90-54 WHITE - CITV CLERK COUflCll /��
PINK - FINANCE GITY OF SAINT PAUL
CANARV - DEPARTMENT � //D�
BI.UE - MAVOR File NO. � -
��
� Council Resolution �,;
Presented By ��� ��
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #77352) for a State Class B Gambling
License by Highland Area Hockey Association at Tiffany Lounge,
2051 Ford Parkway, be and the same is hereby approved/�';,~'��
COUNCIL MEMBERS Requested by Department of:
Yeas Nay
'mo d D1IriOri�
Goswitz _� [n Favor
� � Long
e � Maccabee '� __ Against BY
�n Rettman
'�SO Thune
4V�.ilsOri �,�p 9 1990 Form Appr ed by City tt ey
Adopted by Counci Date � _ V�
Certified Pass d Council re By ��'ZZ
By
t�pproved b avor. Date ' .IAN � � 1990 Approved by Mayor for Submission to Council
gy ,���� By
Pl�LtSHED J A N 2 01990
-
, ���J �C,(�
DEPARTMEIITIOFFlCEII�UNCIL , DATE INITIATED CA � O GJ �/�--
f'
Fi nance/�i7cense GREEN SHEET No. 5 4 7 3
OONTACT PER90N 6 PFIONE INITIAU DATE INITIAL/DATE
DEPARTMENT DIRECTOR CITY COUNqL
Chri sti ne Rozek-298-5056 � �c����� cirr aeRK
NUMlER FOR
MUBT BE ON COUNpL AOENDA BY(DA ROUTINO �BUOOEf DIRECTOR �FIN.�MQT.BERVICEB DIR.
i �MAYOR(OR A881STANT) � C O U I�C�� R
TOTAL M OF 81QNATURE PA (CLIP ALL LOCATIONS FOR SIC;NATUR�
ACTION RE�UESTEO:
Approval f an application for a State Class B Gambling License,:
Notificat on Date: �I -aq-$9
RECOMMENDATIONS:Approvs(/q a (Fq COUNGL COMMITTEE/I�SEARCH REPORT OPTIONAL
_PLANNINO OOMMISSION _�IVII SERVH:E OOMMI8SION ��Y� PHONE NO.
_p8 CO�AMITTEE _�
_STAFF � COMMENTB:
_DIBTRICT COUH'T
SUPPORTS NMICH OOUNpI OBJECTINE
INITIATINO PROBLEM,ISSUE,OPPOR7U (Who.Whet,Whsn,Where.Wh�:
Susan M. urvis on behalf of Highland Area Hockey Association requests
City Coun il approval of their application for a State Class B Gambling
License a Tiffany Lounge, 2051 Ford Parkway. Proceeds from the pulltab
; sales will be used to support youth hockey in the Highland area.
ADVANTAOES IF APPROVED:
If Council approval is given, Highland Area Youth Hockey will operate
a pulltab booth at Tiffany Lounge, 2051 Ford Parkway.
�
,
I
DISADVANTAOES IF APPROVED:
'; GouncU Research Center. RECEIV��
' uk� 2 � 1Q89 (�(�9��
�
CtTY CLERK
DI8ADVANTAQE8 IF NOT APPROVED:
I �
I
�
TOTAL AMOUNT OF TRANSACTIO = COST/REVENUE BUDOETED(CIRCLE ON� YES NO
FUNDINQ SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPWI�
��
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE CiREEN SHEET INSTRUCTIONAL
MANUAI AVAILABLE IN THE PURCHASIN(`a OFFICE(PHONE NO.298-4225).
ROUTIN(3 ORDER:
Below are preferred routings for the Nve most frequent types of dxumeMs:
CONTRACTS (assumes authorized COUNCIL RESOLUTION (Amend, Bdgts./
budget exists) Accept.Grents)
1. Outside Agency 1. Department Director
2. Initiating DepaRment 2. Budget Director
3. Ciry Attomey 3. City Attomey
4. Mayor 4. Mayor/Assistant
5. Finance&Mgmt Svcs. Director 5. City Council
6. Finance Accounting 6. Chief AcxouMant, Fin&Mgmt Svcs.
ADMINISTRATIVE ORDER (Budget COUNCIL RESOLUTION (all others)
Reviaion) and ORDINANCE
1. Activity Manager 1. Initiating Department Director
2. DepartmeM AccouMant 2. City Attorney
3. DepartmeM Director 3. Mayor/AssistaM
4. Budget Director 4. Ciry Council
5. Ciry Clerk
8. Chief Accountant, Fin &Mgmt Svcs.
ADMINISTRATIVE ORDERS (all others)
1. Initiating Department '
2. City Attorney
3. MayodAssistant
4. Ciry qerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and�
each of these pages.
ACTION REGIUESTED
Descrfbe what the project/request seeks to accomplish in either chronologi-
cal oMer or order of importance,whichever is moat appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RE�MMENDATIONS
Complete if the issue in question has been presented before any body, public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council obJective(s)your projecUrequest supports by listing
the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
COUNCIL COMMITTEE/RESEARCH REPORT-OPTIONAL AS REQUESTED BY COUNCIL
INITIATINCi PROBLEM, ISSUE,OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is sfmply an annual budget procedure required by law/
charter or whether there are speciflc wa in which the Gty of Saint Paul
and its citizens will benefit from this pro�action.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past processes might
this proJecUrequest produce if it is passed(e.g.,traffic delays, noise,
tax increases or assessments)7 To Whom?When? For how long?
DISADVANTAGES IF NOT APPROVED
What will be the negative conaequences if the promiaed action is not
approved? Inability to deliver service?Continued high traffic, noise,
accident rate? Loss of revenue�
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addressing, in general you must answer two questions: How much is it
going to cost?Who is going to pay?
. � �go��� .
DiVISION OF LICENSE AN1) PERMIT ADMIIvISTRATION DATE �l� ��'`�/ l t���� �
INTERDF.PARTMFNTAL REVIEW CHECKLIST A.ppn Processed/Received by
L�c Enf Aud
/� S'uS�c � �ccrv�b
Applicant � � Q, !./���-F.SSDC-Home Address J(p5 's �C��h
�T
Rusiness Name �' �j--�� Home Phone (p '�J(� -J`��$�D
�-
Business Address �QS/ �"�Drc� �iCw� Type of License(s) C��lSS � �
Business Phone �QVY� b1� Ylr,� Ll C.Q/►'15Z�
Public Hearing Date ' jL License I.D. 4F �7 3 5 Z'
at 9:OQ a.m. in the Counc'1 ambers,
3rd floor City Hall and Courthouse State Tax I.D. �C C.5 3073�
llate Notice Sent; Dealer �l ���
to Applicant
rederal Firearms 46 ���
Public Hearing
DATE INSPECTIUN
REVtEW VEKFIED (COMPUTER) COMMENTS
A roved Not A roved
�
Bldg I & D �
u �� ;
Health Divn. !
,
u),a-
,
Fire Dept. � �
' u I�r i
�
! �e� ui��s l��
Yolice Dept.
Il�,c�� )�� o�G
�
License Divn. '
� � I�1�' � �.
City Attorney �
1 I I�:�I�1 + a<<--
Date Received:
Site Plan �' 0
To Council Research �a �? ��
Lease or Letter ,,� Date
from Landlord �� ��' 3� '� �
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
- Currer.t Officers: Insurance:
Bond:
- - - Workers Compensation: --
New Officers:
Stockholders:
' • ' City of Saint Paul ��� �7
Department of Finance and Management Services
Division of License and Permit Registration
INFORMATION REQUIRED WITH APPLICATION FOR PERMIT TO SELL PULLTABS b TIPBOARDS IN SaI�T ?AUL
(Class B Gambling License in Liquor Establishments - Renew)
1. Full and complete name of organization which is applying for license
T
s c � � '
2. Address where games will be held / �- �S�J�
Numberr �Street � Ci y Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games ��(L_S CZ/� , �>>L. f�//�S Date of Birth � -�,� - Zf�
(a) Length of time manager has been member of applicant organization s
4. Address of *tanager l�.5�5 U/A,7`S'Cl'I ���, �S� �CJ.[L 1 .��,�1
Number Street City Zip
PProx- 3pm ' ���
5. Day, dates, and hours this application is for � i -
6. Is the applicant or organization organized under the laws of the State of MN? �T e,_�
7. Date of incorporation �a U I q�`�j
8. Date when registered with the State of Minnesota rn(,�L1 ,� T, 1 / %�
9. How long has organization been in existence? � 9�j�
10. How long has organization been in existence in St. Paul? � 95J�
11. What is the purpose of the organization? ��,�j�/n n�'P� [.� n 7�, (��
� I l
I n �"�t P ���4�i �o r,c� .�j-P,o n ���: a_',U
12. Officers of applicant organization:
Name ��i V ►�Cl �0 Z P�/� Name GLl"t�t l�r.�1 P.1
� n L
Address � Qf(G'�p' (,'L►/`�'1'11�1.L/��fllJ(i Address � ��� f ��'u�j/I� i -1" /.l `c�.
Title �r- _c�`r;[P_YT7 �B .� -� '.S� Title � DOB ' - -
Name ��+��r?� � -L� f? ��!'.l'-' Name ,�(� �j //l G C/'LG1�'�
Address ���� �c$/� �G vl ftUPi, Address ��p'71 L) �_n/� rl U�
Title ���Q�, DOB � -�� 9'�3 Title DOB ' �7..7�
13. Give names of officers, or any other persons who are paid for ServiCes t0 the
organization.
Name � Name
Address Address
Title Title
(Attach separate sheet for additional names.)
- . , - �c�'o��
14. Attached hereto is a list of names and addresses of all members of the organization.
15. In whose custody will organization's records be kept?
Name ��'j.( .�GLy� �l (/_!'�F � S Address 11.��1J �,�C�T"<S ori ,�lJ�' ����1�
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name ��L/S'�rI /'!. P,,�r v�S Name
Address ��a��j ���,�-S ph ���Pi Address
p Member of Member of
DOB � -�,�Z� � / Organization? `l � DOB Organization?
T
Name � �l ,` �Y1 q� Name -
�-�—
:�ddress �� 9'� e�' e`�y ��� Address
Member of Member of
DOB ��-02 J- ��j Organization? � DOB Organization?
17. Have you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games? �P_C
18. Attached hereto on the form furnished by the city of Saint Paul is a Financial Report
which itiemizes 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 9 ('
I� �V S � w) � 5'los
Address
who is the �Ob��,�;P.fj� of the applicant organization.
� Name
19. Will your .organization's pulltab o eration be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or does it intend to sign, a consulting agreement or a
managerial agreement with any person or company to assist your organization with the
pulltab sales and/or recording keeping? yes no X
Ir answer is yes, give the name and address of the person and/or company contracted.
Name - Address
tiame Address
If answer is yes, how will such a consultant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a copy of said contract to this application.
�1. Operator of premises where games will be held:
:�ame Tl ���_Y� U �s ��1 � � '1�0 °�.. �l f'T�,1�/rtPr-
Business Address ���S � ��r-l-,( Paµ� ���p,L/ �-�- (i.cL� s�S���
Home Address (1� ' Q
. , (��'o�
' 22. a) Does your organization pay or intend to pay accounting fees out of gambling funds?
yes � no
-r
b! If you do pay accounting fees, to whom will such fees be paid?
hame - �i_�i �j,—�-_�(--p���� Address ��j�/ ��/"� ��2e/ 1f� �_��/�
DOB �� -a� "��p Member of Organization? �
c) How are the accounting fees charged out? (flat fee, hourly, etc.)
��a� ���
d) What do you anticipate will be your average monthly deductioa for accounting fees?
,_� n f�' � �� � '��D 0 �' a, �'I �n�Li
23. ?,mount of rent paid by applicant organization for rent of the hall:
���� �� � rn���
24. The proceeds of the games will be disbursed after deducting prize Iayout costs and
operating expenses for the following purposes and uses:
G y.
25. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul? :�,{ (�, S
26. Has your organization filed federal form 990-T? _�� If answer is yes, please attach
a copy with this application. If answer is no, e lain why:
Any changes desired by the applicant association may be made only with the consent of the
City Council.
}����n h�" ft/�P_a �Oc P� r!�OCi�cf
Organization Name
Ua t e ��' �'��] By: � , Gt�LCJ�,,v
Manager in charge of game
Organization Pr ident or CEO
' ' City of Saint Paul Page l
' Departmenc of Fiaanee and Management Service� �n_�d�
� Division of Licease aad Parmit Adminiatration j�/�
UNIFORlt CHARITASLE CAlSaLINC FINANCIAL REYORT
Dsu " /
1. Nam� of Ocganizatioa � rI I`c�Q r(D C.K Q.P�1 /7 S�S'D GI �LTi 4/f
2. Addres• vher• Charitable Ca�bling ia eondueted ��� __�� t'T e/�SG'�i? �I �� �
3. Reporc for period eovsrin� r ^� �,_,�,_19�through �—�� 19�/
4. ?otal number of days played c�(���
S. Gro�� teesipcs fot above period S `T "/ �� ���o d D
6. Gross prise payouts for abov psriod (laeluda eaah short) i �3 � -/ 3�I'��D
7. Nec receipts - lias 5 minu� line 6 i - �_�!) /o �
8. Expanse• ineurred in conductia6 and opsrating ;s�:
A. Gross vages paid. Attach vorksr li�t vieh /-') / � �!
nam�s. address�s. gro�s vagas. nusber of hour• i / / ��E (l�J
vorked. and amount paid per hour.
B. Rent fot � veeks ; �5��� L'C-'
C. License fee. ; ������t� /
D. Insuranee s
E. Bond ; � � �j ��
P. Dishonorad checks not reeov�rsd i / ` ?s �/D
G. Aeeountiag Expense = �����'� v v
N. Employers F.Z.C.A. ;
I. Pulleab Tax Paid to Depart�enc of R�venu� i / � J (D�J i�� •
J. Iiinn. U.C. Tu ; —^
R. P�deral Excisa Za: 6 Staap = _T � ' • / �
L. Stat� Cublin; ?ax =
M. Miscellansou� Expsnses. Idantif� tha mount
• and to vdoa paid.
�. C��'�� ' _ � �
�
�. � = 1 � �8/. ��5
3. � � .� /l.. �
6. � s�c�
9. Yota�F.xpents� �� ' j� ►vIAL i ____!�`����-��-
10. N�t Iacooe - lias 7 ainu• line 9 ; ��� �( '��,��
11. Cheekbook balanee begianin` of period S � ��)���f �
12. Total of lin� 10 and 11 ; 1L�-� � °��
" 13. Ta ul cootributions (fro� attachsd vorbhe�t) _ ��� `v�r��
14, Cheekbook balsnes ead of reportiag period - �" ���
lins i2 less lins 13 ; U
1 —
�♦ � � VI ,�1 • i nyV
- UNIFORM CHARITABIc GAMBLING riNANCIAL REPORi
LAYIFUL PURPOSE CONTRIBUTIONS - WORKSHEcT CF�a�'
Line #13 - Total Lawful Purpose Contributions. S ;�. ����
List below all checks written from gambling funds which are
charltable lawful purpose contributions. The total dollar
amounts of these checks must match the amount claimed in
line �13. Use additional sheets as necessary.
� CNECK � DATE PAYEE CHECK AMOUN PURPOSE
�. 1! (� `� �l �8$ �z C12�,`�� a.�DO�o ' - �--.�.r�-��'�
� , �, "
1� -9�� � �i i 1 3��0,G�D n �
2. I I $� �,.,. �r,� ������
�, s-88 �� ���.���� 3 F��.�o
3. _ t a c^� �1 � ��'� �.� y.� �I�D 7_
a. ! 33 1 �I-��_� �,. �. �, ��t9 ma.�d��� ����
��I�-8 Q��e�,� �c,��' 1 a�c� � .
s. 1 � �� 5%NC�,�c� � �c� "r�
�,o� ,� ct����
6. I 3(�� 9"�3� ��;►��� � �3 yy��� 1,� c� c1��'�'r.�.
q--/�� �Z� ��'�
�. 13�� �'
s.
9.
10.
11.
12. '
13. �
TO?AL CHECK AI�UNT E
NOTE: These expenditures will be provided to Council Members at your Council hearing.
Be sure that your financial report is complete and accurate.
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. RECFlVED�
. � �N�ii98�9
C�T'{ CLERK
� _ � �
, ��.
__:_.
Dear Property Owner: , L 16211 •• `
Public Hearing on an application for a Class B Gambling
license for the sale of pulltabs and/or tipboards in a
�jJ�Q S� liquor establishment. Applicant organization will replace
• organization currently licensed at this location.
�����C'c�.��� Highland Area Hockey Association
• �
r�����I��(' Tif fany Lounge, - 2051 Ford Parkway
_---,� --� Janua y�1990 4'�� a'+'
, ��� �.-`�C Ci? Csuac� ' �rs, 3r� �oar Ci? 'aa'� - Cacz.-_ ausa
I
3}� C.�:�se �c ?s..-�c 7i�3�. �7e�ar�--._e=c a= :'-�c� a:� �
— v,.��eat Sirr.cas, 3aa� 2�3 C_�� c'aL: - Caur: �u.ss,
�Q�_�:... ��T 5�: ?�zL� ;r•-.t.�ocs
�n8-��Sb �
� • : T aaca �.ag be c�aags= a-����oac t�e caasa3c ��/cr L.cc:La��s a= c�e
L:.ca�sa �:e '_�� = IIi-r�:oz, __ i.s s•rag_st_a ���t ?oL c��: c�� C:=;
C-==�� � 4==== zC =-°a—.��?t � �au ••'*�'s c��=.-�-==��.