90-554 � � ! G � � ,� L Council File ,� 9Q '3.5 T
Green Sheet #� 5853
RESOLUTION � - -
TY OF SAINT PAUL, MINNESOTA ���' � 1
;�
Presented By i�i���
Referred To Committee: ��Date
RESOLVED: That application (ID 1{23165) for renewal of a State Class B
Gambling License by Epilepsy Foundation of Minnesota, Inc. at
the Cromwell Bar & Restaurant, 2511 W. University Avenue, be
and the same is hereby approved/��ed.
ea Navs Absent Requested by Department of:
�osw �
on �
acca ee �
e ma T
un T—
z son � BY=
0
Form Approved by City Attorney
Adopted by Council: Date APR 5 1990
Adoption Certified by Council Secretary BY: . 3 �-��
�
By° Approved by Mayor for Submission to
Approved by Mayor: Date 1irR 9 ��� Council
gy; �'���ii.�?/�` BY'
�'�!�NfD fip� � `f ��Jo.
° `9°����-
DEPARTM[NT/OFFICE/COUNpL DATEINiTIATED GREEN SHEET No. 5853
Finance License INITIAUDATE INtTIAUDATE
CONTACT PERSON d PHONE ��p�p7�NT DIqECTOR �CITY COUNCiI
Christine Rozek-298-5056 ��� Q�'ATTORNEY Q pT1'�ERK
MUST BE ON COUNqL AOENOA BY(0/1TE� RONTMW �BUDOET DIRECTOR �FlN.8 AAQT.SERVICEB DIR.
4-2-90 ❑Mnroa�oR nss�sTnNn �2]-�ouncil R
TOTAL N OF SIONATURE PA�S (CLIP ALL LOCATIONS FOR SIQNATUR�
ACTION REOUEBTED:
Approval of an application for renewal of a Class B Gambling License.
�
Hearin Date: 4- -90 Notification Date: 3 �
r�COMMeNUaroNS:MP►�(N a�(� COWICIL COM REPORT OPTIONAI.
_PLANNINO COMMISSION _dVIL BERVICE OOMhM8810N ANALYST PHONE NO.
_CIB OOMMITTEE
_STAFF _ OOMMENT3:
_DfSTRICT COURT _
SUPPORTS WHICH COUNCIL OBJECTIVE?
INRIAl1NG PROBLEM�ISSl1E.OPPORTUI�k1Y(Who.Whst�Whsn.WMro.Why):
Marlin Possehl on behalf of Epilepsy Foundation of Minnesota, Inc.
requests City Counc'' anproval of their application for renewal of
a Class B Gambling �}- �'he Cromwell Bar & Restaurant, 2511 W. University
Avenue. Proceeds ,�les are used to provide programs and
services on behali Fee of $373.25 has been paid.
AOVANTAOES IF APPROVED: Z
�
��
if Council appx Minnesota, Inc.
will continue � � _.�, �taurant,
2511 W. Univer
�_.-
DISADVANTAQE8IF APPROVED:
_\\
\
DISADVANTAQES IF NOT APPROVED:
���� �►ouncu t�esearch Center
N��� MAR 211990
CITY CtERK
TOTAL AMOUNT OF TRANBACTION = COBT/REVENUE S!lDpETBD(qRq.E pNE) 11Eg (rp
FUNDINt#SOURCE ACTIVITY NtIMCER
Finuwa�u�r�wA�rON:�xPwM
��
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.
� ` City of Saint Paul � y0 5.� `�`
. w
. . Department of Finance and Management Services
Division of License and Permit Registration
INFORMATION REQUIRED WITH APPLICATION FOR PERMIT TO SELL PULLTABS � TIPBOARDS IN SAINT PAUL
(Class B Gambling License .in Liquor Establishments - Renew) �
1. Full and complete name of organization which is applying for license
� P(�...�.('S�'J Foun��T�o�. o�' r�,�vn«s6rf�
2. Address where games will be held ZS/ � �N�vtRS►Ty �� 57 7�*dL �j��c�
Number Street City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games M��-�-�N L. ►�OSS�.I-�t� Date of Birth `�- � � - ��
, (a) Length of time manager has been member of applicant organization `� "�' �
4. Address of Manager �t1�. ��• �tn�.s. `�� `�
Number Street City Zip
5. Is the applicant or organization organized under the laws of the State of MN? � S
6. Date of incorporation r'J / �' I�� •
7. How long has organization been in existence? �� Ha...rS
8. How long has organization been in existence in St. Paul? �� �,,..�5
9. What is the purpose of the organization? �c a 55i w �s� �n
.
�� 4 � � _ � G� S�
10. Officers of applicant organization:
Name L.tt �n(/V �,l�p Y/�( Name �u p�-f JO�r(50�
Address �Ok � �L�12�9r��I`V�( 51.312 Address C.(�. 4>. J�3'��d';'k 3/."Z���S.�k'���
Title ��e.S��O DOB Title � ��y�,,,re,r DOB C, G
Name �J�ArLL �ol"IST�'1 Name /�'�/g'RH �}G.l��. �Z I.L
Address G.�O �Q1TtHr�`'� �Q._��lNl���`�( ��Address 1�2D 5GC/`�MlJ �L,.,
Title 5r.�d DOB Title (�. ��Stn��� DOB
11. Give names of officers, or any other persons who paid for services to the
organization.
Name /"(/�.L�/v I'OSS�.� Name
Address "?7� {2/4yr(GrC� 1�?E,. Address
_ Title `�X��-c'ff�V'� �QLCTOr� ' Title
(Attach separate sheet for additional names.) .
. . � � q�-�s`�
.. , . .
• 12. Attached hereto is a list of names and addresses of all members of the organization.
13. In whose custody will organization's pulltab records be kept?
. Name /`�f}�,L�,I� �d55£.�f'L, Address ��`Z PXT{rl6�,Q ��__
14. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name /"��'}�,C_.0/�( i'O S5�Z.._ Name �C,l�`'� �01�`��7'�'�
Address �77 f�A`f/��Cl� ��. Address 4!(, C�J• �5�'�3',a �'3lzf �C.S,
. Member of Member of
DOB Organization? `'��S DOB G ��.' � ( Organization? �'C�g
Name , ZM/��F'�.�. C�Z..F/�[S Name C.c)/`� - Z. . C..���c',�
Address S3�,G (s��.C'�• ��,,.� �-�yw,c. �IG Address �}3Q� �c.t./�[L�'tt,t C.I�( _�L�_�1pc�
Member of Member of
DOB j- G� 5� Organization? �� DOB � � Organization? �S
15. Have you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games? �� S
16. 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 calendar
year which has been sigaed, prepared, and verified by ��,C.(f� Y'�SS��'C�
���i �s�rna�� ��.
A dress
who is the � �(�Cu,t'11�'� �2{Z�,�T� of the applicaat organizatioa.
Name
17. Will your organization's pulltab operation be operated/managed solely by members of
your organization? yes no �
18. Has your organization signed, or does it intead 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 �
If answer is qes, give the name and address of the person and/or company contracted.
Name Address
Name Address
If answer is yes, how will such a consultant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a copy of said contract to this application.
19. Operator of premises where games will be held:
Name �c.�,S 5�LC,.. �, ��,(/�C.� _
Business Address �5�� C����fS� � J'r�� " �• �`S'l�
Home Address ���S � l�� ��QL ���- : �"� �� ��� I
������� �,- yo -���
. . �
..- .. - . . , . . . _ �. � . . .
� . �Z, a), Does you= orgaaization pay or iauad�to'.pay accountin.g�fees out�of �gambling funds' �.. � .
- yes x no
b) If you do pay accouating fees. to whom vill such fees be paid? •
� � Name CN-�1� �� .�Q Address . 43O C.,�-✓��c-S-. , ��s 5��{' :
. Dos !)�( 2.�G� . . . M�e�ber of Orgaaization?� �S . . �� : � .�
c) Hoa are the accounciag fees cliarged out? lst fee, hourly, etc.)
������t�
d) What do you anticipate vill be qour. average monthly deduction for accounciag fees?
� "7� • -
23. Amount of rent paid by applicaat orgaaization for reat of the hall: �
� � �� .
�� �24.�. The proceeds of the games. will be �disbursed�after.deductiag prize layout. costs and :
� operating expeases for the fo.11owing purposes �and�uses:. `
: . : .�. . � -� �� a"„ � - : � : . .
. . �. � : . :
25. Has tha premises �here t&e games aie to be held baen certified:for occnpancq� by the . �
. � .City of� Saint Paul� . �� . . • . . . � . _. .
26. Hasyouur organization filed federal form 990—T? l� D If answ�r is yea, please attach
' � a copq with this application. If ansver is no, explain why: .
. _ a 9 b _-T�i�: -� � T w� � fi�tD ��
199n 19$�
Any changes desired by the applicant aaaociation may be made only vith eha consent of the
Citq Couacil.
� t�(�,�.pSH `�un�/orl af/YN
•• � Or zacion Rame
�
� Date � — �� "` I �1 By'
linnager in charge of ga�ae
c�, lo � ��n.�---
� Organizatton Preaideat or CEO
• City of Saiat Paul Pag� 1
Departaaat oi Tinanee aad Mana�emenc Servieea A
� Divialon oE Lieans� and Perait Adninistration C y0 -,�j �J' �
UNIFOR?! C1�AAITABLE CAM3LI1tC FINANCIAL REPOR2
Dace � ' 31-9d
t. ct.o. ot or`ans:ac�oa ��IC..L!'S"1 �K^��!'�IOJ�I
2. Addr�s• vh�r� Charitabl• Ca�blin� 1� eoe�eted �5i( U'"�+�•�'�'1R�►�c� �1`�..�C �l�
3. Rspore tor pesiod cov�rin= 5�� 19�° Chsou�h I.�L/3( 19�
4. Total numbes of day play�d � /5
S. Cro�� rseeipts for abov� p�riod = 5�� �Z
6. Ctoss pris� payouts fos abovs p�siod (laeluda eaah short) � `E�� I q�
7. Nst t�esipts - lia� 5 ainus lin� 6 3 - � ����
9. Exp�nse• ineurTed ia conduetia� and op�ratinf =s�:
A. Gross vs`�s paid. Actaeh votk�r list vith
nam�a. addressas, `so�a va=as. a��s of hour� i $���
vorked. aad amount paid p�t doas.
B. Renc for �� veeka ; i�
C. Licena� tee. s � �
_�,
D. Insuranee f
E. Bond f ' �O�
T. Diahoaorad eh�eks not rseo��red =
C. Ateountin= Eapen�s : � '""
N. Employ�rs t.I.C.A. _ �7�
I. Pulleab Ta�c Paid to Dspaswae ot Rr►enus i ���3�c
J. Kinn. U.C. 'fu t 5't'�G ���� 1 � �3�
R. l�d�ral E�ceisa ia�c i Stup � : �2 $�
L. Sest• G�blin� 2a�t , s ,�8 75`'E'�
K. Mi�csllaa�ou� Fa�paetu. Id�ntit� tha �ount
aad eo rhoa paid.
�.�...�..�-� - i � : i 3G3?
z. � 1...�.�- 5�� : S�S
3. �(�/���.... 5*�.� s �-_ _�
AAr-.-..�-i�alL.r �`
�. 5'I.�+ s ��v
F .,.,.�.x,�c�..../�; � u. s S� I -1`�
9. ?oear'lsp�dils �O55Lfdc.-� �
10. N�c IneaM - lin� 7 �im• 11� ! i �� ��
11. Cheekbook balaoe• be=laninf oi p�tiod = d
12. totsl of lint 10 and 11 : ��-� �-,
' ' l3. 2ottl eontzibutioni (fso� sttaehad votbM�t) : ���� ��
14. Ch�ekbook balanes and of r�portia` pesiod - ��7�
lins 12 lesi lina 17 : �
'� �C,e.<��n�.. �l� �7�
v�� � V� J� . rnV�
UNIFORM CHARITABLE GAMBLING �I�`IANCiAI RE?ORT �- ��_���
� � LAWFUL PURPOSc CONTRIBUTIONS • WORKSiiE:T
Line #13 - Tatal Lawfui Purpose Contributions. S
List below al�l checks written from gambling funds which are
charltable lawful purpose contributians. The total dollar
amounts of these checks must match the amount claimed in
line �iI3. Use additional sheets as necessary.
� CHECK # DATE PAYEE CHECK AMOUN PURPOSE
-
�. �o5d 16�3 t�q !�+-�x�wwo �r�Cu•� ��s�sor—°. ca�r'. c�,.� - S�P....Q
2. 104 � <</iS/� fPc��sry �k��'�II i��g�a�, '" Aw.....�c C..�+--�
�dd K.x-s�.;¢..�.+��a, rt,;I��t
� � �c,..�. t�4,�..+� � ���
' �t.�p�.r--.
3. i crt� 1��2�(� 5� �r�y P� 1�?3Y° to� C 4.� - S�- ��P
�• 1 C780 l.?�S(�$� ZPl�.f!'S�( SW'/�at.r�,06R J CtGO
�. Ass��F �oC��,}nt l.:�l."�1
-`� 10�0 ��(3� l� �cw��y �o�,r��ax.� �l c�oo f� � ��►� .
s. ' ��'`d�- •��
,:s��+..�,�,
9. t o�s1 �a.�51/4'1 `1c�nd �F�� ��3�!� �b 2� c c�.� _
10.
11.
12. �
13. �
TOTAL CHECK ANDUNT S y3,'1�'1 �'
NOTE: These expendfit�r°es will be provided to Councfl Members at your Council hearing.
Be sure zhat yauf° financiai report is ccmple�� �ru �cc�r��r.
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UIVISION OF I.ICENSE AND PERMIT ADMINISTRATION DATE `� � 9u / � ��� U
INTERDF.PARTMFhTAL REVIEW CHECKLIST Appn rocessed/Rece ved y
Lic Enf
,_- J � � y
Applicant � � C�t,�vl�`f'��+'� Home Address Q " Yrj�n
Rusiness Name � ��7 /� (,�Q,.�I Home Phone cI! '`'f' �P – � � �
Business Address o�-5 �( (�h�,} A-�r� Type of License(s) �IaSS �j -
Business Phone ��'l.l,W m � ��n L� C�fi►'�S'Q�
Public Hearing Date � �j License I.D. �i ���(p �
at 9:00 a.m. in the Counci C ambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� � S a a �6 �
llate Notice Sent; � Dealer �� ���'
to Applicant � '�l j�
T— rederal F3_rearms �� � �
Public He�.�ring
DATE INSPECTIUN
REVIEW VERFIED (CQMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
N �-
Health Divn.
i N�� '
�
Fire Dept. � �� /� �
i t-i'
I I
! �r�,�/�I� S,e�
Yolice Dept. '
3 � /�
License Divn. �
3 �y �� ; Ej,e,
City Attorney �
� �1 !��
Date Received:
Site Plan lU��} � �U �
To Council P.esearch
Lease or Letter q Date
f rom Landlord a� I v
CURRENT INFORMATION NEW INFOI2MATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders: