90-782 � ' ' � � � ���°� � Council File ,� ��� �
�
Green Sheet # 5862
RESOLUTION
OF SAINT PAUL, MINNESOTA y� �f�
�.-�
Presented \
Referred To Committee: Date
RESOLVED: That application (ID 4�12734) for renewal of a State Class C
Gambling License by St. Peter Claver Society Worn-A-Bit at
408 Main Street, be and the same is hereby approved/eigni,e,�..
Y� Navs Absent Requested by Department of:
s.mon
osw
on �— License & Permit Division
acca ee �—
e man �—
vne �
z son �_ �— BY' I
�
Adopted by Council: Date MAY 8 199Q Form Approved by City Attorney
Adoption Certified by Council Secretary By: �-��-9d ,
By° Approved by Mayor for Submission to
pp y y M�Y � �990 Council �
A roved b Ma or: Date �
.� .��i�- By:
By: ��
P1I�tISHED �r1 AY 19 1990
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO.2�-4225).
ROUTIN(3 ORDER:
Below are preferred routinpe for the five most frequent types of documente:
CONTRACTS (aswm�authorined OOUNGL RESOLUTION (/krtend, Bdgta./
bud�et sxists) Accept. Grants)
1. Outside A�sncy 1. Depertment Director
2. Initiatinp DspaRment 2. Bud�st Director
3. Gty Attorney 3. qty/►ttorneY
4. Mayor 4. MeyoNAseistant
5. Finance d�Mgmt 3�a. Director 5. Chy(buncil .
8. Finance Accourning 8. Chief Acc�untaM, FU&Mgmt S'vcs.
ADMINISTRATIVE ORDER (Bud�st COUNCIL RESOLUTION (all others)
Reviebn) and ORDINANCE
1. Activky Mana�er 1. Inkiating DepartmeM�irector
2. Dsp�Rment AccouMSnt 2. City Attomey
3. Depertment Diroctor 3. MayorMssistant
a. sudget Director a. ay counci�
5. City CIeNt
6. (�lef AcxouMent, Fin&Mgmt 3vcs.
ADMINI3TRATIVE ORDERS (sN others)
1. Initiatiny Depertmerit
2. Gly Attorney
3. MeyodA�iatant
4. City qerk
TOTAL NUMBER OF SH3NATURE PA(3ES
Indicate the#of pe�s a�which signatur�are required and papercllP
each of the�pa�es.
ACTION REQUESTED
�esc�ibs what ths proJ�ct/roquest se�ks to accom�fah in eithsr chronolopi-
cal adsr or order of importance,whichsvsr la most appropriate for the
issue. Do not write oomplete sentsncss. Begin each item in your Iist with
a verb.
RECOMMENDATIONS
Complste ff ths issue in question has bsen preseMed before any body,public
or private.
4
SUPPORTS WHICH COUNCIL 08JECTIVE?
Indicate which Counal objective(s)your projecUrequest supports by listing
the key virord(s)(HOUSIN(3, RECREATION, NEI(iHBORHOODS, ECONOMIC DEVELOPMENT,
BUDC�ET, SEWER SEPARATION).(SEE OOMPLETE LI3T IN INSTRUCTIONAL MANUAL.)
COUNCIL COMMITTEE/RESEARqi REPORT-OPTIONAL AS REQUESTED BY COUNCIL
INITIATING PROBLEM, 138UE,OPPORTUNITY
Expleln the situation or condhions that created a nesd Mr your project
o►roquest.
ADVANTAOES IF APPROVEO
Ind�ate whether this is simply an annuel budpet procedure requfred by lawl
charter or whethsr there an spsdflc in which the City of Saint Paul
end ita citizens will bensflt from thi�p�t/action.
DISADVANTA(iES IF APPROVED
What negative Mfects or maJor changea to existing a pest�procesas's might
this project/requsst produce if it is pessed(s.g.,traffic delays, noise, '
tax increases or asae�rt�ents)?To Whom?When? For t�ayv long?.
DISADVANTA(iES IF NOT APPROVEC _
What wfll be the nsgative�nseq�if the promised action ia not
approvedl Inability to deliver servicx?Continued high treffic, rwi�,
accident rate? Loee of revenue7
FlNANCIAL IMPACT
Although you must tailor the information you'provide here to the isaue you
are addreasing, in general you must ansMrer two queatb�a: How much is it
going to cost?Who is going to pay?
, , � 90- 7�d
UIVISION OF LICENSE ANI) PERMIT ADMINISTRATION DATE � o�� ��/ 3 ! ��-�
INTERDF.PARTMErTAi. REVIEW CHECKLIST Appn roc ssed/Recei ed by
Lic Enf Aud
p ( , �►li�� MP e r-
Applicant o�'� � I e �K� �IG��n►�Sa�� Home Address ) ()C� � On��
t.��,��, - A- ��+ � � �- 6 �7
Rusiness Name Home Phone '�l� �
�usiness Address ��g �Qi�n �'�' Type of License(s) (..�GtSS C ' l.1 G m bl�r�G�
Business Phone /, �a�__ �Z-/'1 U!5-f� ���� �e�
7-�-�—
Public Hearing Date License I.D. 4{ 1� 3 1
at 9:OQ a.m. in the Council Cham ers,
3rd floor City Hall and Courthouse State Tax I.D. �� �If�
llate Nutice Sent; Dealer 1� �'�"
to Applicant � �0 ��j(�
Pe�erzl Firearms �� N 'q"
Public Hearing
DATE INSPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D +
N�� ,
Health Divn.
� !
� ti14 ,
�
Fire Dept. � �
� '��'q" I :
' � ��-� 3J, 5�
Yolice Dept. I
������� �/L
License Divn. �
�������D i f1 l
= �
City Attorney �
t ��i �tj ! �- ��
Date Received:
Site Plan ��a�ll��
To Council P.esearch J 1�
Lease or Letter ate
f rom Landlord _�a � I '(/(�
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, C�%U-� �
� . City of Saint Paul
� Finance aad Management Services/License b Permit Division
� � INFORMATION REQUIRID WITH APPLICATION FOR PERMIT TO CONDUCT CHAAITABLE GAMBLING GAME IN
SAINT PAUL (To be used with the followiag: New A & C app2ication, reaew A & C
Licenses, and new and renew B in Private Clubs.)
1. Full aad complete name of organization which is applying for licease
s r v�.2 c���c �S�<«� - �vo,c.u- � ��r
2. Address Where games will be held �� /�'f�/,� s T ,5T./�i�l��/J'�,(J • SS/D �
^ umber Street City ' Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games ,�/,/�-,�/�' /l�t–y��_ Date of Birth / �
(a) Leagth of time manager has been member of applicaat organization �d Gr�C S
4. Address of Manager /,���� �j��;;�dY1 �7� ��I/LlZ �S�.S~y.3��
Number Street City Zip
5. Day, dates, and hours this application is for /hp�n�t}.t.� - %.'3�-,S '�3 Z'j
6. Is the applicant or organization organized under the laws of the State of I�1? �
7. Date of iacorporation �—
8. Date when registered with t8e State of Mianesota �'
9. How Iong iias orgaaization beea in eaistence? ����S
10. How long has organization bean in existence in St. Paul? � f�Z�,$
11. What is the purpose of the organization? `L>.e S�-�� �iuDCD,�T– � .S/ ����,
�i�i�C�� �.�llr�C.f..�
12. Officers of applicant organization:
Name �- STA�VLGy 5Lt�7�? Name �/A�l� �L'`-��_
�
a,ddress ;� �� /j� . ��e�� S J Address 1�r?l�e� ]�P,�S�L. �% ��/�,�c.. Ss'ti�;
Title (��� DOB �/5-�� Title �p��£iL DOB
Name � S U�1 D�_� Name
Address��}� �.�Mf��� _ SS//j Address
Title �il,��,e��� DOB /,�.�3/� Title DOB
�
13. Give names of officers, or any other persons who paid for services to the
organization.
Name �l� Name
Address Address
Title Title
(Attach separate sheet for additional asmes.)
.�,: , , C���l0- %�d
� 14. Attached hereto is a Iist of names and addresses of all members of the organization.
15. In whose custodq will organization's records be kept?
Name f�/�jr ���, Address `�Df�' _lQ,C�',r��t S'j"
� 8/�i,�c. fi��✓ SSy'�_
16. List all persons with the authoritq to sign checics for dispersal of gambling proceeds:
Name �� ,57A��iJ S'FE/)Z. . Name l�/A-�11 t /77 t"`/�._.
Address �-�� /�. �X�� Address J�6�� JF�SY�t
Membez of Member of
DOB �/S_c/� Organization? � DOB �/-//-2�� Organization? �
ftame j}�/�/�j G :5�L��DE�., Name
Address �1/y,� ��I,r��'z�/,� 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 i.�
b) If you do pay accounting fees, to whom will such fees be paid?
Aame Address
DOB Member of Orgaaization?
c) How are t&e accounting fees charged out? (flat fee, hourlq, etc.)
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 furnished by the city of Saint Paul is a Financial Report
which it _emizes aIl receipts, expenses, and disbursements of the applicant organiza-
tion, as well as all organizations who have received funds for the preceding calendar
qear which has been signed, prepared, and verified by � /,Cy,�,�' /�y7e-y'�
/����� �J`�e�s��► �/,��,�� I�w► S"�3 5/
Adaress
who is the /}�A�1„¢��/L of the applicaat organization.
Name .
20. Operator of premises where games will be held:
Name /�i.jG�� J'�'f���: /J�°��G1/i� U' J'�/���'� --
7
Business Address �L'� ��/}/�U u�'% �7 D�¢G/L_ l�,L% . �a`�/� �--
Home Address
� � . � � � �°" ��d
21. Amount of rent paid bq applicant organization for rent of the hall: .
� ''�/OS ��,� s�ss�6,�)
22. T8e proceeds of the games will be disbursed after deducting prize layout costs and
operating expeases for the following purposes aad uses:
�i� �� �'crsa.aaz� a� �� D'�� �l�GAC Lj�t _
23. Sas the premises vhere the games are to be held been ceztified for occupancy by the
City of Saint Paul? �/C S
�
24. Has your organization filed federal form 990-T? �1d if aaswer is yes, please attach
a copy with this appl.ication. If answer is no, explain why:
��/G/CJ.S. ��/LIl��Al�f_
Aay changes desired by the applicaat association may be made oaly with the consent of the
City Council.
.'ST���Z. �//�!/��2 SGY''%C'T�k�i�[-/��'/%
Orgaaization Name
���� ���
Date o2`at7 J�l� Bq:
' Manager i charge of game
.
Organi tion Preside or CEO
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Deputssnt ot Maanes aod Maoafasaat Sssviees
.'� Di�iaion o� Lic�nas aad Y�salt Ad�iaistsation
�' , 11IfIP'OAlt CFIARI?/181.6 GAl�LII�G ?INAl1CII1L REP0�2
� Dat� .Y
1. llar ot orpniaaeion .�T��7"�L1 C//�U��D�/��-Nr �11D2/�� -� +- /�
• 2. Mdsass vl�r� Auritabl� G��blia� is eoadaeted �ld� �g/�/ST .S T�i�l�L�'
3. bposs !or pariod eov�rin� /�'Ib�Jf 19;�throufh 19�
' 4. ?otal nu�bas oi days pL�sd _�SL
."'�
S. Csou see�ipes tos abov� p�siad i
6. Cso�a pris� pa�ouu fos abovs p�siod (ieelnd� ea�6 shost) i
7. ll�c r�e�iPes - lin� 5 aiau� ].io� 6 i
8. F�cpanaes laenrred in canduetia� and opasatia� ;as:
A. Gro�s va=ss paid. Attaeh vorker list vith
naMS. addr�ssas. fro�s wases. m�bsr oi hasss i 'c' +�` �
vosked. and aaamt paid pss hoar.
• B. R�at !or � veaks t J ��Sf,D�
C. License fee CiJ-[� �'�S�- ; .� ��.�• / �
D. Iaausancs �
� E. � ai.�x��,� ��-✓ : i� o . � o
. T. Distioaosed eh�cks not r�co��s�d i �SB . G�
G. Aeeonnetu� B:p�nss = �
. H. O�plo��ss T.I.C.A. i
I. Pnlleab Ta: Paid to D�pasts�ne of � i
' J. Kian. U.C. Su :
t. led�sal �eisa 'Lax i $tasp i
L. Stat� Cablia� Ta�c i �.���- �.�
!t. Miscsllanaow Exp�as�s. Identil� Clw aatnt
. amd to rbaa patd.
i.M�. 1,p6���1 = �f7, L �
z• s
3. 4
4. i
9. ?otal Esp�a�a 'lCLI►L i • /
10. ll�t ZaaoM - lin� � aiaoa 1l.a� ! � i
11. C6�efcbook balase� bs;ianins ot p�siod i QL��
• 12. ?otal o� lin� 10 aad 11 i � • •
' 13. ?otal cootsibntions (fsoo aetached wrfu6�et) ; �
14. Cheekbook baLnee and of raportias period -
' lia� 1Z l�ss liae 13 . i � � � �-* ��
..� ._�;
Vlli ur �� . rhu�
` • , , UNIFORM CIiARITABIE GAh��ING FINANCIAI. REPORT �=- c�U -��d
� LA1�fUL PURPOSE CONTRIBUTIONS - WORKSiiEET
� � Line �13 - Total Lawful Purpose Corrtributions. � 7,:,f/7,�f'
-. Li st be1 ow a11 cf�ecks written from qambl i ng funds whi cfi are
charitable lawful purpose contributions. The total dollar
� amounts of these checks awst match the amount cla�med in
line �13. Use additional sheets as necessary.
CHECK � OATE ' PAYEE � CHECK AMOU PURPOSE
- -
1. /i /�3 3�a�9' ST Ot�7f�:. C/�UP.�CG�,Ecu 9�/� G � �-D L �� s u y� a�
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TOTAI CIiECK AMOUNT S �.���,
NOTE: These expenditures wi11 be provided to Council Members at your Council hearing.
� Be sure that your financial report is complete and accurate.
�
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