90-1656 � n � !\�� �o ncil File � �cp�
D�� C7 � H ��,
G een Sheet � 11546
RESOLUTION
CITY OF SAINT PAUL, MINNESOT
Presented By
Referred To Comcn tee: Date
RESOLVED: Tha application (ID 4�13372) for renewal of a State Class B
Gam ling License by Church of St. Casimir at chwietz's Bar,
' 956 Payne Avenue, be and the same is hereby a proved/d�e�,.
Nava Absent Requested by epartment of:
Ton
osw
on
ac a ee
e tman —
iuson �— BY�
Adopted by Council: Date SEP i 3 1990 Form Approve by City Attorney
. .
Adoption ertified y Council Secretary By: 1' �d
By� Approved by ayor for Submission to
Approved by Mayor: Date .� ��3 �p � � �g�puncil
By. e By:
PUBIISNED S�P 2 ? 1990
� -/G����' //
� � V
DEPA ENT/OFFICFJCOUNCIL DATE INITIA7ED N� .,115 4 6
Finance/License GREEN SHEET
CONTACT PER30N&PHONE INITIAL/DATE INITIAL/DATE
�DEPARTMENT DIRECTOR �CITY COUNCIL
Christine Rozek 298-5056 A8SIGN �C�TYATfORNEY �CITYCLERK
MUST BE ON COUNCIL A END BY(DATE) 11UNBER FOR gUDGET DIRECTOR FIN.8 M(iT.SERVICES DIR.
City lerk ROUTINQ ❑ ❑
Hearing/ g` 13 QO $y� � C'� ORDER �MAYOR(ORASSISTAN� � (',nttnril
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUE3TED:
Approval of an pplication for renewal of a State Class B Gambling License.
Hearin : � 13 O Notification:
RECOMMENDATIONS:Approve(A)or ReJect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER HE FOLLOWINCa QUESTIONS:
_PUINNINQ COMMISSION _ CIVIL SER ICE COMMI3SION �• Has this person/firm ever worked under a Contract f this depertment?
_CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a city employee?
_3TAFF — YES NO
_ DIS7RIC7 COUR'r _ 3. Does this personlfirm possess a skill not normally sessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVE7 YES NO
Explaln all yea answers on separate sheet and att h to green sheat
INITIATINCi PROBLEM,ISSUE,OPPORTUNITY(Wh ,What,When,Where,Why):
Jerry Tri on b half of Church of St. Casimir requests Co ncil approval of
their applicat on for renewal of a State Class B Gambli License at
Schwietz's Bar, 956 Payne Avenue. Investigative fee of 373.25 has been
submitted. P ceeds from the pulltab sales are used to elp support the
elementary sc ool.
ADVANTAOES IF APPROVED:
If Council ap roval is given, Church of St. Casimir wil continue to
operate a pul tab booth at Schwietz's Bar, 956 Payne Av nue.
DISADVANTAQE8 IF APPROVED:
DISADVANTAGES IF NOT APPROVED:
��C�1V�D Council F�esearch Center
�u�a�1��0 �U� 311990
C��°�: �LE�tK . . _ .
TOTAL AMOUNT OF TRANSACTION COST/REVENUE BUDGETE (CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) ���/
l!V
, . . �. � ��y�-��.�
�DIVISION OF LICENSE PERMIT ADMINISTRATION DATE v� 9d/ S �� /C�
INTERDEPARTMENTAL REVI CHECKLIST Appn roc ssed/Received y
► Lic Enf Aud
.J� r �",�� ►
Applicant (� � o�'�. �S/���- Home Address � ir�..e�
Business Name � � ��2-- Home Phone � 71 �/S��.
Business Address �j(� '1'Q If� Type of License(s) � --
Business Phone � �v� �. C I,c�4�
Public Hearing Date '�� 13 Q License I.D. � I33 "� a
at 9:00 a.m. in the C uncil Chambers,
3rd floor City Hall a d Courthouse State Tax I.D. �� 1V
Date Notice Sent; Dealer � 1�,
to Applicant
Federal Firearms �� �U�,Q.
Public Hearing —'�'
DATE INSPECTION
REVIEW VERFIED (COMPUTER) COrIl�IENTS
A roved Not A roved
Bldg I & D !
���
Health Divn. �
��� I
Fire Dept. �
�'1� I
Police Dept. � IgIa�19�
License Divn. g ��D I
I Q�
City Attorney g,���Qb�
� i
Date Received:
Site Plan r� � a3J 90 Q� J G
To Council Res arch 4 ��I — 1 V
Lease or Letter �C Date
f rom Landlord � 013 _t(�
, . , City of Saint Paul (��-'��
� partment of Finance and Management Service
� Division of License and Permit Registratio
INFORMATION REQUIRID WI APPLICATION FOR PERMIT TO SELL PULLTABS TIPBOARDS IN SAI:1T PAUL
(Class B Gambling Licen e in Liquor Establishments - Renew)
1. Full and complete ame of organization which is applying for icense
�3`, S i� � � 4 v f• c �
� ` , rro�
2. Address where game will be held � G' �> !/ � �„ - .S �l
Number S reet City Zip
3. Name of manager s gning this application who will conduct, o erate and manage
Gambling Games � L L Date of Birth � �� l 6 � �3
(a) Length of tim manager has been member of applicant orga ization 3 � �4!
4. Address of Manage � ��o � �SS /�-i��Yt r �'�� � �'�� :S�.S^ln
Number Street Ci y Zip
5. Is the applicant or organization organized under the laws of the State of MN? �� -�'
�
6. Date of incorpor tion � �� Z
7. How long has org nization been in existence? �,.�� ) S- � �
8. How long has org nization been in existence in St. Paul? ! � C 9 6 S
9. Wiiat is the purp se of the organization? �, - � � ,t �- 0 4 �
/i "'t� �e h�^ �
L0. Officers of app icant organization:
Name�r`y4� � H /T1`Ca�So s. Name p e G-= u
Address 3 � � ,�„� �� "," >» Addres�/�Q,.i �.v �ra �ti P
Title cr�T c i- DOB`D-3/- fiZ Title t/ ,t� - DOB
Name c✓ o Q Name
Address 9 c � 7� � Address
Titl� DOB �--�- � 2„ Title DOB
11. Give names of fficers, or any other persons who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separate sheet for addition names.)
� � ��o-i��
� 12. Attached hereto is a list of names and addresses of all membe of the organization.
13. Zn whose custody 11 orga ization's pu2ltab records be kept?
��
Name ,�� � Address �� � i�.� .q
14. List all persons ith the authority to sign checks for dispe sal of gambling proceeds:
Name h � ��9 N�2 Name � c,L� _ � ��
Address � i yT � Address e�^�/�i C�.,� ..
• Mem er of Member of
DOB d" g=S l Organization? � S DOB � `�Ei" ..3 Organization? � � ,s'
�
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
15. Have you read an do yo horou ly understand the provisio s of all laws, ordinances,
and regulations overning the operation of Charitable Gambi ng games? ' �
16. Attached hereto n the form furnished by the city of Saint aul is a F nancial Report
which itiemizes ll receipts, expenses, and disbursements o the applicant organiza-
tion, as well a all organizations who have received funds or the preceding calendar
year which has een signed, prepared, and verified by �
� G—' ` � � �l .s'�o �
Addr�ss
/
who is the ...5 ,./c f of the applicant organization.
Name
17. Will your orga 'zation`s pulltab peration be operated/man ged solely by members of
your organizat n? yes s J' no
18. Has your organ zation signed, or does it intend to sign, consultiag agreement or a
managerial agr ement with any person or company to assist our organization ith the
pulltab sales nd/or recording keeping? yes no Q
If answer is y s, give the name and address of the person and/or company contracted.
Name / Address
Name / � Address
�
If answer is es, how will such a consultant be paid? (pe centage, flat fee, gambling
funds, genera funds, etc.) Attach a copy of said contr t to this application.
19. Operator of p emises where games will be held:
Name � t.�//�
Business Addr ss ,J�� U
Hame Address ' �O � � Q�►Q %� �4. �i 7'$ '� � � � ��
, , �, � �-yo-�G.s�
20. a) Does your organ zation pay or in •end to pay accounting fee out of gambling funds?
yes no G
b) If you do pay a counting fees, to whom wiil such fees be p id?
Name Address
DOB Member of Orgaaization?
c) How are the a countin fees charged out? (flat fee, hour y, etc.)
d) What do you a t cipate will be your average monthly dedu tion for accounting fees?
21. Amo t of rent pa d by applicant organization for rent of th pulltab sales area:
/� - ''g,�+
� �
GC. ac � �, � P- p
22. The proceeds of t e games will be disbursed after deducting rize Iayout costs and
operat�xpens s for the following purposes and uses:
G c �T ��
� Gw 4 ) o �
23. Has your organiz tion filed federal. form 990-T? ��If a swer is yes, please attach
a copy with this application. If answer is no, e�cplain why
O � G �f ��� p� i� �� �i
G� `b ,� ...1'
Any changes desired y the applicant association may be made onl with the consent of the
City Council.
� G< </J-c ci S. �Q s lysi�l-
• 0 ganization Name
.
Date — �. ;3 r d By: —�.,
er in charge of game
� �
Organ ation President r CEO
. City of Saint Paul Page 1 �
� � � � , Depattmsnt ot Finanee and Managemenc Servieee /S�
� Oivisioa of Llcensa and Permit Adaiaiatzatlon �C/����
/
UNIFORPI CHARITABLE GAl�LINC FINANCZAL REPORT
n�c. —Z �3`9d
1. Nams oE tganizatlon � ,S �� G Z a� �� v s/?� / ``�'
2. Address hers Chsritabl• Gaabling la eoadueced S V �
3. Repore f r period eovaria� � �C� 19�through t! 19�0
4. Total nu ber of days plsysd Z z �
5. Cros• re elpts foc abov pariod ; 7 l l°� U Q
6. Gcoaa p ize payouta for abovs period (inelud� es�h short) i ..3� ��� � �
7. Nec rae ipcs - 11as 5 minus line 6 ; �� � � d
8. Expenae incurred Sn eondueting aad op�rating ;ma:
A. Cro e vages paid. Attach rorker list vith l
na s, addreasas. gro�s vages, nuaber of hours S ����'7�'�`S
vo ed, and amwnt paid psr hour.
B. Re c foc�_ ���� f 3 �Q. a a�
C. Li enea fee S
D. In urance ;
E. Bo d 3 —
F. D ehonorad cheeka not tecovered ;
C. A coantin� Expe`nsa J =
ci// T bT�Urc�i9scd��.'Z-°h' �Py ; '� , U G
H.
I. P lltab Tax P�id to Departa�aC ot Rsveau� ; � ���'/6
J. an. U.C. Ta�t s
R. ed�ral Exeis• Tu 6 Stup =
�/ 3 Z 73- 18
L. eac• Ga�blin� 'fax •�er��S /p�
!I. i�cellaaaoua Expsasas. Idsntit7 cM a�ount
ad co rhoa paid.
. ;
2. :
3. :
4, ;
9. 'Iot �cpsnsu , TO'fAL i ��o � 7�- �i 7`
10. N�e IneoM - lin� 7 desn• lins 9 = f 9 s7 7• j �
11. Ch kbook balaaee bs;iaaia` oi p�riod ; Z S,rC� 0 0
l2. To al oE lina 10 and 11 ; z� �, ^ � �
" 13. ?o al concribuclons (Eroa accaeh�d vorbh��t) : � 6 d�6� 6 �
14. Ch ckbook balanes ead of rspore�n� p�rsod - Z 3�� 3 6
li e 12 lesa liaa 13 ;
�.. � � J� �1 . ,-nv�
• , UNIFflRM C�tARIT�BL� ru+iMBL:�IG =:�IANC inl :�E�4 T �CIQ—�(BS�O
, , � , ��;'yIFUL PURPOSc CONTRI3UTi0N5 - '+�ORKSrit=�
l.i ne =?3 - �ot I !a�+TUl ?vrpos� �ontr�out;or.s. � 28,086.UO
L,st Seio a11 checks wr�t�en �ram gambi�nq 'uRGS '+/til �t are
c7aritabl iawfut purpose contriautions. �ne totai d 11ar
amounts o" these chetxs �nust �natch *he amount claimed in
line �13. Use addi�ional sitee*_s as nec�ssary.
� I
' I aaYE= ruEr� �lqp�� =�,{RPOS"c
C�E�< - � ��A��
1017 `1�:/7/$9 � St. Casimir School �1200.0� F r School Use
" I I
� 1021 �12/12/$5� St . Casimir 5chool 2000.00 F r School Us�
�. 1024 ; 1/9/90 ! St. Casimir 5chool I 3000.00 F r Scnool Use
' I
� 1029 �I 1/26/90 East Side Y;�iCN � 725•00 1 �o Donation
I �
_ io35 i z/13/90 5t . Casimir School � 2000.00 F r School Use
5. 1036 � 2/2$�9 � Home �. School _ I 100.00 or Ulassroo:n U sP
. 103c � 3/13i 9� � St. C;,.s�mLr Scl�ooZ � 3000.G0 ror 3chool Use
� I , �
g I01.�1� I �.;�?i'9 � ��. Casi_:iir �c�io.�? � 2000.00 or School U�L
I a � 11.00 0°o Donation
�, 1045 4/22/9 Parkway Little Le gu 7 ,
iQ, 1049 5/21/9 St. Casimir School 3t�00.0U or School Use
;i, 1053 I6/1$/9 St. Casimir SEhool ' z35o.00 or School Use
�
:L. I �`
I . f
J. Ii �
TO7Al CyEC!C Ahqt�NT 3 200$6.00
- c
'10T�: ihese exe ndztures wi11 be provided to Cauncil Mesnbe at yaur Caurtcil hear;ng.
3e sure * at your financial report 15 comolete and ac urate.
I� r r! f � • � �
. �� � �� � R � � .., � j = 7� � � �
I v 1 � a
r � � i i = � . ]� : • r PI ` ��
• III = ,� � I i = 4 a
� • 1 , � � , � . . � • O ; Z �
2 I � • 4 � + � = • � 1
' � = � = � � �
• • � i � 7 �
! • 1 r�1 = 3 r, s 71 �
I = ' � ' � z I q .}- -. f y �
' � � �/} � � � � =
I � � � 1 � ' '� '� �� ,H ' i � � Q
� s il � ° � •1 • il -� � � s
y � . s� � � .� � �- ' - W � �n
a� � � � �� a �. - � � � "
�1 I{ � ,� � � �I : A - _ { +� i ��.r� at �
a� ♦� •1 � � ' 1 + .
•1 i '' � • • .n..�•r •f � . . � � •
i I 1 a ! �� a , V � �. �
� I � �� = < � ~ . ��' `�� � � I
� � sl � a� � � � I� (,�1+ * i
'� I a� • �► � `�.� : - � � j- �
at w . I � � j ? :
� ;, �S ' �—
t I �} I i ;� �i L � a
� � r ^ .. � .
� � � e �; .i- ! � .
i s �� �
= �1 •
�I _S ' a' � � i
� 7� �41 � � � i
' •� f ,� � � '� 1 i
j f I � �^ �+(` r
. �I 1 f; ]� � ^! !/ { � �
� j u � u y I �
� i ' 't