90-473 �+ � • ' v � �� � Council File � q� -y73
Green sheet � ��3 �
--�ESOLUTIDN ��-�
,�ITY 0��AI PAU�, MINNESOTA '
� � '
i' � �
,� � -
Presented By �� ,.- / � �"7
Referred To Committee: Date
RESOLVED: That application (ID ��51046) for renewal of a State Class A
Gambling License by Arlington Booster Club at 1079 Rice Street,
be and the same is hereby approved/�.
Yeas Nays Absent Requested by Department of:
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Adopted by Council: Date 3��*� `; �f ig�� Form Approved by City Attorney
Adoption Certified by Council Secretary 8 : ZD �`a
Y �
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By° Approved by Mayor for Submission to
Approved by Mayor: Date �'i�l� u � ���� Council
gy; � �^�-�%� ����Z� �--- By�
.
P116t.lSHfD AP� 71990
. . . � ��o -��3
OEPARTM[NTIOFFICE/COUNCIL DATE INITIATED 5 8 3 7
F�nan�eiL��ense - GREEN SHEET No.
OONTACT PERSON 6 PHONE INITUU OATE INITIAUpATE
�DEPARTMENT DIRECTOR �CtTY COUNqL
Christine Rozek-298-5056 ���� �cm nrroRNev [3�CITY CLERK
MUST BE ON COUNdL AOENDA BY(�1T� IIpUTINO �BUDOET DIRECTOR �FIN.d MOT.SERVICES DIR.
3-27-90 (�MAYOR(OR A881STANT) � r.ot�i i R
TQTAL�►OF SIQNATURE PAQES (CLIP ALL LOCATIONS FOR 81QNATUR�
ACTION REGUESTEC:
Approval of an application for renewal of a Class A Gambling License.
Hearin Date: 3-27-90 Notification Date: 3-5-90
R�fJOMMENDATI0N8:MP►�W o►�K(Rl COUNqI.COMMITTEE/RESEARCH REPORT OPTIONAL
_PLANNINO COWIMI3SION _CiVIL SERVIta COMMIBSION �� PFWNE N0.
_qB COMMITTEE _
_STAFF _ COA�iMEWTS:
_DIBTAIC'T COURT _
BUPPORTS WHICH COUNpL OBJECTIVE4
INI7IATINO PR08LEM,ISBUE�OPPORTUN17Y(WAo�WMt,When.Wh�ro.Wh�:
Mary Faser on behalf of Arlington Booster Club requests Council approval
of their application for renewal of a State Class A Gambling License at
1079 Rice Street. Gambling sessions are held Fridays between the hours
of 1:00 - 5:00 PM. Proceeds from the bingo-pulltab sales are used for
youth sports. Al1 applications and fees have been received.
ADVANTAOE8 IF�VED:
If Council approval is given, Arlington Booster Club will continue to
sponsor a gambling 9ession at 1079 Rice Street.
���F���Fn
DISADVANTA(iE31F APPROVED:
�O{��O
C���'t� CLEK� ,
018ADVANTAOES IF NOT APPi�VED:
�ouncii Ke�earcn C;enter
MAR 0 61990
TOTAL AMOUNT OF TRANSACTION = COST/REVENUE�OETBD(CIRq.E ONE) YHS NO
FUNDINti SOURCE ACTIVIT1f NUMOER
FlNANCIAL INFORMATION:(EXPWt� ��
r .
NOTE: COMPLETE DIRECTIONS ARE INCIUDED IN THE CiREEN SHEEf IN8TRUCTIONAL
MANUAL AVAILABIE IN THE PURCHASINt3 OFFICE(PHONE NO.298-4225).
ROUTING DRDER:
Bslow are proferred routinps for the�ve most frequsnt typ�of documents:
C�NTRACTS (assurtNS authorized COUNCIL RESOI.UTION (Amsnd, Bdpts./
budpst sxista) Accspt. Orants)
1. Outside Ayency 1. Depertmsnt Director
2. Initlatin�D�pertm�M 2. Budgst Director
3. City Attomey 3. Ciy Attansy
4. Mayor 4. MayoHAseistant
5. Flr�nce�Mgmt 3vcs. Dfrsctor 5. G'i�r Council
8. Finance AocouMinq 8. Chief AccounteM, Fln�Mgmt Svcs.
ADMINIS'fRATIVE ORDER (Budp�t COUNdL RESOLUTI�I (all others)
� Revielon) and ORDINANCE
1. Activily Marnpsr. 1. Inkisting DspartmeM Dirsctor
2. DepaRment AccountaM � 2. City Attomsy
3. D�paRmmsnt Diroctor 3. MayoNM�tant
4. Budpst Dinctor 4. qty COUhcil
5. Gty Clerk
8. Chief Accountant. Fln 6 Mpmt 3vcs.
ADMINISTRATIVE ORDER3 (all others)
1. Initiatinp D�p�rtmsM
2. CiiY AttornsY
3. Mayod�4sqstant
4. City Clerk
TOTAL NUMBER OF 3KiNATURE PAOES
Indicate ths A�of��whk;h signatuna are required and pe�ercliP
each ot these�es.
ACTION REOUE3TED
Ducribs what ths proj�cf/requs�t seeks to accomplish in sither chro�ologi-
cel ord�r or or�r of importarx��whiChsver fa�rrost a�opriate for ths
issus. Oo not v�rite c�omplete s�ntmx�s. Begin ach ftem in yau Iist with
a verb.
RECOMMENOATIONS
Comp�ts if the issns in quesdon has besn pretentsd bsfore any body, publ�
or privds.
SUPPqRT3 WHICkI COUNdL OBJECTIVE?
Ir�cati which C�pNid�'��(a)YW�P��lusst supports by listlnq
the key word(s)(HOU�INO, RECREATION, NEIOHBORHOOD3,EOONOAAIC DEVELOPMENT,
BUDtiET, SEWER SEPARATION).(SEE COMPLETE IIST IN IN3TRUCTIONAL MANUAL.)
COUNdL COMMITTEE/RESEARCH REPORT-OPTIONAI.A3 REGIUESTED BY COUNGL
INITiATINti PROBLEM. ISSUE,OPPORTUNITY
Explain the sitwdon or oonditiona that crsated e ne�d for your project
or reqt�est.
ADVANTAtiES IF APPROVED
Indicate whather this fs simply an annual budpM proceduro roqWred by law/
charter or whsther tMrs an spsciflc w in whfch ths Cit�r of Saint Paul
ar�d its citizsns wiU b�nstit irom this�o�t/action.
DISADVANTACiES IF/►PPROVED
VVh�t ns�tivs effects or ma�changes to sxisting or past proceases mfght
this Projsct�request produce If ft is paseed(o.p.�trafNc delays, noiee,
tax fncrsaees or a�umsnts)?To Whom?When4 For how bng7
D13ADVANTACiES IF NOT APPROVED
UVhat wfll be the nsgativs consoq�nc�ff the promi�d�ction ia not
approved?InabfNty to deliver ssrvice?Condnued high trafNc, noise,
axidsM rats? Loss of revenue?
FlNANqAL IMPACT
Although you muat taibr the information you provide hero to the iasue you
aro addressing, In qensral you must answer two queations: How much is it
�oi�y to c�st?Who is g�ng to pay'T
. . . . . . l,ryo-��3
UIVISION OF LICENSE AND P�RMIT ADMINISTRATION DATE � o�r1 9� l � 3 ��
INTERDF.PARTMENTAL KEVIEW CHECKLIST Appn rocessed/Rec ived by
Lic Enf Aud
� I - , I^ M a r� f=-a se ►- .
Applicant �-1'�1►� �r� � �DS`�' �-IU-�`J Home Address �' ��
.
Rusiness Name Home Phone � ���3C1� �'
Business Address �D '�c) ����� Type of License(s) �l(,�S ,�}'
Business Phone tn L►U �✓�w��-
Public Hearing Date ��1 (� License I.D. 46 ,-� � 0 ��Ci
at 9:00 a.m. in the Counci Cha bers,
3rd floor City Hall and Courthouse State Tax I.D. 41 1J '�
llate Notice Sent; Dealer �� � ��'
to Applicant �-,5��%
I'ederal Firearms �� 1v I�
Public Hearing
DATE INSPECTIUN
REVtEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
N�/�-
Health Divn.
N�,� �
�
Fire Dept. � ,, 1I� �
i �v
I �
' � � 1130����
Yolice Dept. ��b l ��
� �
License Divn. '
�3 f (�� ; 0/C_.
(
City Attorney �
��I�-�15� � o �.
Date Received:
Site Plan ac1 �� _
To Council Research � s �j(�'
Lease or Letter � Date
from Landlord �
CURRENT INFORMATION NEW INFOItMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
.- � . . �y�-�1�3
, City of Saint Paul
Finance and Managemeat Services/License � Permit Division
,�
INFORMATION REQUIRID WITH APPLICATION FOR PERMZT TO CONDUCT CHARITABLE GAMBLING GAME IN
SAINT PAUL (To be used with the followiag: 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 applqing for license
t�}�' � f I�(_�L�111 ���R�''��3"fZ
2. Address where games will be held (_e"J� Ri.CG� '�SQ-�k�.� ���j� ',�r
Number Street City Zip
3. Name of manager signing this application who will conduct, operate and manage
A
Gambling Games 1�l I�,-�1� �-t"y,�-;, Date of Birth Q- � �1.`?
L
(a) Length of time manager has been member of applicant organization
4. Address of Manager (y�' -`� ���,_ �'-�t>c.;'t C'�t-- �t=�-cy i� ��`�t L ~
Number � Street City Zip
5. Day, dates, and hours this application is for 'r�=;?f `-R�` � � '-`° �
6. Is the applicant or organization organized under the laws of the State of MN? � ��:
7. Date of incorporation Il�- ��`�;
8. Date when registered with the State of Minnesota 5-�-�--�'
9. How Iong has organization been ia existence? S� ���
,
10. How long has organization been in existence in St. Pau2? .�� � �
11. What is the purpose of the organization? ��k�.� �1,�r.rt�i�c ""-���2, �lr�.�'*rt
SPe(�TS
12. Officers of applicant organization:
�' " �
Name ��w� �1��A��ti hl� Name �;,`rF� �..,uri ►'U
Address �� �" �;, ��•?�l� c�; Wt Address Sp�1 �����e-��
Title ��;�, � DOB Y- �- 5"� Title S ct=s. DOB i(- ( 1.. -4��
Name r. �� U Name '� i��. ! .�,'..i �- i� `.�_�,_
Address �S3 .� r'NI�S Address b�� �����;ti cr;�-..�v
n,, J
Title V. 1��5 DOB [-y-j� Title I i�_Fp,e_,�'c DOB 7- ?.���
13. Give names of officers, or any other persons who paid for services to the
organization.
Name Name
Address Address
Tit2e Title
(Attach separate sheet for additional names.)
. . . ��a-��3.
� 14. Attached hereto is a Iist of names and addresses of all members of the organization.
15. In whose custody will organization's records be kept?
�• Name Q iT� Qu�� Address SO�-�I (�f�.� ! �;��. 1'�
�'.
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name �+1 PNK-\.i 1-��F'�S�I^_ Name .jo.�-�v "�_��t,t..�
Address t�Z� t,L�i�T' W`�.� r �c��� Address i.�(3r� �.,�i�.r� ?%�`".��-�-+.�
Member of ' Member of
DOB �-j -- i"� Organizatioa? � DOB g - tt-'l-��i�, Organization? U�"
T-
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) If you do pay accounting fees, to whom will such fees be paid?
Name �?t� tT4= t-��=��_, �C.�'. � Address ;°(�( ,��K `;�-�:�i=�T .� �(���%
DOB Member of Organization? N�J
c) How are the accouating fees charged out? (flat fee, hourlq, etc.)
��C ���•,-c,���i_,� �^•'�E-i-��r _ F i 1�-�. i-F?Y il,i_i_�i.i~C�-� �
, , '
18. Have you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games?
19. Attached hereto on the form fumished by the city of Saint Paul is a Financial Report
which it .emizes all receipts, expenses, aad disbursements of the applicant organiza-
tion, as well as all organizations who have received funds for the preceding calendar
year which has been sigaed, prepared, and verified by ( ,, �7`-P�'i2 c�,�.�
iy c�� (�u�2�.?
Address
who is the tM c vr��,s,� of the applicant organization.
Name
20. Operator of premises where games will be held:
Name i���i�l-� ��'�.��j t u-�-�? ('+�`-r= i,t�,�tv T' �T N(`
Business Address j C���� �c iC-� STtZ�CT
Home Address
. • ` ` ' . . ��ja- �73
21. Amount of rent paid by applicant organization for rent of the hall:
' . ,�l�o�' �:�
—- - - ��/ '� 5,.��S�ceOI t,r�
22. The proceeds of the games will be disbursed after deducting prize layout costs and
,� operating expeases for the following purposes and uses:
, �
1�e u A- /y. �cv
23. Has the premises where the games are to be held been certified for occupancy by the
Citq of Saint Paul? �� � "j
24. Has your organization filed federal form 990-T? 5 If answer is yes, please attach
a copy with this application. If answer is no, e lain why:
Any changes desired by the applicant association may be made only with the consent of the
City Council.
�421�w��k n% �cao s'1�'-r— Cl u �
Organization Name
r/
Date �� � - �1 � By� �14-Q: S£C�����
Ma ager in char game
��.r
-�' 1 ILi�}-�Z` � ; i
Organization Pres eat or 0
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� City of Saint Paul Page 1
Depaztmsnt of Finanee a� llanagemenc Ssrvices
� Division of Licsns� aad Penit Adainistratioa
. Ut�IIFORH CHARITASLS GAI�LING TINANCLU. REPORT
�x Date I - ?.`� �f-1
� } r
1. Nams of Orgaaizatioc �� IQ.L• 1 X�t�`1�1'�Ili f` 5����c� ����-t._J:�
• 2. Address vhere Charitabl� Ga�bling ia coadaceed �`7�]�� k'. �r � S�".���
3. Rspost for period covezing / - � I9✓� t6rough /'Z � �� 19�
4. 2ota1 awb�r of days pLysd '�(
! 5. Croaa ree�ipts for abovs p�riod i � �K������`f•_ �-�
6. Gro�s prisa payouts fos abws p�siod (inelud� eash siart) ; � ���� F `"'��� �w��
7. Net racaipts - Iin� 5 oiau� lin� 6 3 �� �-�---� y�-�_
8. Expans�s incurr�d ia conductiag and operatin; aa�:
A. Gross vages paid. Attach vorfur liat vith n `f �
naaes. addr�ssas, gro�s vagas, mmber of hoars i 'S � 1 � .`-�`'
worked, and amouat paid per hour.
• B. Rent for �� weeks ; �O ,� �4�- ,�%•�r- ,
C. License fee ; �=`��=• '-- `-'
D. Inaurance S � ' � ��=�--'
� E. Bond i � 3� . �C.�
P. Disbonored checks not recov�red ; �s� • �-'�-'
G. Accoantiag Expenae ; t.��(U�o. �U
. H. Emplop�rs F.I.C.A. i �•�3 � . C�U
. I. Pulltab Tax Paid to D�partMnt of xevem�e � �.��� .L�--�
� J. lYian. O.C. 'fa�c i
1C. Federal Excise Tax 3 Stamp ; �' p�
L. Stats Ca�bliag 2ax = ���e�'��
H. Miacallaneow Expanses. Id�ntit� tlu a�onnt
and to vhoa patd.
1. ��C- Z` i '�t_QC�
. . z. c�r-�r--�c� s�.�,p���S s �o.�
3. �re.r��:�5e, i Res � ���C>C�
4. ;
9. Total Espenses '!0?AL : Z�,� �`�.�-(J
L0. Net IneoN - lia� 7 aim� Iins 9 ; `C' f �4 C -y t� /_g(�.�
�- �� � � � �' .4�
11. Checkbook balance be;ianins oi p�riod i �� � � '
�. �
. 12. Total of lins 10 aad 11 = - - �� 77`'�
: 13. Total contzibutions (froa attached voriuheet) i F'��
- 16. Cheekbook balanes end of reporting period -
' • liaa 12 leas liaa 13 . ; �' �'��'' - '�
'``':;�.:. �� '�
�'Z� -�-u 1�-�S S I��«l!� �7•'� vl✓t dt''
� b � �, ���, yo�.y-h ��
�' L v.-, i w
, ' � CITY OF ST. PAUL PAGE 2
' � . � UNIFORM CHARITABIE GAMBLING FINANCIAI REPORT �- 9p_cj73
� LAWFUL PURPOSE CONTRIBUTIONS - WORKSHEET
t . . .. . . . .
Line #13 - Total Lawful Pur�se Corrtributions. 3
r� .
;` list below all checks written from qambling funds which are
charitable lawful purpose 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 AMOU PURPaSE
1.
2.
3. _ /
4 ��' �,
. ' ���
5. �'�
�i �
6. � �'
7.
8.
9. . .
10. �
I1.
12. . '
I3. �
TOTAL CHECK AMOUNT a
NOTE: These expenditures Nill be provided to Council Members at your Council hearinq.
� Be sure that your financial report is complete and accurate.
� � .
. � �
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s +-
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s w � ! �
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