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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 ,