90-1088 0 K 1 ���� � Council File � Q— d
Green Sheet �
RESOLUTION � �. .
CITY OF SAINT PAUL, MIN SOTA ;� ' �`�r :�
� � �_._
�
Presented By �
Referred To � Committee: Date
RESOLVED: That application (ID 4�13488) for renewal of a State Class B
Gambling License by lOth Street Boxing Club at Mike's Bar,
326 Grove Street, be and the same is hereby approved/��-T^a
��— Jea Navs Absent Requested by Department of:
�
on License & Permit Division
ac ee �,
e �
une
z son �— aY�
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Adopted by Council: Date JUN 2 g 199e Fo�► Approved by City Attorney
Adoption Certified by Council Secretary gy; , � �i �/I- �D
By° � �� �.... � . A roved b Ma or for Submission to
PP Y Y
Approved by Mayor: Date � a8 90 �`�`� ��cil
JUN �2 8 �1990
By:
By:
pU�(�SHED �U L 7 )990
. . °� yo-�o�
DEPARTMENTlOFFlCElCOUNqI DATE INITIATED
` �SI�
F;:nan�e Li�ense � GREEN SHEET No. 773� �"
CONTACT PERSON 8 PHONE �NmAll DATE IMITIAtlDATE
�DEPARTMENT DIRECT�1 �CITY COUNGL
Christine Rozek-298-5056 �� 0�A��' ��'�RK
MUST BE ON COUNGL A(iENDA BY(DAT� City Clerk � ❑BUDOET DIRECTOR �FIN.8 MOT.SERVICES DlR.
Hearin 6-28-90 g 6-21-90 ❑MAY�R(���� [� Cn��T+�i 1 R
TOTAL N OF SIGNATURE PAOES (CLIP ALL LOCATIONS FOR SIONATUR�
�cnoN RECUesreo:
Approval of an application for renewal of a State Class B Gambling License.
Hearin Date: Notification Date:
REWMMENDATIONS:MPr'�(N o►�I�1� COUN�COMMITTEE/f�EBEARCFI REPdiT OPTIONAL
_PLANNINO OOMM18810N _CIVIL SERVICE COMMIS81pN �Y� PHONE NO.
_qB COMMITTEE _
_�� _ COMMENT3:
_DISTFqCT COURT _
SUPPORTS WNKYi CaJNpI OBJECTNE?
INIT1ATiN0 PR08LEM,ISSUE�OPPOHTUNRY(Who�Whet.Whsn.WMro�Wh»: .
Lou Danna on behalf of lOth Street Boxing Club requests Council approval
of their application for renewal of a State Class B Gambling License at
Mike's Bar, 326 Grove Street. Proceeds from the pulltab sales are used
to support youth boxing activities. Investigative fee of $373.25 has been
submitted.
ADYANTIU�E81F APPROYED:
If Council approval is given, lOth Street Boxing Club will continue to
operate a pulltab booth at Mike's Bar, 326 Grove Street.
DISADVAN'fAOES IF APPROVED:
DISADVANTAOES IF NOT MPROVED:
RECFIVED �uu���u r�����rc� ��r����
�UN 15��Q JUN 151y�1�
,..
CIT'�' GLERK
TOTAL AMOUNT OF TRANSACTION : C08T/l�VENUH BUDOETED(CIRCLE ONE) YE8 NO
FUNDINO SOURCE ACTIVITY NUMOER
FlNANGAL INFORMATION:(EXPlA1N)
�W
.
��
� e F ,
,NOTE: WMPLETE DIRECTION3 ARE INCLUDED IN THE OREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASINt3 OFFl(�(PHONE N0.298-4225).
ROUTINC3 ORDER:
Bebw are prefsrred routings for the�ive rtwat frequent typss of docurtteMs:
CONTRACTS (essumas authorizsd : OOUNqL RESOLUTION (Amend, Bdqts./
budget sxista) Accept.GraMa)
1. Outside Agency 1. DepartmeM Director
2. Initiating DepeRmsnt 2. Budpet Diroctor
3. Cfty Attorney 3. Gty Altomsy
4. Mayor 4. MayoNAseistsM
5. Fnar�ce d�M�mt 3vcs. Oirector 5. qty Councfl
6. Fnance Axounting 8. Chief AxountaM� Fln d�M�mt Svcs.
ADMINISTRATIVE OROER (Budpet COUNCIL RESOLUTION (all others)
Fisvisbn) and ORDINANCE
1. Activity M�r 1. InitiaUn9 Dspartm�t Diroctor
2. Depertrr�M/lccountaM 2• �Y�a�Y
3. DepertmsM Dfrector 3. MayoNAssistant
4. Budget Dirocta 4. Oityy CoUndi
5. City Clerk
6. (;hief/McouMaM, Fin&M�mt Svcs.
ADMINISTRATIVf ORDERS (aN others)
1. Inidating DepartmsM
2. City Attorney
3. Mayor/Assistant
4. (�ty Clerk
TOTAL NUMBER OF SKiNATURE PA(3ES
Indicate the N of pepea on whfch signetures aro reqWrod and paperc�iP
aach of tf�ess pa�ss.
ACTION RE�IUESTED
DescHbe what ths projecx/roqueat ss�ks to accomplfsh in eithsr chronologi-
cal oMer a ordsr of impatance,whiche�var is most appropriate for the
issue.Do n�writs c�mplste seMencss. Bepin�ch item in your list with
a verb.
RECOMMENDATIONS
Completa if ths iss�e in question has bean pr�sr�ted before arry body� pub�ic
or privats.
SUPPORTS WHIIXi COUN(�L OBJECTIVE?
��di�te wnicn ca,nd�aasc�iw(s)ynu�pro�ecuroquest suppores by�i�ine
the ksy word(s)(HOU31N(i, RECREATION,NEIOHBORHOODS, ECONOMIC DEVELOPMENT,
BUDOET,SEWER SEPARATION).(SEE CO�APLETE LIST IN INSTRUCTIONAL MANUAL.)
�UNCIL COMMITTEE/RESEARCH REPORT-OPTIONAL AS REQUESTED BY COUNCIL
INITIATINCi PROBLEM,13SUE,OPPORTUNITY
Explein the situetion w condidor�s that crested a need for your project
or requ�t.
ADVANTA(3ES IF APPROVED
Indicate wheth�this fs simply an annual budpst procedure required by Iaw/
charter or whsther thsre are sp�cif�we in which the Cqy of 3aiM Paul
and its citizens will bsnsfit from this pro�Ct/action.
DISADVANTA(3ES IF APPROVED
What�epatNre affects or major changss to o�cisting or past procesaes might
this ProjecUrequest producs if ft ia passed(e.g.,traMc delays, na�,
tax increasss or a�msnts)4 To Whom?Wlien?For Fww long?
DISADVANTA�ES IF NOT APPROVED
What wfll be the negative conaequsnces H ths promieed action is not
approved? InabiNy to dsliver service?CoMinued high tratHc, noise,
accident rate? Loss of revenue?
FINANCIAL IMPACT
Alttiough you must tafdor tha iMormstion you provide here to the fssue you
are addresaing,fn psneral you muN answsr two questions: Hanr much is it
going to ccst7 Who is goinq W payt
� � � . �yo-�o�
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE � �v l � �Ll /�
INTERDF.PARTMF.NTAL REVIEW CHECKLIST Appn P ocessed/Rece ved by
Lic Enf Aud
� n�t,
Applicant ���1 S � C� Home Address �O�(oDQ �Ccr�n ,�%v�
�
Rusiness Name a, � � �QS ,�� Home Phone � 7 9--]Q y 3 �'l� (',()'0�'�C ��,(5 l
�7£�/
Business Address ���p �Y�UL c� � Type of License(s) ��Q�S /'� �-
Business Phone ►�p �j��hG� �lGQ�3')�2.- y���l,�k�
Public Hearing Date ��O l� License I.D. �� /� �o"
at 9:0� a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4t �'A�
llate Nutice Sent; Dealer �f �/��"
to Applicant �Q� (7
� I'ederal F3.rearms �� �
Public Hearing
DATE ITSPECTIUN
REVtEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
� ,(�, ,
Health Divn. '
�
� N q-
,
Fire Dept. � �
i N /-}- I
� �� � +� ��f �o
Yolice Dept. �
5' 1£�f 5D ��,
License Divn. i
;
City Attorney �
� � � -1'� � ��
Date Received:
Site Plan J� (1�Cj17 ' / /�
To Council Research ,�'-` 1 �(— �v
Lease or Letter Date
f rom Landlord �L� I y�
CURRENT INFORMATION NEW INFORMATION
Ciirrent Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
- w'orkers Compensation:
New Officers:
Stockholders:
�� �ity of Saint Paul �j� ^�
! ' De artment of Finance and Mana ement Services li' �����d 6
P 8
< Division of License and Permit Registration
INFORMATION REQUIRED 1�IITH -APPLICATION FOR PERMIT TO CONDUCT PUI.LTAB/TIPBOARD Se�LES I�i
SAINT PAUL (Class B Gambling License in Liquor Establishments - New Application)
1. Full and camplete name of organization which is applying for license
� , /
2. Does your organization-meet the definition of a "large" organization as outlined in
the November, 1988 revision of Section 409.21 of the Legislative Co�e?
Attach to this application pertinent financial and/or organizational information to
support your answer to this question. NOTE: Only S large organizations will be allow-
ed to open pulltab operations under the revised citq ordinance. If more than 5 organi-
zations apply, qualified applicants will be selected randomly by the City Council.
3. Address where games will be held 30�� VYDcr�- �fYe-e.�` " S{' •�4..cX, t�Yl�l.�
Number Street City Zip
4. Name of manager signing this application who will conduct, operate and manage
Gambling Games �Q�j 5' �, ��t;V� },�Q� S P � Date of Birth � - �,����
(a) Length of time manager has been member of applicant organization fQ,�
5. Address of Manager ;�� L�'[� ��G )� ��ud (.1Ct.f���,T,m�� ��S�/..� �
Number Street City Zip
6. Day, dates, and hours this application is for ��� �by - �/.�� / 1 U
7. Is the applicant or organization organized under the laws of the State of MN? �
8. Date of incorporation ��� • ' ���
9. Date when registered with the State of Minnesota 9'.,7/���
10. How Iong has organization been in existence? f�,�t� __
11. How long has organization been in existence in St. Paul? �O�
12. What is the purpose of the organization? �e z.�'��i /�w.s,� �
_�
1� i lJ'itM�Y/1/.l1T� Ib(LF�Il�t+f/s
13. Officers of applicant organization:
Name ' � � r] dt,h Y1 cL �lr Name , ��• � � �l�t. Q. . � �
���-� -- yyla, �l u+vod ) 0
Address �� �� � .rrr �v� �71 S_S'�/09 Address 3G O� rG�Yd�Gr� ��j[ ���i'.23
Title �r.l.!i f aG v1� DOB 7/Q- ,��' Title � . DOB ,�/,�;�3
Name V_i„�,�1�_[��!"A�n�2,e,� � _ Name
- - - - �, �:i/��
��;�- ` ��.1,� m
Address �� ��►tGG �/t�u,L,, � Addre�ss ��� Q.r �N
�
Title �Jii�-�j�o-�•l DOB �/-.1./ 'S�� Title � DOB � '� ���,�
. � . � � (;�r9o'���
� 14. Give names of officers, or any other persons who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separate sheet for additional names.)
15. Attached hereto is a list of names and addresses of all members of the organization.
16. In whose custody will organization's records be kept? ,��%����,>��y�j.s'�ay
Name • Q��tin(1✓ Address �°7�3'� ./.i/y� ,���l,GicG
17. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name v Name �r�..�, `�i� -u�'Fl�-1�cJ
� Address ,�/ � (1ZL�ll/��, .L/�
Address .��0 4 -,
Member o Member of
DOB ��f �,- 3 �_ Organization? � DOB �-�'-__S 3 Organization?�
.
Name .�. .� ,, c' �, Name
�
� Address
Address �ri/?� �'GJZr�L�L� , ��
Member of Member of
DOB , -��- �'�2 Organization? (� __ DOB Organization?
�-
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. Will your organization's pulltab operation be operated/managed solely by members of
your organization? yes x no
20. Has your organization signed, or does it intend 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 ^ C�_,
If answer is yes, give the name and address of the person and/or companq contracted.
N�g �l�' Address
Name �j�' Address
If answer is qes, how will such a consultant be paid? (percentage, flat fee, gambling
fuads, general...funds, etc.) Attach a copy of said contract to this application.
2I. Operator of premises whare games will be held:
Name ���GU'L�
Bnsiness Address ?a� ,Cs�Y'DN[. ��f c/�� 1 a1� ��
Home Address
� � . � � � ���o�
� ?2. a) . Does your orgaaization pay or intend to pay accounting fees out oi gambling funds'.
yes ,��(' no
b) If you d�o pay accounting fees, to whom will such fees be paid? ����� S!j�f,,Y,3
Name r� Add re s s �f����(L� i,ar,t,r
DOB Member of Organization? �_
c) How are the accounting fees charged out? (flat fee, hourly, etc.)
d) What do you anticipate will be your average monthly deduction for accounting fees?
�.5����l�t�- �I�Y�rS�ILLIL'
� 23. Amount of rent paid by applicant organization for rent of the hall:
� �33/.-n��-.�,.
24. The proceeds of the games will. be disbursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
� � � �
, , >
{
D�1,�J(/i L ./L.���
25. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization fil.ed federal form 990-T? ��� If answer is yes, please attach
a copy with this application. If answer is no, explain why:
'i`i rS 1' ��c.r/ r���i r�� !s �r� �i�Cc./'.
Any changes desired by the applicant asgociation may be made only with the consent of the
Citq Council.
. �
gaaizatio N e
�
� ..
Date ^I ���1�7�
aager in charge of ga:ae
i� d"'
�
Orga ization President or CEO
� � , � �yo-�o�
' Cit� o[ $aint �anl Pa;� 1
' Dsparts�nt ot iinane� �ad !laea`esant S�r�ice�
Di�ision ot Liean�a ad r�snie Ad�.inisesaeio�+
' UItIIORlt CHAtITMLE CAlW.Iil�i tINANCIAL REPORT
Dae� S�V�-�q 0
: 1. ifa� oi Or`�nisation �����"` ���` r�i ��`� �-
� '(�� ��
2. Addr�s� vh�r� Charitabl� Ca�blia� ia eeo�et�d �t�e \•�-�
3. R�post for P�riod eo��rins � 19a� thseu�6 � 1!�
�. ?otal nn�ber oE da�� pL�ed o1�
S. Cso�s r�eeipts tos aboo� p�riod � ���J�T�'0O
6. Ccos� pris� p�rouea tor abov� p�riod (laelad� euh �hort) _ ��. � 13•��
• 7. tl�t r�e�iptt - lin� S dau• lin� 6 # ��=� �'l,'30
e. E:p�ns�• inenrred in eoaduetin` aad op�ratia; �a��t
A. Gross vase• paid. Aetach vorker li�t �ieh a Q 5(ps. b�
nam�s. addr�s��s. tro�s wa;�i, nueb�r o! honc� : �
vork�d. and asount paid p�r hou[.
• H. Rent tor � vteRs VH�+�NS � �� "'��`
C. Lieens� fea = �y�' �
D. Insuranee �
c. eoed = l °�•�
T. Diihonos�d cheeb noe reeov�rad �
. C. Aeeountie; Expens� � ����• ��
N. Csplo��rt T.I.C.A. _
L. Pulleab ia�c Paid to D�parta�at oi Rrinni��jCG se = `�f � /O' /�
. T�.,o ;
J. Nina. U.C. 'fa�c
. R. ted�cal Excis• Tax 6 Sta� _
L. Stat� Ca�blins 'fax �
M. Misc�ilaa+ous ExPentsa. Id�ntity t6a uonnt
. aed to vho� peid. •
1. �N V�'ti��� = g0 D�•�a--
2. m�sc. 5�►.ppl;cs : II�6.9
�.�.�� � � JoY•SO
�. �9�p. : ir�o.s� 8'�6•y3
!. ioeal Exp.n.., —C—r
10. ll�t Iueors - lin� � �imt lis� � �� � �`�� ���•��
lt. Ch�ckbook balanct b�;im�ins ot p�siod � �_
12. Total oE lin� 10 aod 11 : � "��•��
••�°'. 13. Total eoatribneiont (Iro� aetaeh�d resluN�e) # � �'�• 3�
16. Cheekbook balanc• a� ot r�postint P�si� � ,�. � ' �b�j�,..
� lin� IZ l�s� linf 13 .
: � t 583 oU ; �. Cct,����s
.: ► ���-17 Sa- �,�.� L�.Q
• . �lly UF 51 . NHUL
� • . UNIFORM CHARI7ABlE 6AMBLING .FIN�RKSNEET�RT ���'�0��
' LAiiFUI. PURPOSE COMTRIBUTIONS
�- � . . . . . . .
. �� S i .3 S
Line �13 - Total LaNfui Purpose Contributions. S 3 � ? 3
• List below all checics written from gambling fundS rvhich are
� charitable larvful purpose contributions. Th� total dallar
� amounts of the3e checks a�ust n�tch the amount cl�in�d in
line �13. Use additional sheets �s n�cessary,
CH�CK � OATE ' PAYEE CHECK AMOU P�POSE
�
1. ,5'Qa. ���o�I�d9 �asgvncxar 81�. 375•00 � •�'o,t�ow� �yw�
2. S93 ��i7 /8°� U�� we 5-�- 5��i9 I�k..lol;c. 1�Ino�e o.# C-�
3. _(o�3 �'��i I� �a.ch�.o��:s �16.�S Ficx�+rs �� F�aQ o��a..
4. �3�} ��l��l�'`�i �en�e,��h Za-,,,,,o�ra.. S�o,o o �e..� -Ev�1�:,.r..� C�w�
5. 1�5�1 ��o�l�o Ra�a.�l sPor�s�C�Me.�Q��.Q, I o�9 h�so t���.o,,,� �q�►p �6��.nas�u.W
6. Cn S S �/i��o . Cas1�- I �9.S�I S,,�p I►crS ►r-or C��w`
7. �o�3 ���s�o l,t ,S 1��s� 53.53 t�-�I;c ��o�e a..� C��
8. ��Ll ��o�o ��ia,r,�cu��Ne �jo�• '15�-0o S�c�- � �o� �«�j
�o+ci�� �'sSoe. �! vbgta�•�w-s
9. (o'l D ��a 3 klb Gi�. �u.�.�tt� �u�v�Q �l'19.l0 3 G�+yJ �c u-'� �.�Q.
10. L��1 a- �/13�'ID M�,KeS �rb Shop Ilo�.Oo 'Trcpl��eS �ar yo�.�3ax.e,�5
11. (o`l 3 �h�k1 b ��r:s �i��-� 19 �.3 � C,� t.�o.�._kt,. ��.�.,�Q
12. �"1� ��a-3�j� �iari�all SQoY�s���CoQ �1`1').S� I.vor ko+�.�' �qu..ip.�r ium.�ra�i
G��.�
13. (o�P� �����0 �.oSSvr,or 13i�. 3�5.00 t���o��a�ci� �oyw�
TOTAI CHECK AMbUNT �
NOTE: Tfiese expendi tures rri 11 be provi ded to Co�nct l M�n�bers �t your Counri 1 heari ng.
� Ba sure that your finaneiai report i3 complete �nd accur�te. .
. .� � �+ •� �
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r,�nnrnn• .• � M i
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. . �l�Y �� S� . ��►�� �-ya_,o��
, Ur1IFORM C1�ARITA6lE GAMBLING ,FINANCIAL REPORT
e -� LAWFUI. PURPOSE CONTRIBUTIONS WORKSHEET
��
� Li ne �iI3 - Total laN#ul Purpose Contrf butions. � 3 sl �_ �
• List below all checfcs written from gambling fund� Nhich are
� charitable lawful purpose contributions. The tot�l dollar
amouats of thes� checks must a�tch the amount cl�i�d i�
line #�13. Use additional sheatS as necess�ry:
CHECK � DATE ' PAYEE CHECK ANpU PURPOSE
1. (��i q ��>��� �lob�-� Za.v��c.r 3 S�i MP.�1S �o r �e.r5 a.�' TowV�ne1
2. (�g0 ��a�r90 GokQ.e�. G-�loves �.8•0 o i��S�'r a-�icnn �e.L S �o�� �'`1
? rc,;, S�'�w��- IIPS.oO 1Z� �'e.�-�v�' �c,� Tow►n�`I
3. .(pg � �a7�0 C �
� �� r�. ��
�3 �13��� ���e�.5 �rJ SI�o� 071.00 �YoP���S
4. ►a l85 0o Coa�l1Q.s �-lo�ry �or �ace.vS
5. GSy ��3��10 �dbb.1 Za..�D�c..,
� � 12� Sit�2.��a�k.�,�ur...5 ���, 00 �aK���� S���te..s
6. 'l�� �i ��5U ^� .�
"�ll`)I�0 �.S� ��( r�Q+v�Q�.�v �'�'G�. �y'Z�O ���-�e+!' l�O�C� �� r.�cv�S
7. '1 o c�
8. `1�S ��' �?� ��',asivrav- 1�, Id�.S 3'7�,co � f�' e,ti� F�e. ���r G�� .
9. n_ � ,
'133 `��'�19D �la�co �'�a�c_�! � � 8s•t�o Coo.���es Sr'.�-�'y
31.� �l��b M i V1 h 2S� �'4�i� G�t ue. (�'a b bu-Y �,�,.C?¢,I S�G-�'l Uv1 �°�
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13. � 3� 3/o�-�q0 1`�;�S i d�e��w� L'&S ��l�e1' -�o,r �x��
TOTAI CHECK AF�UNT E
NOTE: These expendttures will be provided tQ Council Mkmbers at your Council hearing.
� B� sure that your finan�ial report i4 coaiplet� �nd �ccurate.
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, � . UN I FORM CHAR ITABLE GAMBL IN6 .F INANC IAL REPORT �C�p-�Q f'�'
. � � tAliFi�. PUR�SE CONTRIBUTIONS - MORKSHEET
G�
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Line �13 - Total LaNfui Purpose Contributions. f �
• List below a11 c.�ecks r+ritten from qambling funds which are
� charitable laNful purpose contributions. The total dollar
� amounts of these checks must n�atch the amount claia�d in
line �13. Use additional sheets as necessary:
CNECK �1 DATE ' PAYEE CHECK AMOU PURPOSE
-
1. '�IyO 3�o��9u '�.O�.S� y.03 5t�P1��e.S �er ��c' 1
2. �y-� 3�0�,�4d 1��-a�S �I�..�r !3�7�S Ci � l O�o C��.Po
3. � 45 3�dt�9u ��s l- 3� s�,^,b Y�c�ev�1►.�-�v �x�sr`�.1
a. '75 3 3/�+��� l�l.S. u�S� 5�9� �u.�d,c.'�I�o�e ck.� G�w�
5. "75S 3�ib f qe Co-.S1n ao.00 3 cvc��� 5�,�I�c.S
6. `��0 3/�zla� Cars�. . 9�.3d 3a�c � � s�,�.pp�;�.s
7. '7� I 3/a��90 C�h g a.by `3�K �^� 5`"PP�i�.� •
8. /�o� 3� �b �a�� G�Ol��!S �� 00 � T�c..k.��s "�� yo� �k aK 2,f.�
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4. /�3 3�1�1 lqQ �l►,Yv1.�2� 7ou-TV��� �a OQ .�Q�o�(� � �Ow��1�oXj��
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I 1. ��� ��O��1 O �05 s raor 1��� 3�S,ou �� �e 2-�v ��vyl
12. "1�1`7 y�o►�10 Il�blo.i Z�LM.ovc,., l8�•'7U Con��.� Sca..Q�1y
13. 7'JB y1�1 �9 0 �+►� 'M.tire.l t; l 8�•7a �te.� S�.�o-��
. TOtAI CHECK ANDUNT �
NOTE: These expenditures r►ill be provided to Cauncil M�mb�rs at your Ceuncil hearing.
� Be sure that your finantial repor�t 13 complete and accurat�.
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, UNIFORM CHARITABIE GAMBLING .FINANCIAI REPORT
� � [ LAtifUl PURPOSE CONTRIBUTIONS - WORKSHEET �l0-/0��
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� rpose Contri buti ons. �� 7�3�s
Line �13 - Total lawful Pu
• list below all checics r�rritten from gambling fund3 which are
� charitable larvful purposa contributions. The total dollar
� amounts of theSe checks aast match the smount claimed in
line #13. Use additional sheets as nacessary.
CNECK � DATE ' PAYEE CNECK AMO PUR�SE
i. '��l� y�o�jq� CAS� �'QO � � To�.Ki.tv��Q.t��.�" {U
2. '�fSC� y���9 0 C'e l�ean. G I o��.S o�50 00 'Tawv na.-,��°K.�' 12eq. F«s .
3'7 o to (1'Lee.Q-�r�v �a�ce�s o-F' Tc,w'v'�
3. .7$ I y�3�q o �-81-� ►
o�q$ ►"'AP.�tQ"�ov �a�Ce.�S�` �Cl�.✓�t.�►�
4. � $�- y�o3�io Co-4 h
5. '1`6 l� y�o S�9v ���a,�c.,`�•�,�k S�toe���,-+�r �i� I�e.�ai r�ax�;�.5 G I a�e.�s .
6. '1$7 4�0�� . �cl tc,,r v.�u�en�Q �roh ��5 a u I�1-�'� a� `S�vMc Mo.-E a.��
o� '"f" "'�Y 9 . ,/�
7. �QZ- y'o� �'lb �►� loL�oO l7, �n�ed -�r �oc�� �aaC�
. �.t Tcwr v�.+a�Lh�
8. "1aS' loq l9 o Ca.�t� N 7�o r-loW�.�s �,� �'�.�.�a.Q a�
r � 558•g�l Y o,�S�h��c.�
9. �q'i �I,�lqo '�� s c3�4 �- cc�y �aya e��
10. �0�- y�13�q� . ��u�h2�T�S Yov-'�'I��ax;,�a� �DOO.ou S��i�{- � yb�i �ax`�
�4 S$ �(�e.�u i i1 c-S
��. 7a� y/,�k�o c.�...s�, a�;�, s,�Pc,�s
12. �)gs y�►��9U �a.}'-�e-�s 1oc.K�15�.{e "7305 G� 5�,.��Dl:e_S
13. g 1�- `���0�9 v ��PI',c+da T�e.�' I�S� 3b Su.pP I,rs -F'o r 6y w�
TOTAI CHECK ANDUNT S
NOtE: TF►ese expenditures Nill be provided to Council Mle�ben at your Council hearing.
� 6e sure that your flnaneial repo��t is canplete and accurate.
. _ � .!� . • ' �
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UNIFORM CHARI7ABlE 6AN�lIN6 .FINANCIAL REPORT �"cf�—�0��
' . � LAl1FUl. PURPOSE CONTRIBUTIONS - WORKSHEET
�
� line �113 - Total Lawfui Purpose Contrlbutlons. =� 7�3•3S
• List below all checfcs rrrltten fram qambling funds ahich are
� charftable 1aNfu1 purpose contributions. The total dvllar
� amouhts of these checks awst match the amount ctain�d in
line #13. Use additional sheets as necessary�
CHECK � OATE ' PAYEE CNECK AMOU PURPOSE
—
1. �I 5 yl>;h,o Ch'i1cQ�r�t,�,:.s �-�asP��1 a so �uv �J o��i�.Y.
2. � I'� `���3�9e S��v�a:.Sl-a� 7•S3 S��Ire s �T�ivti �
3. �ql�:���h �.+�"
4.
5.
6.
7.
8.
9. . .
10. �
11.
12. .
13. �
TOTAL CHECK AI�UNT �
N07E: These expenditures will be provided ta Council M�mbers at your Councfl hearing.
� Be sure that yaur flnancial repor�t is caaplete and accurate. .
. .. i► J .
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