90-691 0 R�I G I N i� � , Council File # _ o—�p��
Green Sheet ,� 5865
RESOLUTION �-
CITY OF S T PAUL, MINNESOTA � �� ;
�_, .::
Presented By
Referred To Committee: Date
RESOLVED: That application (ID ��55004) for renewal of a Class B Gambling
License by Attucks Brooks American Legion Post 4�606, 976 Concordia,
be and the same is hereby approved/�ec�-.
as Navs Absent Requested by Department of:
inr n
o w z �
on �—
� cc ee '�—
e man "�
u e —�
i son � By:
�—
Adopted by Council: Date APR 2 4 1990 Form Approved by City Attorney
Adoption Ce tified by Council Secretary gy: ` �-!�`9Q
By� Approved by Mayor for Submission to
Approved by Mayor: Date
APR 2 5 1990 counci�
By: ��� By s
PU�IISHED MAY - 5 1990
� � � - T ��a —�'�
DEPARTM[NT/OFFICEICOUNCIL DATE INITIATED �
Finance/License GREEN SHEET NO. ����a�
CONTACT PERSON 8 PNONE �DEPARTMENT DIRECTOR GTY OOUNCIL
Christine Rozek-298-5056 ��� UI cm nTror�ev g CITY CLERK
MUST BE ON COUNCIL AOENDA BY(D11T� AOUTING �BUDOET DIRECTOR �FIN.8 MOT.BERVICEB QIR.
4-24-9� �MAYOR(OR ASSISTAN'p � Council R
TOTAL�►OF 81ONATURE PAGiE8 (CLIP ALL LOCATION8 FWi SIGNATUi� .
ACT10N REGUESTED:
Approval of an application for renewal of a State Class B Gambling License.
Hearing Date: 4-24-90 Notification Date:
RECOMMENDA :ApprtHS(A)a R�x(R) (�, �pQpT Qp�'�,
_PIANNINO COMMNBSION _(�VIL SERVIC�COMMI8810N ANALYST PNONE I�q.
_G8 COMMITTEE —
_STAFF _ COMMENTS:
_DISTAICT OOURT _
SUPPORT8 WHICM CWNGL OBJECTIVE9
INITIATII�(i PHOBLEM.ISBUE.OPPORTUNMTY(WAo�M�ha�Whsn��Nhsro�M�hy).
Harry D. S. Thomas, Sr. on behalf of Attucks Brooks American Legion Post �606
requests Council approval of the renewal of a State Class B Gambling License at
, 976 Concordia. Proceeds from the pulltab sales are used for various charitable
purposes. Al1 fees and applications have been submitted. License fee of
$373.25 has been submitted. .
ADVANTAOES IF APPROVED:
If Council approval is given, Attucks Brooks American Legion Post ��'606
at 976 Concordia will continue pulltab sales at =its club.
OISADYANT/UiEB�F APPROVED:
DIBADVANTAOES IF NOT APPROVED:
RECEIVED
�GUncu Kesearch (:enter.
ARR�.2�� APR 3. ��990
CITY CLERK -
TOTAL AMOUNT OF TRANSACTION = t�BT/REYENUE WD�TED(CNICLE ON� YES NO
F1N�Dpi�i SOURCE ACTIVITY NUMlER
flNANCIAL INPORMATION:(EXPLAIN)
� d�
. , , - ��a --��'�
DIVISION OF LICENSE AND PERMIT A.DMINISTRATION DATE J J �U / 3 � ��
INTERDF.PARTMEfiTAL REVIEW CHECKLIST Appn roc ssed/Received by
Lic Enf Aud
�tCc v v� �, S.`"I�t o mli S S r^
Applicant �kS �r�;��5�-vr� L2��c�� Home Address
, �° ��- � y� - �ao5
Rusiness Ivame Home Phone
Business Address �1�.e �nC�✓C�t�v Type of License(s) C(k55 � �
Business Phone LTGt rn �)i n C.� c�-rSe �✓�uJ� �
Public Hearing Date "`�" oZ � �� License I.D. �{ � `J b0 �
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� lU'�'
llate l�otice Sent; Dealer 4� �I/4'
to Applicant ���
rederal Firearms �6
Pub.lic He�.�ring
DATE IrSPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
� l� �
Health Divn.
-- '
��a '
,
Fire Dept. � �
; �'�4 I
Police Dept. I �� � � � ��I
� .
�I cl(�'
License Divn. �
I
I,
City Attorney �
�(l� �� ' o��.
Date Received:
Site Plan ���
To Council P.esearch �� �� ��
Lease or Letter Date
from Landlord ���r
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Boud:
- �v'orkers Compensation:
New Officers:
Stockholders:
N
� �. City of Saint Paul Ci�— l��g�
' ' Department of Finance aad Management Services
Division of Licease and Permit Registration
INFORMATION REQIIIRID 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
����if.G��7?��v�fbA �I/YNIJ3GCa.,�. �.u,.u.,,✓ �rG� � �o�
2. Address where games will be held �710 � AT.�.�,wQ S�/d'�
Number Street City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games �� J.S. THO/y1�5 SR Date of Birth �f��j��g
,
(a) Length of time manager has been member of applicant organization �(� ��qg
4. Address of Manager ��y/ ���„� �. �„w�,Q S-��//7'
Number Street City Zip
5. Is the applicant or organization organized under the laws of the State of MN? y,e S
T—
6. Date of incorporation /q��
7. How long has organization been in existence? / 9� y
8. How long has organization been in existence in St. Paul? �c��L�
9. What is the purpose of the organization? '►/,���� � _�,�,�J
10. Officers of applicant organization:
Name �.e.o-n h)e�-�.d( Name � rme�,Q,eQ �Qu�,G,dL�,�
Address f��l rL�1U4,G►m,,,,� ,5,��.u,,�, iri,,1 ,SS�o l Address $'7/ ,�• .y�,�, �.l�A�,l Ss�e4[
Title � „� DOB !, Title � � DOB /,9 �
�—
Name ��,,�� ,wi�,,,,, Name
�
Address �cj/ ,MT �/;g,�'/a,�/ Address
Title ` DOB �. Title DOB
11. Give names of officers, or any other persons who paid for services to the
orgaaization. /}lp N e
Name Name
Address Address
Title Title
(Attach separate sheet for additional names.)
. : . . ��o_�y�
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� law ..,,lo.�y,��� ;.,,, �l��e6 Address 97G � �•��. /yj�/
14. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name Name
Address /G ' i Address
Member of Member of
DOB Organization? �c„�,S_ DOB Organization?
T--
Name �..�� ��Q� Name
Address / �Z,c,lS"��,,,,,.e„� ,a,�(t��_A►,d�s'io/ Address
—T Member of Member of
DOB Organization? � DOB Organization?
15. Have you read and do you thoroughly understand the provisions of all laws, ordinances,
and regulations governing the operation of Charitable Gambling games? �
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 signed, prepared, and verified bq _ - �
���f� V� � . �• �.�,�,�, m� s�s��i�
Address
who is the � �,r.e,u.e_.._ of the applicant organization.
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 intend to sign, a consultiag 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.GC,u'� /°�..s�� �n.c,��..����i�f�� ��PO�
Business Address Cj 7� �ry��n,�� o�/ �u,Q, }YJi✓ v��/P�f__
�
Home Address
: �. . . . . (l�r ya_�9�
20. a) Does your organization pay or intend to paq accounting fees out of gambling funds?
yes �/ no
b) If you do pay accounting fees, to whom will such fees be paid?
Name p���dyr,,o�,d 7"� �.t�.�nc.t_ Address /�a y/ l�uu�r.n,r.�, ,�. ,�'i.licu,p/1'jN SS//�
DOB Member of Organization? y�s
�
c) How are the accounting fees charged out? (flat fee, hourly, etc.)
�o�l/�
d) What do you anticipate will be your average monthly deduction for accounting fees?
'�/so-a o0
21. Amount of rent paid by applicant organization for rent of the pulltab sales area: _
il/O N e
22. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
. .
23. Has your organization filed federal form 990-T? G��S If answer is yes, please attach
a copy with this applicatioa. If answer is no, �xplain why:
Any changes desired by the applicant association maq be made only with the consent of the
City Council.
a � � #��
• rganization Name
Date �.?,(e I�� By:
ager i charge of game
k�/ . �o[�
. Organization President or CEO
� City ot Saiat Paul Page l
Departasnt of Tinanee and lSana;sment Servicea (
� ' Diviaion of Lieense and Pet'!.t Adsiaistsation � GO-��
�
UNIP'aRli CHARITADLE CAMDLINC FINANCIAL REPORT
Dat•
L. Naea of Ortanisation ��� �'!�►��_.d w.�.^ •�,.�'►, �i"4/� '��006
2. Addr�s• vhere Charitabl� Caablint is coeduetad 9 rd �er,n.��e.�ii �t��u,cli,�N
3. Rspore tor period covarin� i�� 19�_ Chroufh /�d/ 19�
4. Total number of days play�d /B�
S. Cro�a reeeip�s for abov� p�riod = /d�� y/Q'
6. Gross prizs pa�outs for abov p�riod (iaelud� eash short) � g�i S'�7
7. Nat t�esipes - lia� S sinu� lin� 6 f - it0�„f h�/
8. Expsnses incusred in eonductin� and op�rstint �a�:
A. Ccos� va�ss paid. Attseh vorkst liit vith
nam�s, address�s. �to�s va��s. numb�r of hwrs S NeN�
vorksd. and asouat paid p�r hovs.
B. Reat for vesks S r✓eN�
C. License fee ; �s�•�y�
D. Insuranee f ,uduc
E. Bond f /it 5.00
!. Dishonoted eh�cks not recovered i No N�
C. Aeeounein� Expsas� i ,,(t77S.oD
H. Employsr� T.I.C.A. t NoNL
I. Pullcab Ta�c Paid to D�parwnc of ll��snu� � ���'9•/G
J. Minn. U.C. tax = ��'��
R, iedaral Lxeiss !a: i Statp ; 7G�' �Z
L. Stat• Ga�blin� '!u s
M. Mi�csllawou� Exp�aas�• Id�ntit� tM a�aint
aad to rbn psid.
1.Uf�l��-r'es t �oOQ•00
z.�� J�is ,
c sid �gw p a o•oo
3.T��/�� G n� _ �/ /G
�. Ca,�,�.,«l I�aGw = �7a.o0
9. 'loeal Ta�Psnw ToT�►L f /0;S�e4.�5'
10. t1�t IoeoN - lia� 7 d�• lin� 9 3 �,5'7'�.75�
' 11. Ch�ckbook balanee b��imin� of p�riod i 3+ �5 G•O D
12. Total of lise 10 and ti i ��/.�73�
" � 13. Total eontsibutions (fsoi actuh�d vocbh�st) ; �(e7�• S'G
16. Ch�ckbook balane• end ot rsportiat p�riod - � �,�J 9a •a•�
liae I2 le�s lin� 13
— ('lV(JL—
., vr� � v� .�� . rnV�.
� ' , • � UNIFORM CHARITASIE GAMBLING FINANCIAL REPORT
LAWFUL PURPaSE CONTRI BUTIONS - WORKSHEFT ��Q-jp�f/
Line #13 - Total Lawful Pu
� rpose Contri buti ons. 3 �/ 7�', 5�
List below ail checks written from gambling funds which are
charitable lawful purpose contributions. The total doilar
� art�unts of these checfcs must match the amount claimed in
line #13. Use additional sheets as necessary.
CHECK � OATE � PAYEE CHECK AMOUN PURPOSE .
1. /lp o�- �/s/g 9 Oh� P.�t,e s� �r``3.�5/t9' 7,�,,�.��r��,���,l�.c.lqo�-
o2I9I89 H�°��'�'0�`°""��Ri� (PO0•�0 /3l��e� 7�� �jp i�'
2. ��v�� � � ��
�la�r/8 9 ��,�e � m�u� /a��d D �.�
3. /G a� ��.�.�.�
/�a a .�j���8y iwti►, �j C��M:�^�'►e��".� iaa.da ��y"��,.�
4. �
? oo rt' 9��
3/a���i {�n�?�u.e�- C.��-'�- `ve�� �DO�
d I
5. 1Ga� , / �
�-��"�`�"'"� �P�'•do ��� f�a"r' ��� .
���3�85 �cu�i�?
6. /�a 9 70.00 � S�w�
.�l30%9 r�c fY .
7. �( 3� tiw G��"'`r� �u-e.'
�Q�p ���.►,� `�'�U° '��1
s. /G 3 7 y/�6/� . .
�����,� �� � ,�,�r ���- aoo.o� -13� � /�-�°
g, �/39 � .
6 �l���i �e� -�.c'+�'� '��� �8 0•�a �a� ✓�Jt�o-�a�m�
10. /6'� . ����a�.-vru� ��''',�'�y`'
3/���9 �'�'�a � �0•o0
11. ���f? , � ��,l'_..__
,�,�. C,w,eT',,,., /Sp.o 0
12. /��g 5��'�B�S �r. �"�"" ��� ���
13. rl��9 s/��.1 s5 ..��.a� ���� 70•oo
70TAL CHECK AMqUNT S aS6�•�f0
NOTE: These expend�tures will be provided to Council Members at your Council hearing.
-� Be sure that your financial report is complete and accurate.
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" - . UNIFORM CHARITABIE GAMBLING FINANCIAL REPORT
LA1dFUL PURPOSE CONTRI6UTIONS - WORKSHEET �"y0-�y�
� ,
Li ne #13 - Total Lawful Purpose Contri buti ons. 3 �_G 7�• S"6
List below all checks written from gambling funds which are
charitable lawful purpose contributions. The total dollar
arr�unts of these checks must match the amount claimed in
line #13. Use additional sheets as necessary.
CNECK � DATE ' PAYEE CNECK AMOUN PURPOSE
1. /4s'/ S1�.�89 (�rra^�- ,�`",Br�° A� .to.00 ���
�.�1ir1�i4y�� i_ � �4� 71 p,oo • �L�G.
� �y/�-y��y ���,n ��p.� ��� G'�°
2. 6��
� �oa' /oo•o0
3. [b�-y 4 isl 89 �''�'�'.�`°�, . . D��
�p�9/ �� �l""'"'��� '��� /liOD•o0 1 """"
4. /�(v a �o.oa
.G /q��9 �"�` �'`'�"J � ���.���
5. /�G 3 ����
�loo.00
6. i��� .�/�,ls�y �� m�`«a` �`�`'u`t .
7. � �9 �/,ql�y ��.►-d,►�� �-w"�„,�- ��o,00 ���� .
� �,r,,� ,3o m•c o .��`�°,r„..,.`.�
s. ��7 � �/,g l�5 � Na^-�- ��'`c�'
p oo ���wc�vw�
9. /G��F �/3i�sg ��.�. �,�' � � � �, �i�
7�'����� �l�ws`Ifid/�,''�� �`w`.�'u�� .lv m•0 0
10. lG 76 �.oo .���'��`a°
11. /G y y �5�9��y G���"",'�`° . �
���,,,� /� �o•c�o /i.� -��'''"�".�-'^� .
12. /� 8r �/�¢/89 h
C�u� �.O /o•a o c�A��' �•�-
13. I G 8�. �lis'lS 9 •����'��� �
TOTAL CHECK AI�UNT � 3yG 6•0 0
-T
NOTE: These expenditures will be provided to Council Members at your Council hearing.
Be sure that your financial report is canplete and accurate.
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� . . . UNIFORM CHARITABLE GAMBLING FINANCIAI REPORT
LAWfUL PURPOSE CONTRI6UTIONS - WORKSHEET '� �����
. . . . . . . �
' f
Li ne #13. - Total Lawful Purpose Contri buti ons. 3_�( 7�, s 6
List below all checks written fran qambling funds which are
charitable ]awful purpose contributions. The total dollar
� amounts of these checks must match the artrount claimed in
, line #13. Use additionaj sheets as necessary.
CHECK # DATE � PAYEE CHECK AMOUN PURPOSE
1. /mg3
�/��$S �°!9�«�a R� �"'� '� ?m0•oo �t.?�
' 3.50�oo �it!��c.t,�%►<�
2. /!o S� �8'Ig y �''"�- ��uf^^,a.�'`�°
�� � / __ �� eZ0�Oa G�u"'t4�''",
3. 1�9D 9/�3��� r,�ew��-
a. ��5 3 y/���/gs
�•�a�w�4 C/w� �s,00 �a��'—
5. ��y�
y/,�l�5 /���� �^^� ��' �o.o o �d�-�---
� �✓
6. i�95 9/,c/s� � �. �s.00 �'�,� S�-
,
7. /!�5 9 �a���lg S r�^�+- 1�-w �'^"' �� 37•s� .
c b'7��O� �i�cC'�'�"''`e �`,�.�-
8. �7vo �ol3d�gy /V��'A P �
9. l70� ��/r/a9 �°i.0 ,C3oa-�C� /�--°'°o ��-�°�.`� ���
10. /70 5 � G,.� �6Z /s,GG
�,/�dl�� �
11. � 7o G i���l�s ��al3�•�,��y ��� �:oo,00 ��, �
I2. � 7 i� lyl�/�9 �!�'�� �ao -aa ���..� �
/0 0-U CJ Gd��",c',..�`�` '�*^"�`
13. /� � � �r���d y �b�� ��X'c�-�"�
/'L• �7 i� ��/�,.ol a s �� �� 30 0.a o ��' °�
7
TOTAL CHECK Al�UNT � �.3.�3./G
—T
NOTE: These expenditures will be provided to Council Members at your Council hearing.
Be sure that your financial report is complete and accurate.
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