90-356 �,. �°°, � . ,
� ��\ � �; �� � � Council File # Q ' ,570
Green Sheet # 5823
RESOLUTION
TY OF SAINT PAUL, MINNESOTA ZI
Presented B �
Referred To Committee: Date
RESOLVED: That application (ID 4�56429) for renewal of a State Class B
Gambling License by Westside Youth Hockey at John & Paul's,
731 Randolph Avenue, be and the same is hereby approved/
�e�.
Yeas Navs Absent Requested by Department of:
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Adopted by Counc�il: Date MAR 8 �9�� Form Approved by City Attorney
Adoption Certified by Council Secretary g , • ?j/�{
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By� �� A roved b Ma or for Submission to
Approved by Mayor: Date ,j/`��`�� MAR g ���uncil Y y '
By. � By:
Pu�±�s��o �,:�{�� 17 »90_
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DEPARTM[NTIUFFICEIOOUNCIL DATE INITIATED
Finance/License GREEN SHEET NO. �82�
INITUIU DATE INITIAUDATE
CONTACT PERSON 8 PHONE �DEPARTMENT CIRECTOR �GTY OaINCIL
Christine Rozek-298-5056 �� �CITY ATfORNEY �cm cx��uc
MU8T BE ON COUNCIL ACiENDA BY(DATE) IIOU71N�i �BUDOET DIRECTOH �FIN.8 MOT.SERVICE$DIR. +
3-8�.-90 �MAYOFi(OR A8818TANT) � ('.rnmri�. R
i
TOTAL#�OF SKiNATURE PAGE8 (CUP ALL LOCATION8 FOR SKiNATUR�
ACT10N REGUE8TED: .
Approval of an application for the renewal of a State Class B Gambling License.
Hearin Date: -8`- Notification Date: a3 `IlJ
RECOMMENDA :MP��W a (� COUNCIL COMNITTEEII�SEAfiql F�PORT OPTIONAL
_PLANNIN(i OOMMISSION _CML BERVICE OOMMI8810N ��YST PHONE NO.
_p8 OOMMITTEE _
COUAMENTS:
_STAFF _
_DISTRICf OOURT _
SUPPORTS WNHHyii COUNpL OBJECTIVE9
INII'MTINO PROBLEM.18�1E�OPPORTUNITI((Who.WMt.Vlfllen�VYhsre,YVhY).
Mark S. Mules on behalf of West Side Youth Hockey requests City Council
approval of their application for renewal of a State Class B .Gambling License
at John & Paul's Bar, 731 Randolph Avenue. Proceeds from the gulltab sales
are used to purchase ice time, league fees and equipment for the team� All
fees and applications have been submitted.
The License Division is recommending approval of this renewal.
ADVANTAOES IF APPROVED:
If Council approval is given, West Side Youth Hockey wiil continu� to
operate a pulltab booth at John & Paul's Bar, 731 Randolph Avenue.
asiwvarr�ES��r�o:
as�ovv,wr�oes iF NoT nPr�o:
RfCEfVFD
INIARQ1it' Q �ouncil Kesearch (:ent�r
CITY CLERK FEB 2 31990
TOTAL AMOUNT OF TRANSACTWN = C08T/FIEVENIlE WWiBTED(CIR�E ONE) YES NO
FUNDINO SOURCE ACTMT1f NUMBER
FINANGAL INFORMATION:(EXPWI�
dw
. . � . � � ���-�.�
UIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �� /O / � f(o 9 V
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn Processed/Re eived by �
Lic Enf Aud �
/�'1 Cc✓IC S �'1 u l.�-S
Applicaut �� 5"f S,�___ ' , �pc-K�� Home Address I 5,5 E .�.Sc_�i.e�
Rusiness Name . �tl �i n � 1",q-u'-S Home Phone a 3 �- Oc�g�.
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Business Address / 3� ���,, �(p{� Type of License(s) C�q� R -
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Business Phone � �
—��q_r�p� �.�-1'1 U rS`�� t��
Public Hearing Date � S C11� License I.D. 4{ � c�'���
at 9:00 a.m, in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �C � S ��.3� �
llate Nutice Sent; Dealer �� �/'4'
to Applicant ��a3 �t(�
I'edera2 Firearms 4� � �
Public He<.�ring
DATE II�'SPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A proved Not A roved
�
Bldg I & D �
Nj�
Health Divn. '
�
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,
Fire Dept. � �
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Police Dept. �''� I�D I JQ �`t'
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License Divn. �
ala� y�; a ,�.
City Attorney �
a-�'y y�v � p�c�
Date Received:
Site Plan _���1 /�
To Council Research o�- �� �?Q
Lea�e or Letter � ate
f rom Landlord � ('S ��
�
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Gurrer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
, • � • City of Saint Paul d
�y '.3.f�
Department of Finance and Management Services
' � ' Division of License and Permit Registration
INFORMATION REQUIRED WITH APPLICATION FOR PERMIT TO SELL PULLTABS � TIPBOARDS IN SaItiT ?AUL
(Class B Gambling License in Liquor Establishments - Renew)
1. Full and complete name of organization which is applying for license
- � tL.S� S �c� 2. �pu�� \,�o c...�`-�
Z. Address where games will be held �3� �A�c�o�t��+. �? Y� �n S�oZ-
Number Street City Zip
3. Name of manager signing this application who will conduct, opezate and manage
Gambling Games ��p��� S �(\�„��S Date of Birth � - Z3 "��
(a) Length of time manager has been member of applicant organization ( � �,1���S
4. Address of Manager ��S �_- �A.�� �; �,w\ { V\r. �S(d 7
Number Street City Zip
5. Day, dates, and hours this application is for �(�r "1� �,�� M�� Q �
6. Is the applicant or organization organized under the laws of the State of MN? � ��
7. Date of incorporation � g �iC��9 l���
8. Date when registered with the State of Minnesota ' 1� `
9. How long has organization been in existence? l� C,�LR4_S
10. How Iong has organization been in existence in St. Paul? � g l,, �,.,4CS
11. What is the purpose of the orgaaization? ���� �'�����S C l�oG�>
,�
12. Officers of applicant organization:
Name �Q.� �c���-, la a�Sl CJ Name \��\�.n �V.�x nn A n�.,
Address 3�\ '� �b�2 [�ddress ��1 �� �
Title������c.,,��C' DOB ( � "',3( `�{3 Title `�'�AS�-tzQCZ. �OB � ` ' 2-Z" �'�(
Name �or� '+]�� Name 1 IAY�c`., ' `! \".�-�S
Address z-SZ w �o a���,.� Address ��S � �l��a�
-�
Title V�C,� `C�r� . DOB � -'� -S� Title �Q�P� DOB -�� ��
13. Give names of officers, or any other persons who at^e paid for ServiCes t0 the
organization.
Name Name
Address Address
Title Title
(Attach separate sheet for additional names.) �
. , lil� ��`��
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 l v\t�t� IV\v..\25 Address `S S � �...S1�.�a��
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name �p.c� 1v\..,,�S Name
Address \�S C �i�� Address
n Member of ember of
DOB `1-�-� - V� Organization? �e-� DOB Org ization?
Name Name -
:�ddress Address
mber of mber of
DOB Organization? DOB Orga "zation?
17. Iiave you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games? ��s
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 cal.endar
year which has been signed, prepared, and verified by Mp�t-� 5 ��,.�s
15.5 �. �.sa�Q..� � �t�.�\ M� �S lo'�
Address
who is the �A�\.r 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 organization with the
pulltab sales and/or recording keeping? yes no �__
It answer is yes, give the name and address of the person an /or company contracted.
Name \ - Address
:�ame Address
If answer is yes, how wil 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 �O�c� C 'JU�Q��S
Business Address l �� 1�C��1.c�1p� �' �\ �� ��r���"
Home Address `���� ��-Ik ��• �-A��n i r\ � ���ZZ'
� , . . (��v��:�
` 22. �a) Dbes your organization pay or intend to pay accounting fees out of gambling funds?
yes no ZC
b) If you do p�y accounting fees, to whom 11 such fees be paid?
�
rame Addr s
DOB Member of Organizatfon.
c) How are the accounti g fees charged out? (flat ee, hourly, etc.)
\
d) What do you ticipate will be your average monthly eduction for accounting fees?
23. Amount of rent paid by applicant organization for rent of the hall:
� �w� S
24. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
� \l cv�� \c r c�c�l� \2P,C.�fL �e-A-S � �.G:i,(, M�/��
,
25. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
26. 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 the applicant association may be made only with the consent of the
City Coancil.
S► c.� '""`'�
Organization ame
Uate � �P�� `� By: Ir\�cc.�.., � \ \ \�.W�
Manager in charge of game
X�
, Organization esident or CEO
V� � I vi �1 . rMUL
• UNIFORM CHARITABL� GAMBIING �iNANC�AL REPORT
� LAWFUL PURPOSE CONTRIBUTIONS - WORKSHEcT �'�CQ y�p
Line #13 • Total Lawful Purpose Contributions. S �1 S�UU°
List belcw all checks written from gambling funds which are
charitable lawful purpos� contributions. The total dollar
amounts of these checks must match the amount claimed in
line �#13. Use additional sheets as necessary.
' CHECK # OATE PAYEE CHECK AMOUN PURPOSE
1. ��JE7 ��y 15 �'1��T S.c�.� �o�►�'• ��0�-. (CE TIME
2. 1`t'o`-f �R�" t� Lt-S u..S� �ct2 �o.1�'� �OOO" ,�e,s�.�c �u.S
3. . ��3Z Q�.— �� �p.\AC�- �7o�tC-rS \��'� �OO �tv�.`}�`\ �Ql�.�
4. ��453 �LC. � L3-7�ST ���� �oc.-� �C�� IC.L� TIM� ; £ci�. �� K�tlS
5 .
6.
7.
8.
9.
10.
11.
12. �
13.
TOTAL CHECK AMOUNT $ �1 �W
NOTE: These expenditures will be provided to Council hlembers at your Council hearing.
Be sure that your financial report is complete and accurate.
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� Departa�nt of Finaate aud Mana�esenc Setviees n/�G���Q
Division of Lieeas� aad Penit Adainistration L� �
UtiZFOR!! C7�ARITABLE CA![SLIIiC TINANCLIL ltEPOR?
n.�.�5 An O
1. N,o. cr oc`ai►i:ieion�JSt•ST �•�e.�./oc�� C'��4
2. Addr�sa vher• Chsritsbl• Caablin� is eondueesd ?3� 1�A�o`c�L.
3. Repore for period eov�rin� \ M R� 19� thsou�h 3� � 19 O�
4. ?ocal auabar oE days play�d Z'�g
S. Cros• reeeipu fot abov� p�riod ' t ��,55�•.��
6. Crosa priza payouts for abws pariod (iaeluda ea�h shost) i �-�� `"S�Z `�
7. Net reeaipc� - lia� 5 siaua lin� 6 3 _ S�� ��4'�
B. Facpense• incurrsd in eoaduetin� and op�satin� fa�:
A. Gcos� va�as paid. Attaeh vork�r liit vith � (� ��
nam�s. addzass�s. `ro�� va�es. maber of honrs f "i �J�•
vork�d. and uwnt paid p�s hoar.
B. Rent foc ,� ���1�* ; �-i Zy 0���
C. Licensa fea f � �� •L�
D. Insuranc� s
E. Hond = (�s, �O
!. Dishonorad ehaeks not reeover�d s
C. Aeeountini Expenu :
Fi. Employ�r• l.1.C.A. ; ` a �/• �S
I. Pulltab Ta: Paid to D�partatat of R��anu� ; � `� � '$�
J. liian. U.C. iu i ��•� �
R. lad�ral Gceise ia: i Sea�p = � �0 S�1�
br. Stat� G�ablin` 'fax =
li. Mi�esllaa�ou� Exp�naas. Id�ntif� tM a�onnt
aad to vho� p�id.
1. �s�•e n..�r = I S�-t�k.9(.�
:. G��s : ���� .��`�'
�. Iv�S� S�PP�� s ►��. �o
.. C3�.� �-�-5 s � ��°� Z.�-1 �.9 .��
9. 'lotal Fspea��a �� _
10. N�e IneoN - lias 7 aiaa• lin� 9 = � Z�� '�'
11. Chsckbook balanee be�imtin� of p�siod ; y Z S'�3
12. Totsl of lin� 10 and 11 ; ��0,����
' � 13. iotal conttibutioni (troa attaeh�d wrbh��t) _ '�J�� �' OQ
16. Ch�ekbook balancs and of rapottln� period - 1 � ��� .`1�
line 12 lus llns 13 S
c�.�.1�k ��1 S 3 :Z t
l�Pos,� zs4,.qa �,,;5� 8 . SO
l n c ru.scs c bt� 2� .00
G+��.� .n scs�� So 3 , vo
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