90-976 OQ � � ��I H l Council File � _ � -
1\ i Y �r.
Green Sheet # ��00
RESOLUTION �
CITY OF SAINT PAUL, MINNESOTA ��,
��
Presented By
Referred To Committee: Date U
RESOLVED: That application (ID ��34301) for renewal of a State Class B
Gambling License by Harding Area Hockey Association at
Minnehaha Tavern, 735 White Bear Avenue, be and the same
is hereby approved/d�-
eas Navs Absent Requested by Department of:
mon
o�o w z '�
— � License & Permit Division
acc ee
e m
u e v
i son �— BY�
�
Adopted by Council: Date �U� 7 1990 Form Approved by City Attorney
Adoption Certified by Council Secretary BY: , Jf. ���
� �� � {
By' Approved by Mayo� for Submission to
Approved by Mayor: Date � � � JUN 7 1999uncil
C By:
By: �� .���
PUBUSNEO J UN 16 1990
_ � �'G-�7� �/
DEPARTM[NTlOFFlCE/OOUNdL DATE INITIATED
Finance/License GREEN SHEET NO. 7�Q0
CONTACT PERSON a PH�NE INITIAU DATE I ITIAUDATE
�DEPAATMENT aRECTOR �CITY COUNqI
Christine Rozek-298-5056 �� ��y��Ey �CITV CLERK
MUBT 8E ON COUNCIL ACiENDA BY(DATE), C i t y C 1 e rk lIOUTINO ❑BUDOET aAECT�i �FIN.8 MQT.SERVICES aR.
Hearing/6-7-90 By/ 5-31-90 ❑�Y����ST� � Cnnnri 1 r
TOTAL#►OF 81QNATURE PAtiES (CLIP ALL LOCATIONS FOR SK�IATURE�
ACTION REGUEBTED:
Approval of an application for renewal of a State Glass B Gambling License.
Hearin Date: 6-7-90 Notification Date: 5-24-90
RECOIiAMEN0AT10N8:APP►�(�)p�(R) COtN�L
_PLANNINO OOMMI8810N _GVIL 8ERV1�COMAMSSION �Y$T PHONE NO.
_q8 COMMITTEE _
_8TAFF _ OOMMENTS:
_DISI'RIC'T COURT _
SUPPORTS WHK)M COUNqL OBJECTIVE9
IWTIAT1NCi PF�BL.EM.18811E.OPPORTUNI7'Y(Who�Wh�t�1Nhsn�WhKS.WI►Y).
Don Sperr on behalf of the Harding Area Hockey Association requests Council
approval of their application for renewal of a State Class B Gambling License
at Minnehaha Tavern, 735 White Bear Avenue. Investigative Fee of $373.25 has
been submittted. Proceeds from the pulltab sales are used for youth hockey
expenses. ,
ADVANTAOES IF APPROVED:
If Council approval is given, Harding Area Hockey will continue to �opergte
. a pulltab booth at Minnehaha Tavern, 735 White Bear Avenue.
as�ov�wv►oes��o:
DISADYANTAOES IF NOT APPROVED:
R�CEIVED
�►Y251� ��'uncil Research �;en�e.�
CIT`! CI:E�K MAY 2 5�990
.�r�,o
TOTAL AMOUNT OF TRANSACTION : COST/REVENUE BUDOETED(qRq.E ONE) YES NO
FUNDMIO SOURCE ACTIYITI/NUM�R
FiNANqAL INFORMATION:(EXPWI�
��V
' , ' � , �-90 -�7(0
DiVISIUN OF LICENSE AND PERMIT ADMINISTRATION DATE � � 7D / r �p �
INTERDF.PARTI�fF.NTAL REVIEW CHECKLIST Appn roc ssed/Received by
Lic Enf Aud
Applicant �'Q r�.f h �(�� Home Address V�n S� v r
Rusiness Name .�-6 vd,;vtiG A-y�Pw �--tpG�P� Home Phone 7 7� � � �y /
Business Address (,�;-� ����f AUp✓►1Type of License(s) r�!(.55 � "' ��im(���.�y
Business Phone ��S (,����.t, �2I:t✓ �'� �1CQ,,.,�.� ��vlp(,J�
Public Hearing Date � '1 �� License I.D. �f � y3o1
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� 7�yS��7
llate Notice Sent; Dealer 4� �l�'
to Applicant
rederal Firearms �� _�,Q�
Pub.lic He�.iring
DATE INSPECTIUN
REVLEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D 1
� �
Health Divn. �
' �l�- '
�
Fire Dept. i �
i '`� I`� �
Police Dept. � �II�f�
d!�
License Divn.
i
��.���a b ,L
City Attorney �
� �3 �� a,�
Date Received:
Site Plan 1'����' � �j
To Council P.esearch :5 ` �
Lease or Letter � D te
from Landlord f'�' S � �%
r
CURRENT INFORMATION NEW INFOKMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
' � . City of Saint Paul f�,� G /-
, Finance and Management ServicesiLicense S Permit Division V �� - l ��°
INFORMATION REQUIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHARITABLE GAMBLI:TG GA.`!E LV
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
A � SS �i a
2. Address where games will be held ,��� yy� �%" � A� �v� S P ("i+�L, ti 1���
Number Street �City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games�pN/��� .��,�� }Z Date of Birth )a� /7�a(�
(a) Length of time manager has been member of applicant organization � RS
4. Address of Manager �L7� (�j�J�C12 A..�'/eN1�17 SI� �A��. /tiC/�/� ��D b
Number Street City Zip
5. Day, dates, and hours this application is for
6. Is the applicant or organization organized under the laws of the State of MN? �
7. Date of incorporation ` 9� �f
8. Date when registered with the State of Minnesota J 9(0 9
9. How Iong has organization been in existence? o� J �!�A� S
10. How long has organization been in existence in St. Paul? a} �/�A jZ,S
11. What is the purpose of the organization? 1/ L� f /� l"�p�/���
12. Officers of applicant organization:
`� Name �o nrA, dZ.�D�/
. Name jy�1 G�}A,�L_ ��1l�ut��,I/�/�. _
� Address /D�7 � �Q��l�l $ 1 Address �� ���C.� S �
/�c(tne4 '� ,1 1'�F-14�S DOB 10�
Title � %�f=S�� E,v�DOB 1 �' Title ���-��
Name �A I�� ND�/�- N'ame
Address �^�� So 1N'l.V1N�e� Address
Title .,. �,� DOB �^ �a���� Title DOB
13. Give names of officers, or any other �ersons who are paid for se1^ViCeS t0 the
organization.
Name Name
Address Address
Title Title
(Attach separate sheet for additional names.)
� .� � �D -97�
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 ��N �����Z Address ,,��7� U�1���, J�.��D/V �YJ
I6. List aIl persons with the authority to sign checks for dispersal of gambling proceeds:
Name ��,� ,4��R,(�. Name �Rc i 1�i c,I� ,� �A N ��
Address /(�7������R/�'�en! /'t�1,� Address y��� ��A}��
Member of Member of
DOB 1a�/7�oZt� Organization? � DOB �^ 03 —�,t,- Organization?
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 Address
DOB Member of Organization?
c) How are the accounting fees charged out? (flat fee, hourly, 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 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 by �h,�s ��� `�,
I ��s' �?�.=2 � �aN r2�
Address
who is the IY�AiV/�G � of the applicant organization.
Name '
20. Operator of premises where games will be held:
Name �11��/1!N� 1�/�A� �Av h=1ZIV
Business Address 73� �L'1!!�! � � ��A 1-Z A`t �-
Home Address
� � � . �-9e--���
21. Amount of rent paid by applicant organization for rent of the ha11:
f ,
__�10a��o �. �a„��i�
22. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
� �`' I
�7` a C.� `
;�
23. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
24. Has your organizatio filed federal form 990-T? �Y�� If answer is yes, please attach
a copy with this application. If answer is no, xplain why:
Any changes desired by the applicant association may be made only with the consent of the
City Council.
A . j= = 5'��n��.
Organization Name
Date 3"���9� By: t�
Manager in ch ge of game
� /.
`���� '-�-
��' ��/ �-'w ;;���"
,
�Organization President or CEO
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7 71 7 �: i�'-:� ;i , a 1J = � ? �e �
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� • , Citq oE Saint Paul Pags 1
' - Departnent oE Finanee aad Managesent Secviees
' Dlviaion oE License and Peait Adainistratioa /� 6 0 _�j ��
l, �
UNIFORH CHARITIIDLE CAN3LINC FINANCIAL REYOR?
Date � -���-��
1. lfass of Orgaaisation �a�17/NL,/4 Il.�'� /XBC.��'1� /QS'S G/A )/[9 N,1
2. Addrsss vher� Charieabl• Ca�blinf !a conduet�d ����wf�)�� ��iQ Q A�/�e'
3. R�port !or p�siod covsria� f�) 19� ehrou�h /� �3� 1�
, 6. Toul number of days plqed
5. Cro�� r�c�ipts for abova Q�riod = ��/'� 7 � b� U
6. Crosa prizs payouta for abw� p�riod (includa caa6 short) � �`� 3 7 c� _
� /
7. Nat raceipts - 13ae S miaus line 6 S �.� �� C3
8. Expanses ineurred in conducting and oparating 6a�e:
A. Gcosa wage� paid. Attach vorkar list vith
namsa, addreasas. gro�s wagss� number of hours f �� �7
vorked. and amount paid pas hour.
• B. Rent fot weeks :
C. License fee =
D. Insurance i � d `��
E. Bond ; � � v
F. Diahonored checks not recov�rad = ! � �
G. Aceounting Expense :
. H. Employess F.I.C.A. ; � ��
' I �
I. Pulltab 'fas Paid to Departa�nt oi Raveaue S 7.j
J. Minn. U.C. Tax :
. 1C. Federal Exeisa ta�c 6 Stasp :
• L. Stat� Caabliag Taa =
N. Hiseellaaeous Expansaa. Idsntiiy CQ� mount
. and to vhoa paid.
�. �.�A,�y,�A� ; ��g�
z.Ca��aF l��4F���.._. ; /3 9 7 �
�(:�q►R,t3oo���SeG�1
3• s���e.��_s s q33
�. �e�ts t=��C-�4�.'�. ; � / � . .
. ��aesi � aC�a mru. : � 7a �`J
9. 'lotal F�c�snses
10. li�t Ineos� - line 7 ainus lins 9 f •�� � ��'
11. Checkbook balane� b�ginaing ot Q�riod = ' ��? �
. 12. Total of lin� 10 and 11 ; � � �«�
"'"`. 13. Total concributiona (froi attuh�d vorluh��t) S ��� �
14. Cheekbook balaae• aad of raportiaa period = ; � Q /' Q ,
• . lin� 12 lsss liaa 13 . � t9
..• ..�.:.
U�1rUKM �nHK11H��t W�iM��lNV r1nHn�1H� KtNUKI
, ' � LAWFUL PURPOSE CONTRIBUTIONS - WORKSHEET ��� _�)�
Line �13 - Total Lawful Purpose Contributions. S c�D.aa�.�
•. List below all checics written from gambling funds which are
charitable lawful purpose contributions. The total doilar
� amounts of these checks must match the amou�t claimed in
line �13. Use add�tional sheets as necessary.
CHECK # DATE ' PAYEE CHECK AI�UN PURPOSE
�. $dy J-a � lTAF�17. IN[? At`�-A 1�do, o� �t �R�N-AS� �c.� i M�
z. o�� ,- ao � , �y �� s� '�v1— lY�.�� ya��� �,����,�
8
� a.., 3 c �� a �= s<< ���� � �y, 90 e�ltf ��a���.�
s. _$� l y � � 1�� ,,.��
, � I--�A��f.v(.�. A��A 1��,o c� l � ►�cl4a �
4. �1 � a 3 J DOe�O t� �c� r�c.f�AS� 1���!/v1,i�
5. $ 1 � a-a � 1�-a'��t�+G A`��� � � �RAMb
6. g3! 3� 31 c�i� � F5i���� 1--. a3?,au
yo� ��+ � ►�
r2 c.i4d1�� r c,�i n� i�
� c. � 1
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�'�a,o� � � u
s. �'3�1 '�- 11 1��1�Z��►1�. �R�� > �c�� i Mr�
� ��K���
9. �5'�7 ��9 !-��,Z��Na AiZ�� ac�eo � Q � o��tt �2oLi?�^^s
-� ao, o o y
�- L" Iq.�K17- C'OAl�`I l7F_zN1c.Y� " J/
10. �? � � -�3 ��6
i�� eD�,o o ���crt-��� ��''C
11. �� 7 � �o�� !'`A►�I�IN� ����� �b� Ov r l`r ��C9�lZ���S
o1ab � l;y� � s� i��� � ���3.�a y
i2. 9�.�' �
13. �
TOTAL CHECK AMOUNT S o?D�?7�7d
� NOTE: These expenditures will be provided to Council Members at your Council hearing.
� Be sure that your financial report is complete and accurate.
_ � .� 3 � �
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