90-96 M�HITE - CITV CLERK
PINK - FINANCE G I TY OF SA I NT �A l.} L COUIICIl /�/
CANARV - DEPARTMENT File NO. �D_ / Y
BLUE - MAVOR
nc ' Res tio �� ��
- . � .3�;,
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID ��12646) for a State Class B Gambling
License by Como Area Youth Hockey Association at Patrick�s Lounge,
1318 W. Larpenteur Avenue, be and the same is hereby approved/
�-i�e�..
COUNCIL MEMBERS
Yeas imo Nays Requested by Department of:
G sw t z Dimond ' '�
Lo Goswit� In Favor
Ret man Lon� ;
Sc ibel Maccabe�e - �' __ Against BY
So n n Rettman
W lso Thune ';
wilso ,JpN 2 � �gg� Form Approved by Cit A rney
Adopted by Cou cil: �ake
Certified Yass d by,Council , etar BY /�°��/�
B5� � �
, �,��g�� 2 4 1990 Approved by Mayor for Submission to Council
Approved by INayor: Date �
gy _�%�GL--l��a`�.�il'-' _ BY
PUBl.tSHED ��� - 3 ?990_
� - @���-9�
DEPARTM[NTIOFFICEJ�COUN ' DATE INITIATED �^��
Finance/ cense GREEN SHEET NO. �+
OON7ACT PERSON 6 PHONE INITIAIJ DATE INITIAUDATE
�DEPAfiTMENT DIRECTOR �CITY C�UNpI
Christine Rozek/298-5056 �� Q�,A��RN� _ ��7y CLERK
MU8T BE ON CQUNqL AQENDA BY(D TE) ROUTIN(i �BUDpET DIRECTOR �FIN.8 MqT.8ERVICE3 DIR.
1-1(�-9� ❑MAYOH(OR ASBISTANI] Q f:nnnri 1. R
TOTAL N OF SIQNATURE PA (CLIP ALL LOCATIONS FOR$IQNATUR�
ACTION RECUEBTED:
Approval f an applicatian for a State Class B Gambling License.
Hearin D te: 1-16-90 Notification Date: 12-22-89
tiECOMnAENDn :�PV►ow(N a lR) COUNqI f�N f�PORT OP1'IONAL
_PLANNINCi COMMISSION _pVIL SERYICE COMMISSION ANALYBT PHONE NO.
_qB'COMMITTEE _.
_�� COMMENTS:
_DI87AICT WURT _
SUPPORT8 WHICH OOUNpL�JECTIVE
` INITIAl1N0 PROBLEM.ISBUE� (Who�YVhat�WMn�Whsn�Why):
David L. A derson on behalf of Como Area Youth Hockey Association requests
City Counc 1 approval of their application for a State Class B Gambling
License at Patrick's Lounge, 1318 W. Larpenteur Avenue. Proceeds from the
pulltab sa es will be used to fund ice time, equipment & tournaments. All
fees and a lications have been submitted.
�ovMrr�s��ovm:
If Council pproval is given, Como Area Youth Hockey will operate a
pulltab boo h at Patrick's Lounge, 1318 W. Larpenteur Avenue. '
o►s�ov�wr�oes��e:
#��-C���EQ
� . •�1�81990
C1TY CLERI�
DISADVANTAQES IF NOT APPHOVED:
t�ouncil Kesearch Center.
JAN 0 5199t}
TOTAL AMOUNT OF TRANSACTION f�6T/REYENN@ BUDOETED(CIRCLE ONL� YE8 NO
FUNOINd SOU� ACTIViT1f NUMOER
FlNANqAL INFORMATION:(EXPLAII�
: t�go
� ° - , , .
� k <
�� . ..�4� � .
• NOTE: COMPIETE DIf�CT10NS ARE INCLUDED IN THE(�flEEN 8HEEI'IN$TRUCTIONAL
MANUAL AVAiLABLE IN THE PURCHASIN�i OFFlCE(PF�NE NO.�4225).
ROUTING ORDER:
Below aro preferred routings tor ths ffvs moet froqusnt typea of documeMs:
OONTRACfS (assum�s�utl�orized COUNqL RESOLUTION (Am�nd, 8dgts./
bud�st�s) /lccept.Grarna)
t. Outsids Apsncy �. DepaMment Direct�
2: Inidating DepeRmsM 2. BudQst Director
3. qy Attomey 3. CItY AttomBY
4. Maytu 4. Maya'/Assistant `
5. Finance 8 MqM 3vcs:Director b. qty Council
6. Flnance Axountinp 6. Chbf AxountaM, Fln&Mgmt Svcs.
ADMINISTRATIVE ORDER (�, OOUNqL RESOLUTION (��)��
1. Activity Maneipsr 1. Initiatinp DspertmeM Director
2. Deparbnsnt AocouMaM 2• �Y��Y
3. Dep�Rm�nt Director 3. Mayor/Aaistant
4. Budpst DI►eC�or 4. dty COUnCiI
5. City Clerk .
6. Chief AcoouMeu�t,Fln 8 Mqmt Svcs.
ADMINIS7'RATIVE ORDERS (all oth�s)
1. InidaUng WpaRmsM
2. City Attomsy
3. MayorlAs�SSU�M
4. City Clsrk
TOTAL NUMBER OF SIQNATURE PA(iES
Indk:ets ths#�of poge�on which sip�turos ue required and p�percliD
s�ch of thqe�a�.
ACTION REOUE3TED
De�crlbs what ths p►ojscUnqus�t sesks W accompli�1n either chronologi-
cd ortlsr w ordsr of importar�ce�v�hichsve�is most appropriste for the
i�ue. Do not write complets ssntsnc�a. Bpin each Rem in your Iiet with
s verb.
REOOMMENDATION3
. ComplMe if the isfue in queqion haa basn pressMed bsfore anY�Y� P�aic
or private. �
3UPPORTS WHICN COUNCIL OBJECTIVE?
Indicate which(�oundl objsctive(sI Y�+�P�ro4��bY li�i�p
ths key word(s)(HOU81N(�. RECREATION. NEIQHBORHOODS, EOONOMIC DEVELOPMENT,
BUD(iET, SEWER SEPARATION).($��MPLETE LI3T IN IN3TRUCTIONAL MANUAL.)
COUNqL COMMITTEEIRESEARCH.REPORT-OPTIONAI A3 REOUESTED BY COUNGL
INITINTINti PHOBLEM,�183UE,OPPORTUNITY
Explain the situstion or oa�ditlora that;c+wted a need for your project
or requeat.
ADVANTAOES IF APPROVED
Indicste whsther thfs fs simply an annusl budpet procedure required by Iaw/
cherter or wMthsr thero us epeciflc In which ths City of Ssint Peul
and ita citlzens will bsnsflt from thi�pr�t/action.
DfSADVANTAC3ES IF APPROVED
Whet nepative siNcts or myor chanpea to existina or past proc�es mipM
this project/requsst produw N ft is p�sosd(e.g.,tratflc delays, noise�
tax increasss or as�easrt�ents)?To Whom?Whsn?Fa hov�r long?
DI8ADVANTA(iES iF NOT APPROVED
What will bs the nspative cor�quencss if the pranised action is not
epproved? Inabllity to deNver ssrvk:e?CoMinued high tratficc, ndae,
accidsM rate?Loss of revsnus?
FlNANCIAL IMPACT
AkNough you must tailor the infom�atbn you provide here to the issue you
ue eddrasinp, in psneral you must answer two qu�tions: How much is it
Qoin9 to coet?Who is�ofng to PaY?
. � . . � l��o -��
UIVISION OF I.IC�NSE AND PERMIT ADMINISTRATION DATE �/ �C� �/ / �°�" /°� � / �v
INT�.RDF.PARTMENTAL REVIEW C;HECKLIST Appn rocessed/Received by
Lic Enf Aud
Applicaut CO ►'Yl,v �-}�'�A �JFyu..�(„ _�-�p(�ic„� Home Address
Rusiness hame `-t T�Y�C K S (, <,[r C� I Home Phone
Business Address f�J� �. Gu � pen7f4 �" Type of License(s) C �GS� � C7k rn bl���i
I
Business Phone �nUPS-�-t�ti,`�'�Jn �4�
—�
Public Hearing llate ( (�� License I.D. �1 f o� (> ��
at 9:00 a.m. in the Counc 1 C ambers,
3rd floor City Aall and Courthouse State Tax I.D. �� � y� ���v
llate l�otice Sent; Dealer 4f ��4
to Applicant �a-aa�� NI�
Pederal Firearms 4�
Public He<.�ring
DATE INSPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
Bldg I & D �
N�A- ,
Health Divn.
f
' �l�t
-- '
Fire Dept. I �
j �I� �
I ��,,� � /3-f��I
Yolice Dept. I
,�,e, - c��c�
� �� � {�, _� d-���'�,�u.�l
License Divn. t J ? u �l �
t
City Attorney �� ( �
a, ' ��
Date Received:
Site Plan � �'3 D I��'
�—r To Council P.esearch
Lease or Letter Date
from Landlord � � �3dJ��
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
. -- r, � _ ,:....., ,.
- � > .:. D-g�v
. , _ . f � L-.
. ' ' Charitable Gambling Control B�ard FOR BOARD USE ONLY
Room N-47b Griggs-Midwey Building ���
1821 University Avenue
St. Paul,Minnesota 551043383 PAID
(6121642-0555 • � �, , �F AMT
� : r ���``� �, � CHECK#
R_�.��,.'��. �.+ DATE
` GAMBLING LICENSE APPLICATION „
, �
INSTRUCTIONS: �
A. Type or print in ink.
B. Take completed application to local goveming body,obtain signature and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with a check.
C. Incomplete applications may be retumed.
D. Enclose license fee wkh application.
Type of Application:
❑Ciass A— Fee S 100.00(Bingo,Raffles,Paddlewheeis,Tipboards,Pull-tabs)
j$Class B— Fee S 50.00(Raffles,Paddlewheels.Tipboards,Puil-tabs) ����m�
❑Class C — Fee S 50.00(Bingo only) �fM1lO1'��'���0"�fO��
❑Class D — Fee S 25.00(Raffles only)
Check one: ❑1 A. Organization has never been licensed.
�`7 B. New size—Give base license number. -�- � -
O 1 C. Renewai of existing license—Give complete license number. � - 0 - 0
�1 D. Changt in class of an existing license—Give complete license number. 0 - 0 - 0
❑Yes o 2. Has organization ever received a Lawful Gambling Exemption Permit from the Board7 If yes,give complete
permit number
es❑No 3. Have Internal Controls been submitted previously on a form provided by the Boardl If no,please attach copy.
4. Applicant Official,leg I name of o ganization) 5. Business Addr s of Organ' ation
C oM� ` r� ' � � 13 8�7
6. ity,St ,2ip 7. nty 8. Business�Pho'n�g Number
�-s-, , �,. � 1 c.o b2.� lo«-g3lv
9. Type of organization: ❑Fratemal ❑Veterans ❑Religious �Other nonprofit•
•If organization is an"other nonprofit"organization,answer questions 10 through 12.If not,go to question 13."Other nonprofit"organizations
must document its tax-exempt status.
OYes�No 10. Is organization incor orated as a nonprofit organization7 If yes,give number assigned to Articles or page and
book number: �C' Attach copy of ce�tiflcate.
�Yes ONo 11. Are articles filed with the Secretary of State? ,
❑Yes❑No 12. Is organiaation exempt from Minnesota or Federal income tex�tf yes,please attach Istter from IRS or Department of
Reve�ue declaring exemption.
❑Yes�No 13. Has license ever been denied,suspended or revoked7 If yes,check all that a ly:
ODenied OSuspended ❑Revoked Give date: - -
14. Number of active members 15. Number of years in existence Note: Attach evidencs of
�� �S, three ysars existence.
16. Name of Chief Executive Officer(Cannot be 17. Name of treasurer or person who accounts for other revenues
Gambling Mana er) of the organizatio ,.�annot be Gambling Manager)
A►�t.T►�U 1'� AQ 1.1 �:A��sL�..
Title Tttle
� . �TR�`cS -
Business Phone Number Business Phone Number
�� ► �g3� � � �t ► �� - o�S"
18. Name of establishment where gambling will be 19. Street address(not P.O.Box Number)
conducted
�A-r . 1 �'J I �.R�' NT 2
20. City,State,Zip __�,`..,,,.._.. 21. County(where gambling premises is located)
�CC..i-��,-�.."
�--�`-�T - �At�l. ���r_; 5 5 ��1-�tSE
CG-0001-0318/88) �' �,' L White Copy-Board Canary-Applicant Pink-Lxal Goveming Body
;`" '�' Page 1 of 2
I
. --R�- - -�.-�------ ;- ._ ___.__.� . ___ .
. r: . (��/Q�9K/
Gambling Llcense Application `
Type of Application: ❑Ctass A lass B O Class C �Class D
�,Yes ONo 22. Is gambling premises located within city limits?
�Yes ONo 23. Are all gambling activities conducted at the premises listed in#18 of this appiication?If not,complete a sepsrate
application for each premises(except raffles)as a separate license is requi�ed for each premises.
❑Yes�No 24. Does o�ganization own the gambling premises?If no,attach copy of the kase with terms of at least one year,and
attach a sketch of the premises indicating what portion is being leased. A leese and sketch are not required for
Class D applications. �.
25. Amount of Rent Per 26. Do you plan on conducting bingo with this IicenseT If yes,give days end times of bingo occasior►s.
Month or Bin o Occasion Day Time ! Day Time Day Time ,
� ���e"'� .
es ONo 27. Has the 510,000 fidelity bond required by Minnesota Statutes 349.20 been obtained7
28. Insurance Company Name(not agency name) - 29. Bond Number
V N i-z'E. - O D 8
30. Lessor Name ` 31. Address 32. City,State,Zip STlU1.�)!�'TE.�L.
_ o ti�r t,'D �,C A I �1 IV . T �. �', 5�082
33. Gambling Manager Name 34. Address �` C'�t�S tate,Zip
! 1 ` 2.� 1.1 �4- �'JJ :'t' {�V C. t�+� ��I 1'i
36. Gambling Manager Business Phone 37. Date gambiing menager became
( �`� ,� �U�_�:,,s�3 member of organization: Month 1Rear �/��
❑Yes ONo 38. Has the license termination form been completed?Attach copy.
�Yes ONo 39. Has the compensation schedule been approved by the organization?Attach copy.
40. List the day and time of the regular meeting of the organization.Day ��'r`'ii�,n: �- rr.�r�. Time "7' ''-�� P!.A•
41. Bank Name 42. Bank Address [� 43. Bank Account Number
�onn0 N O fLT�-1 i G t���,;� �Ep� G�'^,(�,, (e;. �-E.�t�J(�i c,J ( t'��.�-
V►-� t o�.J �r-. l�a v . 5� `J-'=�?����
GAMBLING SITE AUTHORIZATION
By my signature below,local law enforcement officers or agents of the Board are he�eby authorized to enter upon the site at any
time gambling is being conducted to observe the gambling and to enforce the law for any unauthorized game or practice.
BANK RECORDS AUTHORIZATION
By my signature below, the Board is hereby authorized to inspect the bank records of the gambling bank account whenever
necessary to fulfill requirements of current gambling rules and law.
I hereby declare that: OATH ' __ �
1. I have read this application and all information submitted to the Board;
2. All information submitted is true,accurate and complete;
3. All other required information has been fully disclosed; _ -� .:.._ ,
4. I am the chief executive officer of the organization; �
5. I assume full responsibility for the fai�and lawful operation of all activities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the Board and agree, if
licensed,to abide by those laws and rules,including amendments thereto;
7. Membershi list of the or anization will be available within seven da s after it is re uested b the board.
44. Official,Legal Name of Organization 45.�� a�ure u �signed-b�efFiz�cutive Officer)
�/ n c X'i �/' ���=�
Title of Signer Daife //� /�_ � '
' r1 _ 1 1�
ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application.By acknowledging receipt,I admit having been served with notice that
this application will be reviewed by the Charitable Gambling Control Board and if approved by the board,will become effective
60 days from the date of receipt (noted below) unless a resotution of the local governing body is passed which specfically
disallows such activity and a copy of that resolution is received by the Charitable Gambling Control Board within 60 days of the
below noted date.
46. Name of City or County(Local Governing Body) � If site is located within a township,item 47 must be completed,in
addition to the county signature. If township is not organized,
�� �� • � �(� �L.,/ � county must sign.
Signature f rson receiving epplication 47. Neme of Township
X ( ,< <' ; , ' •�-� 1�� �.dJ
Title Date recei'ved(60 day period Signature of person receiving application
' � 'begins from this date) ._-
�.:'. ... ir�.� 1`{-1,t`�:ltyC.;. �.. �o_ s� ��
f ., i �g X
48. Name ofp'erson delivering application to Local Goverr�g Body Title
.. � _
CG-0001-03 (8/88) White Copy-6oard Canary-Applicant � Pink-Lxal Goveming Body
Page 2 of 2
' � ' . � , . City of Saint Paul �'�/Q-9�
Department of Finance and Management Services
� Division of License and Permit Registration
INFORMATION REQUIRED WITH APYLICATION FOR PERMZT TO SELL PULLTABS � TIPBOARDS IN SAIti'T PAUL
(Class B Gambling License ia Liquor Establishments - Renew)
1. Full and complete name of organization which is applying for license
�l�M L'7 �'`� �� '( muT�l � DG1�CE'Y �-\SSD �.
2. Address whete games will be held �3 j Qj LAQpW'C�I�.�N&� �7:fAUt, �v`1� l�
Number Street City Zip
3. Name of manager signing �this application who will conduct, operate and manage
Gambling Games�A�/((� �., , �1�13�EtZ SE�tJ Date of Birth �-�9-��
(a)� Length of time manager has been member of applicant organization
4. Address of Manager y f� � /
Number St eet Cfty Zip
5. Day, dates, and hours this application is for J� � S� -i-}.�tU�L�._�a1 . �94i�
6. Is the applicant or organization organized under the laws of the State of I�T? �
7. Date of incorporation � �8D
8. Date when registered with the State of Minnesota '�-- 2g- /�1��
9. How long has organization been in existence? � LJ�L'J�$,
10. How long has organization been in existence in St. Paul? � �J�S
11. What is the purpose of the organization? �j2[�MU'T� �'�OL3"rl-1 �-1 DCK��/
i t� �Mb ��t P�
12. Officers of applicant organization:
Name M EA��E N A2Tt-�U IJ N�e �D� �DS�TJ'TW I�L
Address ��JB'7 �phnp �V� Address 1?Sloci ��.�,AIS�
Title ���_ � DOB �- �-�3 Title v. Q(Z�G�. DOB � -�j--�-�
Name ��lIZ1�1.� !��'�GL Name �o � TA�1 nIZ �DOW UC;
Address pj I � �2LIiJG,�j"D►� Address �d�S 1 . J�SSA1.n1 IJE
Title ���, DOB �-2�p-�� Title J�--CT DOB �`-Z�-r'j�
13. Give names of officers, or any other persons who are pai�d for ServiCes to the
organization.
Name � D1•)'E Name
Address Address
Title Title
(Attach separate sheet for additional names.)
. • - ���-96
14. Attached hereto fs a list of names and addresses of all members of the organization.
15. In whose custody will organization's records be kept?
Name�i��.�qRT�1u� Address 13 Srj �Mp ���.
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name V1aV 1 O 1� , i-�1�D�12 S�*�IJ Name
Address � ��� ��,�,����l Address
Member of Member of
DOB �-�g ..-�� Organization? ���g DOB Organization?
Name �a 2�,��SS 1"`c.L._, T Name -
Address B�(� �Q,.lr1 tJ�.-�TO � Address
Member of Member of
DOB �-'a[o�8 Organization? �s DOB Organization?
17. Iiave you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games? 6.��5
T
18. Attached hereto on the form furnished by the city of Saint Paul is a Financial Report
which itiemizes all receipts, expenses, and disbursements of the applicant organiza-
tion, as well as all organizations who have received funds for the preceding calendar
year which has been signed, prepared, and verified by �Av1� � .�1�D��1J
'7� c� � L.o�1 G c�-nz• T .9 t��- W • �1 I'�
Address
who is the �/ql'yl$(rj,rJ�a /���,e of the applicant organization.
Name
19. Will your organization's pulltab operation 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 organizati n with the
pulltab sales and/or recording keeping? yes no
If answer is yes, give the name and address of the person and/or company contracted.
Name - Address
:�ame 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.
21. Operator of premises where games will be held:
Name HIZ/V�[.�_��/g C �?T/ZJG��./lS J
Business Address /3 18 L-iQ/ZPEIVT�L3�2 /�' ��vG /,�'/d� .��/.��
Home Address ���"f d,s � /9/'�O /4 �"14�i / ��i��t�Jl4T�.c e///�� �s��-� __
, � � � ' � � - ���o-��
22. a) Does your organization pay or intend to pay accounting fees out of gambling funds?
yes no
b) If you do pay accounting fees, to whom will such fees be paid?
Name M � M CCPA� Address ti3g� '�?J�2��( LA�J�
DOB � Member of Organization? '�D.
c) How are the accounting fees charged out? (flat fee, hourly, etc.)
�l..AT �'��
d) What do you anticipate will be your average monthly deduction for accounting fees?
QV o �
23. Amount of rent paid by applicant organization for rent of the hall:
r- oo � • � �° � t2
24. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the fol�owing purposes and uses:
..ZCG— �l�'J��,g /�i Prh�iV T ! ��•�N�2/J��TS
25. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul? 1/���,
26. Has your organization filed federal form 990-T? �� If answer is yes, please attach
a copy with this application. If answer is no, xplain why:
Any changes desired by the applicant association may be made only with the consent of the
City Council.
Comof�� yvT.0�vc,x �ss oc.
Organization Name
Uate ��.� ��- 8,9' sy: n . ���
Manager in charge of game
N/�17,LL� ,�Al2T/�lJ,t� �
Organization President or CEO
`�
. � � � . . ��v-��
State of :tinnesota )
) ss
County of Ramsey )
being duly sworn, say _that_he_is
(are) the petitioner _in the above appli-
cation; that he_has_read the forego-
ing petition and know the contents thereof;
that the same is true of h own knowledge.
Subscribed and sworn to before me this
�` 'a8y of �l: 19 �
� � � f?� -
(�l /�n� � 0/L4��
Notary Public, Ramsey unty, Minnesota
My commission expires s �Ry o
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