90-215 0 R i G 1 �I A L � Council File # �"'a�/J�'
Green Sheet � V 7 �
RESOLUTION ,--^- ,,
CI OF SAINT PAUL, MINNESOTA (
�q �
Presented�' y \ ��
Referred To Committee: Date
RESOLVED: �'hat application (ID ��38415) for renewal of a State Class A
�ambling License by Church of Holy Childhood - Men's Club
at 408 Main Street, be and the same is hereby approved/�c�d.
�a� Navs Absent Requested by Department of:
�o wn�� —�'—
on -'�'—
acca ee �—
e man �""—
une �—
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Adopted by Council: Date FEB ._„a Form Approved by City Attorney
Adoption rtified b Council Secretary By: • ,Z� -�d
By° Approved by Mayor for Submission to
Approved y Mayor: ' Date FE g - g 1990 Council
'� �
By: � ��'•�' ,lt��/ BY�
�i1Bt.ISNED � ��, 17 i 990_
. . . � �'r yo als
DEPARTM[NTIOFFICE/COUNGI DATE INITIATED
GREEN SHEET No. �647�A�
CONTACT PERSON R PHONE �pEpARTMENT DIRECTOR �CITY�UNCIL
Christine ozek-298-5056 NV�� ��'A�NEY �CITY CLERK
MUBT BE ON COUNpI AOENDA BY(DAT� 110(ITINO �BUDOET dRECTOR �FlN.d MaT.SERVtCES DIR.
2—$-9� �MAYOR(OR A8818T1� � f!n�,nni 1
TOTAL#�OF SIGNATURE PA (CLIP ALL LOCATIONS FOR SIQNATUR�
ACTION REOUESTED:
Approval o an application for renewal of a State Class A Gambling License.
Hearin Da e: 2-8-90 Notification Date:
RE�OAAMENDATIONS:MP►�W a►� COUNCIL COMM�REPORT OPTIONAL
_PLANNINf3 COMMISSION _q L 8ERV1�COMMIS810N ANALYBT PNONE N0.
_(�B COMMITTEE _
—STAFF _ COMMENT8:
_DI8TRICT COURT _
SUPPORTS WHICH f�llNpl OBJECTIVE?
INII'IATING PROBLEM.ISSUE.OPPORlUN (Who.Whet�When,Whsre.Why):
Jerome Rrz arzick on behalf of Church of Holy Childhood - Men's Club
requests C ncil approval of their application for renewal of a State
Class A Ga ling License at 408 Main Street. Proceeds from the ga�nbling
session ar used for interests of Holy Childhood Church and School. All
fees and a lications have been submitted. '
ADVANTAOES IF MPROVED:
If Council pproval is given, Ho1y Childhood Church - Men's Club will
operate a mbling session at 408 Main Street.
DISADVANTAOES IF APPROVED:
D18ADVMITAQE8 IF NOT APPROVED:
��� �uur�cc� Kesearcn �ente�:
�1��Q JAN 2� 199�
dtY CIE�K
TOTAL AMOUNT OF TRANSACTION C08T/REVENUE BUDOETLD(CIRCLE ONE) YE8 NO
FUNDIN�3 SOURCE ACTIVITY NUMBER
FlNANCIAL INFORMATION:(EXPWI�
��
. . . ! � ��-a��
. �
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DiVISION OF LICEN�E AND P�:RMIT ADMINISTRATION DATE � � � o / �� � �/
INTF,RDF.PARTMF.NTAL REVIEW CHECKLIST A.ppn P oce sed/Recei ed y
Lic Enf Aud
Applicant ��� t,h O� �� '� 'd�� Home Address
M-2 v�S ��-�
Rusiness Iv'ame Home Phone
Business Address ' �� �Q(h Type of License(s) C,IQ�fl ' ��(tvnb���
�
Business Phone �_ ��eV�S¢� �PY�9LJ�I
Public Hearing Da e � � �� License I.D. �l �g ���
at 9:04 a.m. in t e Council h mbers, c�
3rd floor City Ha 1 and Courthouse State Tax I.D. �� � �J �� -i�5
Uate Nutice Sent; Dealer �� �U I�^
to Applicant � �`a�"9a
Pederal Firearms 46 ���
Public He�.iring
�
� DATE II�'SPECTIUN
REVL�W VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
ti�� ,
Health Divn. '
I N�f� '
�
Fire Dept. ' �
j ��� �
I
Police Dept. � �2 ►ti`�I �°�')�5
� n�
�J�_
License Divn. � , � �
�� �� �
City Attorney i �
�
� � �r�� o �
I Date Received:
Site Plan � ��- � q
� To Council P.esearch �O `
Lease or Letter Da e
from Landlord �� 1
I
�
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 �r GA ���,c
� Finance aad Kanagement ServicesiLicease S� Permit Division �_" �Ri'�
INFORMATION REQUIREp WITH �1PPLICaTION FOR PER'�IT TO CONDUCT CHP,RITABLE G�,MBLI�G GA.`IE I;I
SAI:IT PAUL (To be used with the following: vew a & C application, renew � S C
Licenses, aad new and renew B in Private Clubs.)
1. 11 an complate name of org ization which is a plying for licease
. /
Z. Address ere games will be held � ����
Number treet City Zip
3. Name of manageir si iag this applicaticn w[io will conduct, operate and manage
Q y
Gambliag Gamesj Date of Birth �� � t7oG
(a) Length of Itime manager has been member of applicant organization ��,
4. Address of Maniager 3 , �'S�O�
Number Street ity Zip
5. Day, dates, a�tid hours this application is for � � � .�.3�� i
�
6. Is the applicant or organization organized under the la s of the State of MN? _���/,
7. Date of incorporation � �
�
8. Date when regiistered with the State of Minnesota
9. How Iong has c�rganization been in existence? �
� I0. How Iong has organization been in existence in St. Paul? _�.3 �
LL. What is the purpose of the organization?
12. Offi ers of a icant organization:
Name -•
� Name �
.
Address
� A �S'/o8 e3 �c�/Of
Title (�B �d /�— 3�' '�itle �$ � S� //,
Name " Name
Address
' ress
c��`/O�
Title DOB �/ /�/� Title �B
13. Give names of officers, or any other persons who are paid for 52rviCes t0 the
organization.
Name Name
Addrzss � Address
Title Title _
(Attach separace sheet for additional names.)
.�� . •6- � ��- � � ' '� -
;�" �w� -�-�' .
14. �ttached heretp is a ist of nam�and addresses of all members of the organizat:.cn.
15. Ia ose custody will organizatioa's records be kept? (�9a a��
N � Address � •
����
16. i t all rsaas wit the authority to siga checics for d ersa c g p oceeds:
' �' � ,�(/ � Nane
a�d es� 1 � Address
M er of � �''rlo�• Member of
B �Q' � .S� Organization. , DOB Organiaatioa?
� Name
� �
Add ess Address
p � emb of �� Member of
DOB�/ ' ���!�, Orga ization? DOB Organization?
�
17. a) Does your r zatio� or intend to pay accounting fees out of gambling funds?
Yes °
b) I ou do ay accounting fees, to whom will such fees be paid?
N � Address p /x
i �o�
g�� �= � Member of Orgaaization? .
c) Ho are t�e ,accounCing fees charged out? la , hourly, etc.)
� �
18. Have you read aad do you thoroaghlq understand the provisions of all laws, ordinances,
aad regulatio�s governing the operation of Charitable Gambling games?
19. Attached here�o on the form furnished by the city of Saint Paul is a Financ al Report
which it .emizes all receipts, expenses, aad disbarsements of the applicant organiza—
tion, as well as all orgaaizations who have received fun or the preceding calendar
yea ich has been signed, prepated, and verified bq
3 � �s's/o�
Ad ess
who is the of the applicant organization.
Name
20. Operato of remises where games will be held:
�
Name
Business Address ����� '
Home Address ��
�� i�� v�'.s�i'�s'
` �
o�� o — � �-�/'Z 1,
, , � ,
i
- . �yo -a�s
21. Amount of rent paid by appli ant orga�izatio� for re�t of the hall :
/ . � . . . . . . . :. .
. . . . _.
22. The proceeds of the games will be d�s6ursed after deducting .prize lal�!out costs '
an operatfing ex enses for he following purpo s and� uses: � � �
. . .� . - . �
./�—
.�_—__1__� /l,_—_,—____
TO CITY COUNCIL COMMITTEE:
Any changes desi red by ❑ FINANCE, MANAGEMENT& PERSONNEL consent of
the Ci ty Counci 1 .
❑ HOUSING& ECONOMIC DEVELOPMENT
❑ LEGISLqT�ON �
�
PUBLIC WORKS, UTILITIES& TRqWSPORTATION
❑ COMMUNITY&HUMAN SERVICES �
Date: , 7i�' vZ ,
i ❑ RULES& POUCY
I i
I ❑ HOUSING& REDEVELOPMENT AUTHORITY
c0
ACTION
❑ OTFiER
DATE �
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UNIF4RM C�-IARITABI� G�IMBIING FINANCir�L R£�ORT �jI�.�Q _���
� • ' L�11�1FUL PURPOSE CDNTRIBUTIONS - '+IORKSHE:T u
li ne #13 - ITotal Lawfui Purpose Contri butions. S ���c�� '�
•, List 6ie1� all checks written from ga�linq funds which are
chari�able lawful purpose contributions. The total dollar
� amaun�s of these checks musL match the amount clat�ed in
line �13. Use additional sheets as necessary.
CNECK � OATE ' PAYEE CHECK AI�U PURP
ps"�� �� . ' — 30 0 0,00 �o
1. , _� � � '� �So o.o a .. �'
P�o �' 9 9. ,
2 �.�� . ,3'Io'�''�. y � .• ,$'00.vo " � ��
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TOTAL CIiECK ANDUNT ,
NOTE: These eacpend�tures wili be provided to Council Membe a yo r Council hearing.
� Be s at your financial report is canplete and accurate.
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� � � Departaeat of Fiaaaee aad :iansgeseac Servieea / OD a/5
Division of Lieeass and Yessit Adsiniatsatioa �� �
tJNIFORlt C�AALTAbi.E CA!lbLIBG FINANCIAL REPOR?
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Q. Rsparst tes p�siad wvssia= �' 1� t!►rou�h ��� 3� �.1�.
V�1•,,. `� Total nwb�r ot da�s pla�ed
, � ��Cro�s ree�ipcs Eor abov� pasiod s
{�\. � � Gsoia psis� paroucs fos abo�� pasiad (iuelnd� eaa6 s6ose) i
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. � i Nee raesipes - Iine S ainus liu� 6 = �
� 8 Exp�n��a ineuss�d in eonduatinf and op�satia� ;a�a: �—`�""
� A. Cross va6es paid. ✓Attaeh vorkst list vith y
aames. addsess�s. 6ras� vs;es. nu�b�s oE houss = / q ��t� �
� B.� d. and aaount p d � out.
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C. � License fee � �� �'��/�'�� r T� �►�� '
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D. I Insuranc $ D
E. ,� Bond C �iN� ��7� ; �Di �� �
T. Dishoaoced checks not reeovared i t���� `
` , t� : � DO.DD �
� G. Aecouncing Expansa
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H. Employ�rs F.I.C.A.
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� � L. Pulltab Ta�c Paid to Departasat of Rrsnu
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V � 1C, r.a.r:l Ex�s.. ru a se,.p s � � 9 �� '
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` ti. lli�esllan�oua Fsp�naes., Id�ntit� th� a�onat
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10. N�L Ineos� - lia� T ainu� lins 9 = 9
� 11. CU�ckbook balane� ba;ionin� of pariod i O�
12. Total ot lioe 10 and 11 ; •
�k �:�: .� .2 �
13. Tpeal coneriDutioaa (fsaa attuh�d voriuhest) i
14. Chsekbook balane� end of rspoecinf paslod - ; � �
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