8 NO
FUNDING SOUFiCE ACT1111TY NUMOER
flNANGAL INFORMATION:(EXPLAIN)
� � . , � , .
NOTE: COMPLETE DIRECTION3 ARE INClUDEO IN THE CiREEN 3HEET INSTRUCTIONAL
MANUAL AVAItABLE IN THE PURCHASINO OFFlCE(PHONE PIO. 298-4225).
ROtJTING OR�EA:
Below aro prefened routings for the flve moet Mequent types of documeMs:
OONTRACTS (aasurt�ss autho�zed COUNGL RESOLUTION (Amend, Bdgts.!
bud�st exisla) �°►xePt.Orartts)
1. Outside Agsncy 1. DepaRment Dtrector
2. Inkfatir►p D�psrhrieM 2. Bud�st Director
3. dty Attorney 3. City Attomey
4. Mayor 4. MayoNAaeistant
5. Finance d MprM 8vcs. Director 5. City Gouncil
6. Finance A�ountinp 8. Chisf AxarMant, Fin&Mgmt Sbcs. .
ADMINtSTRATtVE ORDER (B�, OOUNCIL RE30LUTION (�����
�1e�ri
1. Activity Manaper 1. Ukietinq Dspertment areclor
2. Depuhr»M AawuMaiM 2. (�ty Attorney
3. DepaRm�nt DlroCtor 3. Mayor/AnistaM
4. Budget DI►�CMr 4. City COUMcfI
5. City Clerk
6. Chisf Is►ccountaM. Fln�Mgmt 3vcs.
ADMINISTRATIVE ORDER3 (ell o3hera)
t. InRiMing DsputmsM
2. qty Attornoy
S. MayorMtefatant
, 4. CNy Cbrk
TOTAL NUMBER OF SIONATURE PAC3ES
Indicat.ths#of pepes on which�igMtures are required and aP ps�p'
sach of thess� __�
ACTION REGIUE3TED
DescHbs what th�q+oject/nqwM aeska to axompUsh in eRt�r chronob�i-
cal ader or order of importance,whichsver is moa app►opriate tor the
issus. Do rrot w�its complats ssntenc.�es. Begin each item in your Iist with
a wrb.
REOOMMENDATIONS
Compl�ts H th�fesue M quatlon h�s bs�n preNnt�d before any body.P�bIIC
or privats.
SUPPORTS WHICH COl1NCll 08JECTIVE4 '
Indicats which Cou�dl obl�(s)Y��P►o1�roQ�s�PPo►�bY���9
ths key word(s)(HOUSINQ, RECFiEATION, NEK3HBORHOODS,ECONOMIC DEVELC�MENT,
BU0f3ET, SEWEii 3EPARATION).(SEE CAMPLETE LIST IN IN8TRUCTIONAL MANUAL.)
COUNCIL COMMITTEE/RE3EIWCH REPORT-OPTIONAL AS RE�UESTED BY COUNCIL
INITIATING PROBLEM, ISSUE,OPPORT'UNITY
Explain the situetan or oonditlo�s that c►e�ted a nesd for your project
�requsst.
ADVANTACiE3 IF APPROVED
Indicats wt�ethw thte is simpy an�nnwl budpst p►ocedure rsquirod by law!
chart�r or wt�+�tti�ttare �pe�ciflc w� m which tM City of SaiM Paul
and its citizens wfll�from lhis pro�CHactbn.
DISADVANTA(iES IF APPROVED
What nsgative effocts or major ct�angss to sxistinp or past processes might �
thia project/roqwN produce N it fs passed(e.�.,trafNc delaya, noiae,
tax incrsasss or�s�saneMa)?To Whom?Whsn?For how long?
DISADVANTAQES IF NOT APPROVED
What will be the nsgative conspuencss if ths promised action ia not
epp►oved? InabiNty to defiver ssrvice9 Contlnued high traiNc, noiee,
accident rete?Las of rovenusT
FlNANGAL IMPACT
Altho�h you must taflor ths inMrmstion you provide here to the issus you
are addr�einy, in gsneral you must anawer two questbns: How much is it
�oing to oostZ Wha is�oiny to pay?
� . � � � - � � �G �
UIVISION OF LICENSE ANI) PERMIT ADMINISTRATION DATE �� �� �� / �� �� � �
INTERDF.PARTMF.I�'TAL KEVIEW CHECKLIST Appn Processed/Received y
Zic Enf Aud
De�0 r�S �YUsR r
Applicant C ►�c;.�t � �- ��.�/� Home Address ,��.�D �`�h �� ��-�D
Ros�� f �n � so�,� � C��3� SSiio
Rusiness Name � y Home Phone �a�j - � 7Gj �
Business Address � G ��1 �ice� �� Type of License(s) C=�QSS C - �ju,m�jjr���
Business Phone ����� � Y� UP'�<<jr 1'�u;� rZ� - �e(•'iP�J�(
Public Hearing Date ��ag)� License I.D. 4� a ���r �
at 9:00 a.m. in the Counci Chambers, �
3rd floor City Hall and Courthouse State Tax I.D. 41 �i ,�-
llate Nutice Sent; Dealer 46 � ��
to Applicant 1�,--� �
� rederal Firearms 46 � �,4-
Pub.lic Hearing
DATE II�SPECTION
REVtEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
I.� �.q' ,
Health Divn. �
� �� �
i �
I
Fire Dept. � �
' "�'I� i
�
S e rrtl <<I a8 ��"j
Police Dept. I
� � , � �y ���
License Divn. �
j����j ; O/L
City Attorney �
la����1' ��
Date Received:
Site Plan I� � � �c1 C,
To Council Research �� `���� I
Lease or Letter Date
f rom Landlord �� I �c�` �5
CURRENT INFORMATION NEW INFOKMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
- i�'orkers Compensation:
New Officers:
Stockholders:
' . City of Saint Paul �� �Q ��
Finance and Kanagement ServicesiLicense � Permit Division
ZNFORMATION REQUIRED WITH APPLIC�TION FOR PERMIT TO CONDUCT CHARITABLE GAMBLIVG GA.HE IY
SAIi�1T PAiTL (To be used with the following: New A & C application, renew A & C
Licenses, and new and renew B in Private Clubs.)
1. Full and complete name of organization which is applying for license
.�• �'�'^�`'� `
2. 'Address where games will be held JQ ? q �C�-r.��• ,�'J� � , �S'�l7
Number Street City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games � � Date of Birth a- a- j Q�/ �
(a) Length of time manager has been member of applicant organization
4. Address of Manager ��f6 r-� ��6'.�`w""G�a� - S J// �
Number /��,�v Street City Zip
S. Day, dates, and hours this application is for � � �-� Gf,�vr���_ �
G'�,�, { TQ� r
r�y;
6. Is the applicant or organization organized under the laws of the State of MN?
7. Date of incorporation
8. Date when registered with the State of Minnesota
9. How Iong has organization been in existence? �/ �G6 ��� -'''°
10. How Iong has organization been in existence in St. Paui? �r��''
11. What is the purpose of the organization? ��-x�-al.r.o�-u° � �
12. Officers of applicant organization:
Name / Name ��� e�n /�SnGY'
.',
Address �-' Address �e8° ��QY'�p� v��j"�t'e� .5�5'/Q�
Title �DOB Title � - DOB /a- a- q ��
Name ��� � Q (LY'r� Name e 1 p ��7'� ��l�'1�.N8�( ��
n �,j'.r/0,3 2/--
Address � 6� �, � fsUP.-��ltelip Address ` T�lL��
Title DOB D 1 3.� Title DOB �_1��
�—
13. Give names of officers, or any other persons who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separate sheet for additional names.)
� . - � . , � � � y�o-�d
14. Attached hereto is a Iist of names and addresses of all members ot the organizaticn.
15. In whose custody will organization's records be kept?
Name � � Address .� �- s� —6 �i��° ��l-1,(i:,Q�
+
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
�Name (�%�L��t��►� /��vrk,�-� Name
Address 3 t% 3 ,7� �-� Address
Member f Member of
DOB � a.b Organization? ,y�o DOB Organization?
'3—
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
17. a) Does your organization pay or intend to pay accounting fees out of gambling funds?
yes no X
b) If you do pay accounting fees, to whom will such fees be paid?
Name Address
DOB Member of Organization?
c) How are the accounting fees charged out? (flat fee, hourly, ete.)
18. Have you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games?
19. Attached hereto on the form furnished by the city of Saint Paul is a Financial Report
which it .emizes all receipts, expenses, and disbursements of the applicant organiza-
tion, as well as all organizations who have received funds for the preceding calendar
year which has been signed, prepared, and verified by ,C�� � �ti-�"�
,
iZ � S D -� ���i� �eZ�� ��� t%'�.c.e- o��l�- `�w,,�.�✓• V s// �
Address
who i$ the of the applicant organization.
Nam
20. Operator of premisea where games will be held: .
Name �� v'`� ��-��"`�''`'`.ti� �� -
Business Address / � ? 9 / `"-���f �- ��► ��`�"~' �`� �� � -
Home Address ~ ` 6 Q v' ; � � �- �� �3 �
� � � �� � � , , � � y� ��
'L1. �mount of rent paid by applicant organization for rent of the hall:
� �GCr'-� 's'�s�`-�' - ,j ,�'`a.`,1/� �6� 7 s �'
,
22. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
��- �%�,�-��C� - ��� '�.��
. , � , �
23. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
24. Has your organization filed federal form 990-T? �� If answer is yes, please attach
a copy with this application. If answer is no, explain why:
Any changes desired by [he applicant association may be made 'only with the consent of the
City Council.
�
r�������������
Organization me
D a t e ��� ��"—��I BY: �(;�a�-�--''�' �it'°�i��- �
Manager n c arge of game
. ' •
Organization re dent or CEO .
+ ( :^ - � .
� = i � + ?
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n � A � I �
. A A '� � y ', � v �p �
� ? 3 .e' � � � 3 `�
7 - 3 �I ; T � ^ � � 7 �
'r ] = � ,,0 i+ r A r+ � �
�' 3 a ' =
n .' a T i � Z ti � � 7 � a
= 3. � + � y 3 3 �+ .'9� m 3 �
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r. � n ( - � � .. o a �"
• •• = � Z I rr rl :� ll
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'� � � _ � 7r A � �
— � A T = � .O m , n '
�8 '0 � � , � r v v v
9 71 '< � � I� ^ •1 = (� `e l 71
' r � :I I� � � -�. � ( a
� ►�,+ .t � � � . � �� �' � 9 � + l
r- A '+ _= � ,� � � r.
r�0 f'S � , �� -� (� � S
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r A ; �S i I ; i� ^ = A �
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^ I � j . � � d � O A
i '� � I`
D �� I . � � � � I
y
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Z � { ��. A � �
„ I e O ° ._
3 ; I I � �
. ` - � Clty of Saint Paul Page t �] .
• Department of Finance and Hanagement Services � �`fQ-�D
' Division of �icense aad Permit Administration �
lJtiIFORM CHARITABLE GAlmLINC FINANCIAL REPORT
Date
1. Naaa of Organization •
2, Addreas vhere Charitabl� Cambling is eoadueted � 7 �'/� . �• � ��
3. Repost for period eovering ��' � 19� through � � 19�9
4. 'focal number of days played �1
S. Cross receipts for above period = -L� � � 's`�� �
6. Gross prize payouts for abova pariod (lnclude cssh short) f 7 �� � ��� �
. 7. Net receipts — line 5 minus lin� 6 f � s� ���' ��
8. Expenaes iaeurred in conductiag and oparating 6ase:
A. Cross vagee paid. Attach vorker liet vith
names, sddresses, gross vagea� au�bsr of hours S
worked. and amount paid per hour.
• B. Rent for �_ veeks = '���si 4�C�
C. License f ee ; ����s�
D. Insurance � b C` a�
E. Bond ;
T. Dishonored checka not recovered =
C. Accouncing Expense ; �'�"�
H. Employers F.I.C.A. ; � �`"
. I. Pulltab Tax Paid to Department oi b�snue ; •�'�`�
. J. Hinn. Sf.C. Tax s
. 1C. Federal Excisa Ta�t 6 Staop =
L. Stata Canbling 'Lu s � ��A � ��
M. Hiacellaneous Expenaes. Identifr tha asount
. and co vhos paid.
�, ,�,�,,�,�,,,��,,,�� s i 7 S� �/
- z. ;
3. ;
4. ; -
9. 'fotal Expensee TOTAL i ! � 4��` � � '
10. N�t Ineoa� - lina 7 �inu• lin� 9 = ` b ��' 6 �
11. Checkbook balanee beginning of p�riod = g`s�� ��
. 12. Total of lina 10 and 11 S � 6 `� y` � �
: 13. Total contributions (froi actached wrluheet) ; � 7 ��� �
ib. Checkbook balance end of reporting p�tiod - = G� �� � �
' lina 12 less liaa 13 . 7
• � ..;�:_