90-416 ORIGIN� L � � � ' �
Council File � (� "��
Green Sheet �
RESOLUTION /%'�,
/ r' F` \
CITY OF AINT AUL, MINNESOTA � Z,�, �
. ��_.:
Presented By z
Referred To Committee: Date
RESOLVED: That application (ID ��56011) for renewal of a State Class A
Gambling License by Rice Lawson Booster Club at 1079 Rice Street,
be and the same is hereby approved/����
eas Navs Absent Requested by Department of:
1 O
osw � �—
on �i—
acc ee -�
e man T—
une �
son BY�
a
Adopted by Council: Date MAR 1 5 1990 Form Approved by City Attorney
Adoption ertified by Council Secretary gy: ' � '�/Z7/9Q
By� _ Approved by Mayor for Submission to
Approved by yor: Date � � � Council
B .+���.'ls3�/ By:
Y�
�UBIISHED h�AR 2 41990
_ _ . e�.��r�
DEPARTM[NT/OFFI(�K�UNqL DATEINITIATED GREEtV SHEET NO. ����+
Finance/License
INITIAU OATE INITIAUDATE
OONTACT PERSON 8 PIIONE �pEpApTMENT DIRECTOR �CITY WUNpI
Christine Rozek/298-5056 �� �cmr�rroaNer �cm c�r�c
MU8T BE ON COUNCIL AOENDA BY(DAT� p0Un1�Ki �BUDOET DIRECTOR �FIN.6 MOT.SERVICES DIR.
�wu►roR�oa�sr,v�m 0 .o m c i 1 R
TOTAL#�OF SKiNATURE PAOES (CLIP ALL LOCATIONS FOR 81GNATUR�
ACT10N REOUESTED:
Approval of an application for renewal of a State Class A Gambling License.
Hearing Date: � � ,(� Notification Date: 3 o'Z qC�
RECOA�iMENDATbN3:Approvs(l y a F�:t(ii) (�V �pppT ��q��
_PLANPHNQ COMMISSION _qVIL��COMM18810N ANALYST PMONE t�.
_pB OOMMITTEE _
—3TAFF � COMMENT8:
_DISTRICT COURT _
8UPPORT3 WHICN OOUNpI OBJECTIVE9
INRIATIN(i PROBLEM.ISSUE�OPPORTUNITY(Who�Whtl.WMn,�Nh�►s,Nllyr):
Kathy Crea on behalf of Rice Lawson Booster Club requests City Council
approval of their application for renewal of a State Class A Gambling
License. Gambling sessions are held Friday evenings between the hours
of 7:30 - 11:30 PM at 1079 Rice Street. Proceeds f.rom the bingo-pulltab
sales are used to support the youth activities and programs of Rice Lawson
Recreation Center. Al1 fees and applications have been submitted.
MVANTAOES IF APPROVED:
If Council approval is given, Rice Lawson Booster Club will continue to
sponsor a gambling session at 1079 Rice Street.
DISADVANTAOEB IF APP�D:
OISADVANTAOES IF NOT APPROVED:
���
��,� �our�c;� t���:���;cn (;enter
CiTY CLERK MAR 0 21990
;�, - ---- ._ _ .
TOTAL AMOUNT OF TRANBACTION = C08T/REYENUE BUDOETED(q�E ONE) YF.� NO
FUNDIN�i SOURCE ACTIVITY NUMCER
�N�wG�iNwRtiu►noN:�exPwM
Clf{(/
,
� >�
NOTE: OOMPLETE DIRECTION3 ARE INC:LUDED IN THE QREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASINCi OFFICE(PHONE NO.298-4225).
HOUTIN(i ORDER:
Bolow are prefened routin�for the five rtwst frsqwnt types of documeMs:
OONTRACT3 (assumes authorized OOUNCIL RESOLWTION (Amend,BdgtaJ
budget exists) Accept. Grants)
1. Outsicle/1genCy 1. Department Director
2. Inkiating Dspertmsnt 2. Bud�et Director
3. Gry Attomsy 3. City Attomey
4. Maya 4. Mayor/Assistant
5. Flnancc�d�Myrnt Svcs. Director 5. City Coundl
e. Finsr�e AocouMiny 8. Chief�ntaM,Ffn&Mgmt Svcs.
ADMINISTRATIVE ORDER (Budpst CAUNCIL RESOLUTION (all od�sra)
Rsvisbn) and ORDINAN(�
1. Activity Manager 1. Initiatinp DspartmsM Director
2. Dep�Rment Accountant 2. (�ty Attorney
3. D�rtmsM Dirsctor 3. MayoNA�istaM
4. Budpet Dir�ctor 4. City CbUhCil
5. Gty qsrlt
6. Chief Act:ourrtant, Fln�M�mt Svcs.
ADMINISTRATiVE ORDERS (aN othera)
1. Initie�irro�spertmsM
2. Gty Attorney
3. MayoMAseiatant
4. qly Clsrlc
TOTAL NUMBER OF SICiNATURE PA(3ES
Inc�cate the N M pegss on which sipnature�ars roquired and Qs�rcli
eech of these a�es.
ACTION REGIUE8TED
Deec�ibs wh�ths project/roquest sssics to accompli�in efther chronolopi-
cel ordsr or orclsr of impoRance�wF�chsvsr b most spproprfsts for the
Iseus. Do nat write�mplMe sentences. Bspin sach ftsm in your list with
a verb.
REOOMIiAENDATIONS
ComplsM if ths iswe in queetion has been preesMed bsfore any body,public
or private.
8UPPORTS WHICH COUNCIL OBJECTIVE?
Indkx►te which CouncH objsctNro(s)Y��P��'�9�a�PPo�bY IisUng
tM key word(a)(FIOUSINCi, RECREATION,NEIOH80RHOODS, ECONOMIC DEVELOPMENT,
BUDQET, SEWER SEPARATIO�1).(3EE OOMPLETE LIST IN �N3TRUCTIONAL MANUAL.)
COUNGL OOMMIITEElRE3EARCH REPORT-OPTIONAL AS REOUE8TED BY COUNCIL
INITIATIN(i PROBLEM,ISSUE,OPPORTUNITY
Expisin the situation or c�ndidons th�crseted a need for you�proJect
or requsst.
ADVANTACiES IF APPROVED
Indicste whsthsr this is simply an annwl budp�t procedure required by law/
charter or whMhsr there are spsciflc_ways in whk;h ths qty of Sairn Paul
and its citizens wfll bsnslltt from this proNcUa�tbrr.
�SADVANTAGES IF APPROVE�
What nspatiw etf�cts or major changea to s�ating or paat prxesses might
this prnject/requeet produ�if R is pesesd(e, �traffic dilaYs, noiae,
tax increaase or aessesments)?To Whom���or how long?
DISADVANTADES IF NOT APPROVED
What wfll bs ths nsqative conaequences if the promissd e�tion ia not
appra►ed�Inabflity to dellver aervic�?ConUnued hi�hh traffic, noise,
ac:cident rate? Loas of rsvenue?
FlNANqAL IMPACT
Although you m�t tailor the information you provide hsre to the issue you
ars a�rs�inp, in gsnKal you must anawer two questions: Hrnnr much is it
going to c�st?Who is�oinp to p.y't
, • , . . , , � c�o-�l�i
DIVISION OF LICENSE AND PERMIT A.DMINISTRATION DATE � I g l� l � l� ��
INTERDF.PARTMENTAL KEVIEW CHECKLIST App Processed/Received by
Lic Enf Aud
��-h� C v��
Applicant ���p ���fi� ���C�u b Home Address j 0�5 ���� �-(.Q�S �
Rusiness hame Home Phone
Business Address �G��j I�� �.'� Type oF License(s) I�iGSS � '
Business Phone ��(,� v,�b���S �.iL, � 1'LDi-Jti-�
�S
Public Hearing Date � � License I.D. �{ ��� � ��
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� � S o2$�U �
llate Nutice Sent; Dealer 4� � �A"
to Applicant 3r�� `�4
rederal F3_rearms 4�' ���'
Public He�.iring
DATE INSPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
���.}'
Health Divn. ��� '
�
i
, I
Fire Dept. � NI,L�. �
i
i �
� �� ( � I�j(�j�
Police Dept.
�I��I��1C� ��.
License Divn. f
�-I a-�J5�i d�-
City Attorney �
�Ia �k�i d �
Date R ceived:
Site Plan � d
To Council Research 3"��(�
Lease or Letter Date
f rom Landlord � �����
-�
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 /�' ��+�!`
Finance and Management Services/License & Permit Division
� INFORMATION REQUZRID WITH APPLICATION FOR PERMIT TO CONDUCT CHARITABLE GAMBLING GAME IN
SAINT PAUL (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
�i�'--2 O-�'�
2. Address where games will be held �� s�`' �� �'',Sl
� Number Street City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games Date of Birth �G - ,3^ ��
(a) Length of time manager has been member of applicant organization �a ���p ,
4. Address of Manager �O/�� r, G�,,��� � /� �J//�
Number Street City Zip
� � � � � ,� �/�.
5. Day, dates, and hours this application is for .�J /..�(�/�� �
/ .'30 , - � s,
6. Is the applicant or organization organized under the laws of the State of MN? �
7. Date of incorporation "�f - �l"'�/
8. Date when registered with the State of Minnesota ��- a l/ � �/
9. How Iong has organization been in existence? L���� . 1,�,�
-�
10. How long has organization been in esistence in St. Paul? .�('�t�
11. What is the purpose of the organization? p
I2. Officers of applicant organiza on: �`� C'�'��
� sName � Name
,
Address (> �T. Address f1�7 ) �_
Title �j�� . DOB :- -s Z Title ��:���. DOB J- - d
• ` I
Name Name
Address Address J�
Title DOB - � ���� Title DOB �G --�,�r-J��
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.)
. .. . � , . . . . �;,� �o ����
. 14. Attached hereto is a Iist of names and addresses of all members of the organization.
15. Ia whose custody will organization's records be kept?
Name Address�U/J � �,
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name Name
L.cyCGGP� � '
Address �� Address �Uq,S� j�G���� c3--r-.
Member of .- Member of
DOB �(� �Z - Organization? �� DOB .� �p�j�-�}�ZOrganization? �
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 ���� ������
b) Zf you do pay accounting fe , to whom will such fees be paid?
r
Name Address �
J�
DOB �j- - Member of Organization? J �'� � �a 3
c) How are the accounting fees charged out? (flat fee, hourly, etc.)
/=-�-�- ��� Q____
18. Have you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games? �J � S'
19. Attached hereto on the form furnished by the citq 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 tfie preceding calendar
qear which has been signed, prepared, and verified by
r-- j— /�� �
Address
who is the of the applicant organization.
Name
20. Operator of premises where games will be held:
Name � �
Business Address /G s�'�
Home Address
. . . . . . . ��d-�1�
21. Amount of rent paid by applicant organization for rent of the hall:
. �
� , �
22. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
C✓XQC ,
23. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul? Cf�(/>
24. Has your organization filed federal form 990—i? ���°(' If answer is yes, please attach
a copy with this application. If answer is no, ex�plain why:
Any changes desired by the applicant association may be made only with the consent of the
City Council.
�,�e��1�a� L''��
Organization Name
Date �' �� — � Q By: /
Manager i charge of game
d�� � �
Organization President or CEO
� 7 � _ � 2 � � � y 31 1 S �
�
r7 r7 f0 9 � T .� 9 a P► � '� = �1
A A 1 !'! 3i ' '7 ', � . ;t
S 9 � t t T � � � n 9
� n 3 '� � r• �e 3 . `e
7 9 — .. i+ ^ O
= � .� � i� T �0 � � C �
�
a C r+ r A r ^ �
n ' a S 1.• � i m S �s
� 3. � � •f „ � 3 � r' � _ � 3 =
. r+ Z n 3 �3
. .� � ti I .� O 71 �0
s � �3 � 3 r► •t � ai
ti � � �,, a a _ I_ �- 3 `� �
�' � � �� �� j r. � ra 3 � �
� ,� A � � � ' O m
„ r c �
:s a •e I ■! p �e s I� � � ......
o � � �I a$��C a � ,� ti ( m
z C�Vl I � � ;O I 1f
r A ,� � 7 , X Z;�..� T ,9 I �
A �0 ' ���Z Z '9 i � e�►
' I � .� r'f S
7 � � �
n A 9 � j � �„�� ' ; Ir � ti �9 ^
r �w � � � I
r7 ;9 4'��; � 3 ^ 7 � 31
,.� ��� � I �0 C r► � S S
� � � i T � a � � ��
�e' r+ A
a �a — � �
S
b.�..� � � � t J ]I
i �I � t � �, v �
� : I ib � � � ..
e � `
�
- ,. . . _ . . , r ��Q -c�/6
• Cit� oE Saint Paul Pes� t
�� Deparhent of Tinsnc� �nd Hanaseeant Ser+ie�s
Di�isioe ot I.icensa aod Parait Adainislsation
�I�'�IT/►SLLr GANELING fINANCIAL RE?OR2
� Otta ' ��
� e � f�' r,n��2� C'��
. (, 11ame oi Ocgsnfzation �1 C� � Q n
��l�r'� v�.a�r
2, Address vheri Charitabl� Ca�blins is eonducted �Q� 3� 19,�
3, Report foc plriod eoverins �1" '
19�„ ehroush
4. ?otal nu■bts oi da�s }lapad 5� - �5 3 9 1 y�7�
� � •riod s �
• s. Cro�• r�eeipt� for abo+i p �'')_A�.��
. ���
6. Cro�s prisi I�routa for aba+a 9�r1od (�ncludi ea�h short) � O
7. N!t r�e�i0t• - lini S ainus lini 6 : � �
d, Expanses ineutred in eonduetie� and op�ratins �a�es = ��/ �`rl, f�
A. Cross va`es paid. llttach vorker list vith -�
nae�s. �ddressee� `toss �_���. r�b�r �� hourb
wock�d, and 'mount paid p�r hout• # �f b�y,,7U
. d. Rlnt [ot J� vedki y�¢.tl.a.el�s 3 ay��
�w�l -ta.4� S�r°.�1e # 8 5 3.Sd
C. License iee �g�� t8
o. �,...� Eq�� p�^��` #
# /Do 0 0
L. Sond 3 30��
i. Dishoaoced checb not reeo��r�d � �Q,p,00
�
(i. Accovatin� Expen�e
p, Emplo��rs l.I.C.A. _^ �aqeS � /
; e[�(o SS.3 1�
I. 4ulltab Tuc Paid to Deparhtne oi R��lnu� '����
� .t. �:-u:e-�rer A d�.ev �i S t � s
. ! 5S,'7y
x. Ted�cal Exeise iax 6 Stasp a �,yo' `t'
. } � 7
L. Stati Ca�blins Tax
. N. Hiscellaneoue Eacp�nses. Identit� tbi �eoount
� and to vho� p�id.
i. 1-ea-�`�lQ���"'�..�� � aS9h.y$
: z. �l�n;sc. S�P�;es ! �97,5�7
s. �a�� ChcvryeS # f 4�.00
�• � ' a �r�r�
�u :
9. '�otal E�pe�s�s � ,y,i4q.G� � _
t0. ll�t IneaN - line 1 dnn� lio� 9 � �Q/�s. �
11. CL�cl�book balaace ►efionin� ot p�riod 1',O S 5• 1 D
_
12. lotal ot 1#ne 10 as+ 11 } � � U�r.1• p�
• 13. ?otal eontsibutioos (fsoi attaehed vorks6�et)
� �
. 16. Cluekbook balanee end oi t�porting peli� ' # 9��� •a'�
• . lin� 12 lus lina 13 �
� • ..�:..
. ..♦ � . J� . . .�.J..
• • � . . . UNIFORM CNARITABIE GAMBLING .FINANCIAL REPORT � �� �.���
' LAWFUI PURPOSE CONTRIBUTIONS - WORKSHEET
Lin� #13 - Total LaNful Purpose Contributions. S ���l��O�� ��
• List betow all checks written from gambling funds which are
� charitable laN�ul purPos� contributions. Th� total dollar
� amounts of thesp chpcks must m�tch th� �mount cl�imed in
line d�13. Usp additional shepts �s npcpssary.
CH�CK � DATE � PAYEE CNECK AMOU PURPOSE
1. oZ ll�f ��03�89 C��-y o� 5� I�a.,.�.� '1�7• b f C;� yo�.�in �ro5�a��,�.5
2. o�IaS �1i�189 �-�So� S-�.�o� '75•� C.oror.c�.-Eittr. C�ou�n.
3. . a�7 lo '�ao�$q Nea-�e.r Co���r '75,oo �o�'o✓�o�i wt r�o��..
4. aial �hoi�'i i��ee� Zt ec� Ce�.�er ISo-oo ��sc..lac.� �� Tee��..�ce.
5, a�a$ '/aol S�i ►��E 1-b(��.10..� �a.r�y 100 0o CI���Id�vea.:S x-w,a s ��-+��
6. a 131 'I��I�q P��r. �I P S I 37.sd 5� ��•+•-�ea.Q Ch i ldl.re.uS S�� ►�'1
7. .�13a. ��2��$1 R��r �IQS 19o.So ����-T��Ke�-��1c1�,ld��e�.
8. ���C!- 1/7VI4-1 �\� !J` J� �0..�L r I' •V �1 � ��V�1 `'1 r����KJ
�
9. a i4g aJ►y185 ��-ha,� A�pS I bs.o� �:i��� ►c,tCe�s - ��. eL�Jb�•-,.
lo. al'�q a�41�9 . (�-��� 11 p.S � `S.00 Ska lZe+�.Q- a�-cl�'�ldl.r�t..
11. a�5► a/��I�`i �5�-etictiQ�..Sp�r�►�6�As ']53,�0 ��9,� � s����lo����
�f �„��; �e�,.
12. a �b a— ala i I$9 ma,.+rr- �I��r�,�- yS.tx� K;,�;s k�.s l�e�Icx�!( Te�..r�a.v�Y
is. a Ib�} 3/031�t C�� a� S� t�a,..Q 69.85 C; � c.�o� ��09 vQ.�.�.
� TA?CHECK ANDUNT � I�S�. I�
T�
NOTE: These expenditures will be provided to Council Members at your Council hearing.
� Be sure that your finaacisl report i� complet� and �cc�rate.
� � � • •
.� '� � � � � � � i w 7�
� �
� � . � � � � � � h ` �y
� � � �1 A ` . � A ~ � � r
y
w� , � 3 � e ; � ; • � • a >
' � • • '� ,� s � +s
� � � = w � � v � � � � ��
•� � � w
s
� '- -`' = ' - � ''"3 : - f 3 ' � .. �
.
tC'� ��! � • � � � � i : S � � + : � �
`C;� S • � � ` � • 9 A � v�.rv ! _ !
a�n� ,`n ,� _ w ; � .r�..r . ; : ; � � � � 1
� �0�� � � i i r w 1 j � � v • f��
• � � ♦ s •
.- L�� � � � � ! t Q + _ .. �
��=- -�Z z .� ' 3 ^ ' = ' . . �
z�c �
� ;c�n — Z , � 3 � " :
. � � -
� w .
� v � � i h � � • �
� + w . t\` � $ •
! i
� i ' � '
7� � � C� � � s
� s
� � s �
1
• ' � � UMIFO,RM CNARI7A8LE GAMsvI.ING .FINANCIAL REPORT � �� .,(,�/�D
,' LANFUL PURPUSE CONTRIBUTIONS - WORKSHEET
Line #13 - Total LANfuI Purpose Contributions. S ��)0�7� g�
• List below all checfcs written from gambling fu�dS which are
� ch�ritable laNful purpose contributians. The total dollar
� amounts of thesp checks must match the amount claimed in
line A13. Us� �dditional sheets �s necess�ry.
CHECK � DATE ' PAYEE CNECK AMOU P�_
-
�. a�e� 310��9, ��r�. ����,C�.��r a�.�s �����. �i�r �,����p.
2. a�e.g �o718q 12ay Roz��I.eS �S��.S' �is��1�.�ITen�7.b�;�.-.
s. a►�n 31�-,I� ��e; ���e��or ���,e.s B�sk�+l�+� Te�,�, v��
4. a�71 3�a1� L�a.��o�. �ee.Q "1 I•�S Naa.�r t d�e. �r k.tdL'S
5. al'7� 3�a18� 5}eJC�e�SS�oY�„��oc�5 I�o�9 ) S�pl�es �z,� �e¢,; Ce�-�G''
6. a�'1y 31i�1ff1 ��.�'' So i Kc�. 73.ao Ea.s�� C��-�� � ���S
7. oZ ��� �d.?��g9 -f'0..� ���KE�, Ia��O �4:S�1.°.(r�t�r�r�iPs Rjr ���5
8. o'xl�l"� 3�����9 C.�,�U -�Dp�!S $O.b�- Foc�� �ceS�e�'t�n.����-�r K+�.
9. �t"��1 31a31� ka�� C.ve� yy,�� S'�f'P��es F�ar �Q.s�er t��x �
l0. aaob `�f���ts� t'?tCQ,`�t�e.��e.�,Ce��er qyb.�l ���;,p�„e,.#--�'� �e�, C�r�.�e.�
11. o��•1� 5�i��� Covv►O Ser�o�r'�aaf� 5a.00 �ov�c�'ivv+ N S• Se.�icv CIaSS P��'
iz. �a�q s)�►I�q sk. �e�r r�d2s Ch�,.�c.�.
SO.00 VC�L0.�IDv. F}.S. �^' iOYC,IC15S�at
�3. a�ay 5')►�I� !�'7�a�n o�T R�.-w� �o�ao tZ��.�,� -��e�, ..�.,o,, �.,I,��Id���.
. �j.rt�4�..P -
TOTAL CHECK ANbUNT � a A�. 0 g
NOTE: These expenditures will be provided to Council Members a� your Council hearing.
� Be surp that your financi�l report is complet� and Accurate. .
_ ' � : .1 � i � � � w •'��
� � � � �
_ � i ♦ ' 3 � : � . e 3 �;
� .. .� w
� I • ; a f � a � e >
. � � e '+ _ � � • • _ � _
.,_''; ,� � 3 • - .. - ,. _ ,s - ;;
'f (� �i � " A s i � Z � � �
� �
� W • s w � � r � `� �- • � � � � s
� � � � � .. ; 3 �
Z3 .. � 3 ; � . � ; • . ; � , ��
�>� • � z I + r : e � � � � �i
.,.,t>fi,,,e A , � � a A ..•r.� s ��= _
C3Q� �r A J j, �.r�r • A : � � � � � i
, '�;��� � � "'� '� + � 7 ; v t • 7� -�
•
r ,. ,��:C � . � ; ^ � ; w s + ' _
� • , • r + • �
:� • � � � 3 � � A
Z � � • � -�' � � ��
yN��r � : ; .� � _ -
' "< � �� 1 = �"' � '_, i
W , 1 � � �i �
• ,� � �+ .� s
a
-� � � �, � �<
,
. �11i Uh SI . NNUI
' • � � - ' UNIFORM CNRRITABLE GAM84ING .FINANCIAI, REPORT �j� I-
�' LANFUL PURPOSE CONTRIBUTIONS - WORKSHEET (�" ��"����°
Line �113 - Total LaNful P�rpose Contributions. � �'�bb���
• List below all checfcs Nritten fronl gambling funds which are
� charitable law�ul purpose contributions. The total dollar
amouhts of thes� checks must match the amount claimed in
line �13. Use add9tional sheet� as necess�ry.
CNECK � DATE � PAYEE CHECK AMOU PURPOSE
l.. a aZ�1 SIa�18� '�C�,����,��.1 So� a 9,9 I f Y1 e,� ��� k�s Floe r l�c.!'ry Ttn..
2. a��'7 5�31�S9 �i M l�a�a.rZ aoo .00 (�✓a,��' �Far' U.S R. 5�br fs
Te�s �ta p t�.y �� E�•.ra�e.�.
3. �ay$ �%o�$y I�. Cow�a.r. 3a000 Cos t� af k��.S S�ar-FS�qk�
4. a-�-b?-- ��03�� �Ar 1���a.� (�xS�e-vS �S.o a �oSe�ti�( '�S��ic�r-�E?e S
r; ��� �r Cti�Id��
5.
a a�o ��i 31�i N�" 500.� Co�+ �Q
6. a� �3c� `��iil� . t��(d) nlo�L�ain
'��oo� S'�-,Tv;p Cos� �,r C�.��I�
7. a a81 7/aiI$9 l�all �o.:��r �148,�o T��-�a�r�C�����v�p
� �
s. aa�l� 7/a�is9 ,rn�.���c��.! f��e1e.�;cS 3�0.00 � r-e�s � ���I�-.uts sPe�l�
Tea.,,u.�
9. a'-SS ��at3�69 k,��� �a�e�c�S�aJC�� �o.ao 'Fe.�s �z�r 1�e.e lvee So���•.l�
10. a}� 7�a��8q ►r��Kes �t � Shop ��q.Sa S;e;fi Fa� 14�i �3aSe ��l
11. �a q S �a►�6q I� �o.,.,��e. � 9 l�•9 O S�.P P 1�cS �r t�aro.cQ�,
12. a 3�3 &��118� rna.n,a's �l �z�, 1,a.� �+�t 'l3o„seic�11 Teu.w. t�o.r-�-t.
�
13. �31$ gl�-�Ik9 �,�,e. �0..�nt � 1o53r1 ��e,�ses o� G;�IS Sa��loe.�1
TOTA�L CHECK ANbUNt � a'79�.�� �ta.w•.
NOTE: These expenditures N111 be provided to Council Members at your Council hearing.
� Be sure that your financial report 1s completd and �ccUrate. .
� � az +� •
- � r r � a i � r � i i •' ��
� g ♦ + � �
� � ~ � _ � � - �^ , ♦ � ` ��
� �. � • ; O �7D
,1 � .�j 4 . . � � � ' O i
~••t i • '� r • � _
� � O • `� w � ! � t •a
� �* • .. � � w ' � s � � "�
5 � � '� M � ; � � ; ' - � 3 ' �
�� � . � � + � � �
' ' � � � � • / � I� �
� �� + Y 3 = , � S � , � + ' 1�
� � A � i � • � � ,� w.rv ����.�� J
��� c � � � � i ` �.�..r • ,� � � w � � 3 i
� �C : � °• •s• � i � • r � + '� .•
°'�3 � .. . . • - e � s `� .
• ' � , _ ^ ' `r s
• ! t
� - S � •. s � �
IJpKZ'�,' ' �\ � � ` � • � + � w ��
r
� f A 1�
� �" , � � �i � s
>e � .-, � 1 3 � " �' �' :.i � -
,
: � � � „ � �
ii � ` ` J � a
�� i <� I
1
l.l 1 1 Ut J I . ► HUl
' � - " UNIFORM CHARITA6LE GAMBLIN6 FINANCIAL REPOR? �
-' LAI�IFUL PURPOSE CONTRI6UTIONS - WORKSNEET �Q4'�`�
Line �i13 - Total Lar+ful Purpose Contributions. S � �! �b �'�,
• List below �il checfcs written from gambling fund5 Nhich are
� charitable liwful purpose contributians. The tot�l dotlar
� amounts of these checks must mstch the �mount cl�imed in
line +113. Use addltional sheets as necessary.
CHECK # OA7E ' PAYEE CHECK AMOUN PURPOSE
����1�8�1 IZtc.e �ee�"�t.�e�-i�� '�la.�to. rq�.�Qw,�.�- -�� Ce��-✓.
1. �3 Iq ce•�-te.r
2. a340 q���-��i Su e 'De.i��.Aa ��o 0o it���� k�d14 5pov���vp�
3. �3�5 4����$� I�a--�ly �a�Ne, e�"1) "]9 �riZ.ef '{'b✓ �id1s S(br[r���l°
4. a3�� 9��q1$9 kaa..l�vee.r�i' �59•31 v�tes �r �c4.t S�ov� �a�t�e�
5. �3�18 �/�alts� She.11.�rt"he� I�e�. �3,58 Y�1n�er�a.�S �� SOp,orfr �a�quc�
6. �35�1 9/�°I I�9 I,�°h.:,s lv, I;e, '1�oc� F�e.a -�ar C►«.�,�5 f� c�Ne.�� f c;�f
1 5(�o.�'S 1'"�- ct..••��,.e 4-
7. a 3��' �°IoaJtS9 5 pox �a.r. '7�y•8i s�a� 4c �Y�,tk. �o�le,.� �o`,r-
f3$•�3 C�,I�ve�.
8. �3�3 10�o��t�i SQar�a� �':,�c0���ie S � Valux�eers Au�-v� i
9. a 3�g ►�I,blsy ��.� cre�, so,�� +���aw�e�•� s�-Pp��cs
10.
a37�j o���189 i��+ Sa'� ka. 181.5"U olls far Wa�ta�.a��.'4�a.r+�
11. a 3�D ��J�q�6°1 ��c.e. S�'u,��� �e�.�er 563,g� 5'�,P�°
I;eS �✓ C���e�,C�.,� e,
a3gs ��1a3� l�uhale,SnJe Cl�.lo l4S77 1'�allc�e..�''�'� 5u����-s
12. .
0�3$-7 �o�t�l��l I?�ce, `'��ree� �u.C� � c� I�'l►Sc. s�PI��es a�' �.��y
�3. r�, c Q.,-.�e,�
l' .1.a.�� -
T�TAL CNECK AI�bUNT �1�L'Urb.
NOTE: These expenditures will be provided to Council Members �t your Council hearing.
� Be sure that your fin�nci�l repor•t is complete and �ccurate.
. .. � a s .
� -� .i � '� � ; � s � � �
_ � + _ ; � � . , _ � ; ��
� • � •~i � � . � + � i � � �+y
6' _�,� I � » s . f � a � e >
'; . � 3 : � ' � S • = � : . ,
~ r � : � �= w s � s � � " �
3 � �- � s � � A • � � • � i � n s
� � 3 3 ' � ; : � ; � 3 � � $
i � � � � � � � � � '' �
�� � . � . i I + . � � •
i� � � ^� • � � � •r••►v � !
r� 111y���+ r ( �' w � ` � .r�►�r � � � � � 1 • J� �.",t
"'�� �c � �� i � v w • • � � `� � • f� -�
p, aS � ,� • '� � � � s � •
� ��;^1 ,^ � � '� � Q � 3 .. a =
V1 i � � • • � • � s
/� w + j� �
`�,x-,'�i�,, (/� � �• s w 3 � s, � ��
� �r � � � �� � v s =
� � i
�m � , U` � ' 3 � � , � a � .
'CJ
� ; � i z
�
� '
�
, �lir uh �I . NHUL
� � � UNIFORM CN�kRITABIE 6AM84ING .FINAMCIAL REPORT �_��_��,y
.' LANFUL PURPOSE CONTRIBUTIONS - WORKSHEET
l�� 0��, 8`�
Line �i13 - Total Lawful Pu�rpose Contributions. 3
• List below a11 checfcs written from gand�ling funds which are
charftable lawfut purpose contributions. The total dollar
amouhts of these checks must n�atch the amount claimed in
line �f13. Use additional sheets as necessary.
CNECK � DA7E ' PAYEE CHECK AMOUN PURPOSE
-
1. 14�3 �s��`s�89 �a.'r So;�ICo.. �� C�r��-�s �C'aY Kt�l .�'.�Pov�5
�r�LL Q.'I''
2.
3. .
4.
5.
6.
7.
8.
9. � '
10. �
11.
12. .
13. �
��j To�.P -
TOTAL CHECK ANDUNT s a�
NOTE: These expenditure3 will be provided to Council Me�nbers at your Council hearing.
� Be sure th3t your financl�l repoPt is co�plete and accurate. .
r �'
.� . �
A � � � _
• � � i @ � ' � � � , � 7��
� • � � •
� , i � � � A ` A ; i � � � �
� ; '� e � • O 1 Q>
� � O � Z „�� , = 1 = •�
'�� ^, •j • � ~ = A � � � � � ��
� � w � A � � � � : � �
_ � � = a : = ; > .
�3 + � ' � d ` ' � • � 1�i
� �� A I � � � � �~� ��� !
u'� t"'� � � � � �.r�.r �+ A 7 � � � ,� � 1
„'��� � V� • + � • • + � � � • � �
O�'y Q�Cy 1� � �' � � i � ^ • s
� CS�-] , �i � � • � � �
•
� y � i • 3 �
�� ��z — � ! ' � � v � •'.
w � �
�� � + � i � � � �
� � ; � � i �
� 1
,