90-1681 � � � � Cc�uncil File #` �����
INAL
, qreen Sheet � 11545
` RESOWTION
F SAINT PAUL, MINNESOTA
Presented By
r
Referred To Comm�ttee: Date
i
RESOLVED: Tha application (ID �637646) for renewal of a�State Class B
Gam ling License by Deafness Education & Advo acy Foundation
(D. .A.F.) at Mr. Patom's Saloon, 995 W. 7th $treet, be and
the same is hereby approved/.�x�rie��, i
,
�
a s P,bsent Requested by Department of:
zmon
�s i�Z License & Permit Division
n �
acc e �
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i son �, By' j�
Adopted by Council: ate
SEP 1 3 19gp ��m' Approved by� City Attorney
Adoption C tified by Council Secretary gy: � • � � p/Z6�fv
BY� Approved by May�pr for Submission to
Approved by Mayor: ate � / f�Q ��;' � L_- '���uncil I
By: By�
PU LISNED �t P 2 2 1990
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DEPARTMENT/OFFICE/COUNCIL DATE INITIATED N�i _115 4 5
w � Finance/Licen GREEN SHEE
CONTACT PER30N&PHONE INITIAUDATE INITIAUDATE
�DEPARTMENT DIHECTOR a CITY COUNCIL
Christine Roz /298-5056 Asa��N �CITYATTORNEY �CITYCLERK
MUST BE ON COUNCIL AQENDA BY(DATE) C1. CZ x' NUMBER FOR ❑BUDQET DIRECTOR �FIN.8 Mf3T.SERVICES DIR.
ROUTINO
9 r� �O $ � O ORDER �MAYOR(ORASSISTANn � (:nttnri 1
H in
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Approval of a application for renewal of a State �lass B Gambling License.
Hearin : 13I�� Notification:
RECOMMENDA710NS:Approve(A)or ReJect(R) pERSONAL SERVICE CONTRACTS IIAUST ANSWE THE FOLLOWIN(i�UESTIONS:
_PLANNINO COMMISSION _CIVIL SE VICE COMMIS310N �• Hes this person/firm ever worked under a contract r this department7
_CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a city employee?
_STAFF — YES NO
_DI3TRIC7 COURT _ 3. Does this personlfirm possess a skill not normall ssessed
y by any current city employee?
SUPPORT3 WHICH COUNCIL OBJECTIVE7 YES NO
Explaln all yss answers on separats sMet and a ch to yroen sheat
INITIATINO PROBLEM,ISSUE,OPPORTUNITY(W ,What,When,Where,Why):
Neil Johnson n behalf of Deafness Education & Advocacy Foundation (D.E.A.F.)
requests City Council approval of their application for renewal of a State
Class B Gambi ng License at Mr. Patom�s Saloon, 995 W. th Street.
Investigative fee of $373.25 has been submitted. Proce ds from the
pulltab sales are used for direct services to the deaf hearing impared
community.
ADVANTA(3E3 IF APPROVED:
If Council ap roval is given, Deafness Education & Advo acy Foundation
will continue to operate a pulltab booth at Mr. Patom's Saloon,
995 W. 7th St eet.
DI3ADVANTA(iE3 IF APPROVED:
DISADVANTAOES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION � COST/REVENUE BUD(iETED(C CLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN)
���.-���1
- DIVISION OF LICENSE PERMIT ADMINISTRATION DATE � �� O / o/17 J�Q
INTERDEPARTMENTAL REV CHECKLIST Appn rocessed/Received by
Lic Enf Aud
Applicant � � Home Address �( �• �O�rZ� ��'�-�c�
Business Name -� ��►'ns��D°�Iome Phone � y— 3(���
Business Address 5 (Q, -]'�'1 �� Type of License(s) ; �-�1�SS �
Business Phone C( Wi�j 1� n l.� e �Y1S-e-. � 1't�4�f
Public Hearing Date �� �t� License I.D. � 3
at 9:00 a.m. in the ouncil Chambers,
3rd floor City Hall nd Courthouse State Tax I.D. �� 7 �c�
Date Notice Sent; Dealer � � 11
to Applicant
Federal Firearms # � ��/�
Public Hearing
�
DATE INSPECTION
REVIEW VERFIED (COMPUTER) COrIl�IENTS
A roved Not A roved
Bldg I & D �
1�.7 �
Health Divn. I
N�� i
Fire Dept. I
� �a- I
Police Dept. �� ���� ��
���a,� ��o o,�
License Divn. �
��i3�90 I
o K—
City Attorney f
�`�a��q�,
f
Date Received:
Site Plan
�.__.�
To Council Re earch
Lease or Letter Date
from Landlord �b bt� �r1"�
p
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�__ . - - - _T .�� _. _
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. City of Saint Paul �'� �������,
, • , . . epartment of Finance and Management Servic�s
' Division of License and Permit Registratio�i
r
�
INFORMATION REQUIRED WI APPLICATION FOR PERMIT TO SELL PULLTABS � TIPBOARDS IN SAINT PAUL
(Class B Gambling Licen e in Liquor Establishments - Renew)
1. Full and complete ame of organization which is applying for 'license
�� � c + r O •�-cnC
2. Address where gam s will be held �j �� a U � (�
�
Number Street Cit Zi
Y P
3. Name of manager s gning this application who will conduct, erate and manage
Gambliag Games Dat of Birth � �i ! ��-�-
(a) Length of t manager has been member of applicant org nization � (�Cw Y S
t -1 � �
4. Address of Manag r 1 O� dd � �((�, �
Num er Street C ty Zip
5. Is the applicant or organization organized under the laws o the State of MN? V('(, S
�_,�
6. Date of incorpor tion �
7. How long has org nization been in existence? O
8. How long has org nization been in existence in St. Paul? � S
9. What is the pur ose of the organization? �' '� ��
� � � � �
10. Officers of app icant organization:
Name � �,� � n � Name
Address 6 C6 hp�Cf f Address S�� N�.17
�
Title i/�,� DOB 3 � Title " q�� Y DOB
Name � � Name �--l � D
�I`� T Gt U ' . 1 •{-}_W
Address �� �j Address (p -�- �
Title V V �B �� Title DOB �_s�!�
11. Give names of fficers, or any other persons whd�d fo services to the
organization. ' � �L ( � '��a�¢ GY��y�2�'�'tbh
GC Q.GI
Name Name
Address Address
Title Title
(Attach separate sheet for additio 11 names.)
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f
� �1��'/�°`� _
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,,12. Attached hereto is a list of names and addresses of all membe�s of the organization.
, ,
13. In whose custody w 11 organization's pulltab records be kept�;
� l
Name l �i„ �c 1 `�l�Q _. Address �����Q �p� t¢. ��
14. List all persons ith the authority to sign checks for dispe sal of gambling proceeds:
Name � y Name
Address �p ( Address
Member o Member of
DOB -- Organization? S� DOB - Organization?
Name Name U `/
Address '7'� ���� ( M N Address �. � � �� S�- ��
Member of ember of
DOB ( Organization? ���� DOB `-j �/(a Organization? ��—
15. Have you read an do you thoroughly 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 Financial Report
which itiemizes 11 receipts, expenses, and disbursements the applicant organiza-
tion, as well as all organizations who have received funds �for the preceding calendar
year which has b en signed, prepared, and verified bq
Address
who is the V � of the applicant organization.
Name
17. Will your organ zation`s pulltab operation be operated/ma ged solely by members of
your organizati n? yes no
18. Has your organi ation signed, or does it intend to sign, consulting agreement or a
managerial agre ment with any person or company to assist !your organization with the
pulltab sales d/or recording keeping? yes no
If answer is y s, give the name and address of the person and/or company contracted.
S-t Pa�1�h+.A�
Name ✓ Address i v� ~/(�'
Name Address
If answer is y s, how will such a consultant be paid? (p rcentage, flat fee, gambling
funds, general funds, etc.) ttach a of said contr ct to this application.
19. Operator of p emises where games will be held:
i
Name G�
Business Addr ss Ct S �� � �
Home Address
_ _ �
--------__ __
. �I C�,c y�-/��
� . ,,
20. a) Does your organi ation pay or intend to pay accounting fee out of gambling funds?
yes no
b) If you do pay ac ounting fees, to whom wi11 such fees be p�id?
, I � L S-� P��l,M�
Name � p � � , Address �ja�V �J�'L�� �t(�,q�_�S(l�
�
DOB Member of Organization? _� �
c) How are the ac ounting fees charged out? (flat fee, hou y, etc.)
�
d) What do you a icipate will be your average monthly dedu tion for accounting fees?
� °° �
21. Amount of rent pa d by applicant organization for rent of t pulltab sales area:
� � �
22. The proceeds of t e games will be disbursed after deducting ;prize layout costs and
operating expense for the following purposes and uses:
,✓
23. Has your organiz tion filed federal form 990-T? e�� If nswer is yes, please attach
a copy with this application. If answer is no, lain wh :
An chan es desired the a licant association ma be made o I with the consent of the
Y S Y PP Y Y
City Council. -
� � � ��
� • rganization Name
Date � By: ��u�'l,
M ager in charge of game
�� S�i(n.c.
Or a i tion President or CEO
I'
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_ _ �
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- C..q of Sa1aC 7au1 ?age ; �
•�w . p� Depar:�ent of Fiaante aad '!anageaenc Setvice�
. 7ivisioc af Lieenne and Peratc Adalai�c:stion
U;{jrpR.Y CiARITASLE GAl4ELL'tG FIVAHCLtL REPOR?
- �aca
L. Nsas of 0 gaaizacion c . � ��� ��G � '
2. Addraas ere Chsricabl• Gtablia; la cvndueced ) �� � �.
J. R�porc Ea period eov�rias. L9� throu=h 19 t�
4, Tacal nu er oE daya plsyed � !d
5. Cross re elpca fac above pariod 1 f o D � � �•
6. G[o�a Qr z� payou[a for abw• p�riod (ineluda eash �hort) f / . .,
/
7. Nec cece'pta - 1Sae 5 ai.aua liae 6 � t -��jJ�?'�!. �
$, rxpsnae :aeurTed 1a coaduccia; and op�ratiag ;ma:
A. Gca � vasee paid. Acuch vork�r liat vich ' I,
nam s, tddt�nsa�. ;ro�s vagae, number of houra i ��.�-^
vot ed, and amwat paid psc hour.
3. Ren Eor �7'`� veefv �Q 1'17QjT1 �r"J f I �L���
C. Llcense fet S �
D. In u:ance s /'
E. 9a d � S ��� ��
T. Di honoced checic� noc recovared ; �`�
G. Ae ouncSng Expmse : ; y�u f�?o �
K. plo7rera F.I.C.A. _ �� ����• `� � �
cJ £,' u
I. P llcab Su Paid Co Daparm�ae ot R��enua 3�; ' � ' . ' / �
1. K Aa. V.�. Tax fp � �.l7l�a, �I
K. datal T_xcisa Tat� i Sessp sf� �
� } �L. tsca G�blin� :u �
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lL. Ch ekbook balaaca be;inaisi; of Period f �
l2. To al oE linr l0 aad ll �, f _ r ' �3��O��
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'� I4. C «kbook �alanca ead aE rsporttng per2od - /,
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� � SECT I ON M -
CtTY OF ST PAUL
UNIFORM C ARITABLE GAMBLING FINANCIAL REPOR
ACCT. CODE AMOUNT OPERATING EXP NSE -
530 265.99 Repairs and ma ntenance
509 883.24 Outside servi / �
bookkeeping
S 10 329.67 operating supp ies
S 12 42.00 freight/post '
539 314.93 travel expens�
�
556 64.54 bank char�s j
548 855.75 permits and i censes
575 5946.10 expensed equ' ment
595 334.31 misc.
597 -563.63 cash over a short
line 9 TOTAL , .
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