89-141 WHITE - CITV CIERK
PINK - FINANCE G I TY OF SA I NT PA U L Council
-"�CANARV - DEPARTMENT �/ /,
BLUE - MAVOR File NO.
C uncil Resolution C�
, � �_
Presented By
Referred To Committee: Date
Out of Committee By� Date
RESOLVED: hat application (ID #59523) for a State Class A Gambling
icense by the Church of the Holy Childhood Cana Club at
08 Main Street, be and the same is hereby approvedfdtr�.�cl..
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
I.o� [n Favor
coswitz
Rettman � B
s�he,ne� Against Y
Sonnen
Wilson
I �N � � ���� Form App ved by Ci A orney
Adopted by Council: Da�te �p
� 1 ' I ( — bC
Certified Passe cil . c BY
gy,
h�pproved b Ylavor: Date �N J � ��8� Approved by Mayoc for Submission to Council
By — BY
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Christ��►e, . �ek ,+�Fc�a -���R�� ��«�
� AounNC� �� . �auncil Research
Fi nanc & t. . =5456 °�": �- �,,,;,,��,
A}ap�i catian for r�ewal af a Ci ass A C�,amb3 i rrg !.i ce�se. �A-L(. Fc,2�t S�
Natifica�io date: 1-10-89 Hea`ring Date: 1-26-89
:(App►ove fA)a Flel� ) OQt1NCIL RESEARpI RE�tkEC� ' `
� .. �� rIJINiNO COMR�810N qVIL � WMMIS8101J � DA7E pJ�.. . dR� ANiflvSr�� � � . ��PHONE lID. . . .
� �nOMI6q.00MMI�ON .IBQ-.��� OCFK)OL BOARD . � . � . . � .
� � � .�.6'iAFF . � �. . � OpA�MN�ON � . � �.�E A81$ �`�'-. ADQi��#FC.-MDEDt fM AD��'l�� ���__�ADOiD•.. � ��
OIBTRK.TOOUNCL � � � �—� � - ._ .. � . . ..
?— . , •£7fP{JINATION: - , � . . . . .-. . . .
.. �� ffi1rP0A19 MIIMpI COl1tJCL 08JECTNE?'� - . . � - . . � .. � . . � - . . - � .
NM7fM"MO�lill,MN1F,DMOA7IN�'Y �YI41sE.iMrn.WtwnMi Why): _
- serome Krzm rzick, on behalf of the �'.hurch �f the Holy Chi1dh�rd Cana C1ub,
requests Co ncil approval :of his application for renewal of a Class A Gambling
� License.at 08 Main St.reet. Gambling sessinns are held vn Saturdays between
. tt�.:haiwrs o 6:30 �M and .1U:34 PP�. Proceeals .from the gamtil:ing sesst'ons �re
donated to he church.
x�,+ow tca�ue.�.M..��ar.r�u�. : . - , - ,"
All fees an applications have been submftted. A11 14� payments are cur�rer�t.
�iAE�11BiCli fN11rC Whu4 ane To wtian): ...,, _ • _ `:
If Counci 1 pproval i s gi ven, the Hol y Chi��ood Cana Cl ub wi 11 canti nue
� __ to sponsvr gambling`session.
w�e,nr� . .,r� - �s
Coun iI Research Center
. JAN 1�1��59
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DiVISION OF LICEN E AND PERMIT ADMINISTRATION DATE ' �' J� C�f�/ �02- 3O �
INTERDF.PARTMF.NTAL REVIEW (:HECKLIST Appn P oce sed/Received y
Lic Enf Au�i
A ,licant C/IU►�G 1 v-�__��Y5�i1.1 �I'I �� �� �a� � G�Z h'1 �C S���S �
p� � i ome Address 1�7
Rusiness Iv'ame (,�, �ij Home Phone �P 7�' o�3 �7
Business Address Qg M Q111�� Type of License(s) �.Q`1.Q(,�JQ� Q � �
Business Phone l�ss A �-lC�i'►'1 �j1�/'►Oj L1tLPmS�Z/
�
Public Hearing llate � Z �9 License I.D. 96 ��� ��
at 9:00 a.m, in t e Council Ch uibers, �
3rd floor City Hall and Courthouse State Tax I.D. �6 � �
llate Notice Sent; Q�C,� Dealer 4� U I�-
to Applicant � �� g� � IJV
P'ederal F3searms �6 �
Public He�.iring �
DATE INSPECTIUN
REVtEW VERFIED (COMPUTER) CUMMENTS
A proved Not A roved
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Bldg I & D �
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Health Divn. '
N�R� '
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Fire Dept. i �
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�o���e Dept. �� rg� � � K
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License Divn. '
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City Attorney �
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Date Received:
Site Plan � � f�C�
To Council P.esearch l (3 v I
Lease or Letter Date
from Landlord IZ �j(� g
. . ��-��r
.��.,... Charitable Gam ling Control Board For eoard Use Only
Rm N-475 Grigg -Midway Bldg.
�'� 1821 University ve. ` Paid Amt:
- St. Paul, MN 55104-3383 • � Check No.
' �":••••"�� (612)642-0555 � Date:
GAMBLING LICENSE RENEWAL APPLICATION
UCENSENUMBER: �-gp,;�-�@� /EFF. DATE: 431�1�83 �- �AMOUNTOFFEE: 5189.�i
1.Applicant-Legal Name of Org ization 2. Street Address
C�IURC�i OF HotY :aIID!!Onp r,•��}p rri�g-ST PAJI ta35 Miuwa Par��aa
3. City, State,Zip 4. County 5. Business Phone
St ?au1, 1111 551i8 ' Raas� 51Z 5��-)�95 •
6. Name of Chief Executive Office 7. Business Phone
Kathlaen R�.enthai " )/-�r�-+' �'r`�`��� .
8. Name�f Treasurer or Perso/n o Accounts�for Revenues 9. Busiaess Phone ' ,
i �.-/. ���..✓ '�/.+ � •t �� ���'� c�l�,,,_ i-��.r^u
10. Name of Gambling Manager 11. Bond Number 12. Business Phone ` �
� ' r,�
Jero�e xrZ�i1�Z1Ck 591�I;ET / . i�� % - - ,
13. Name of Establishment Where ambling Will Take Place 14. County 15.�No.of Active Members
1
Nor�1 St�r °f:;p hs_oc 5t ?�a 1 �amse� • �..4.--� ���,.
.- _,. � .
16:Lessor Name ' -` _ .::, . 17. Monthly Rent: �
North iida Building 8ssociati n � 54:�
18. If Bingo will be conducted with t is license, please specify days and times of Bingo.
� � Days Time Days Times D�ys Times
>`.�;; ' -�' 1,r
- �,
19. Has license ever been: Revoked Date: � - ❑ Suspended Date: ' ', ❑ Denied Date: ��..,-�
_ _ .-- _. . � _ .
20. Have internal controls been sub itted previously? L�1'es ❑ No(If"No,"attach copy)
21. Has current lease been filed wit the board? l�'Yes ❑ No(If"No,"attach copy)
' 22. Has current sketch been filed wi h the board? �YVes ❑ No pf"No,"attach copy)
_-,_ _ . . _ _ _. . , .. ....... __ . ... .... _..__._._. _... ...... ....._
;, G/#MBLING SITE AUTHORIZATION
By my signature below, local law en rcement officers or agents of the Board are hereby authorized to enter upon the site,at any time, gambling is
being conducted, to observe the ga bling and to enforce the law for any unauthorized game or practice.
BANK RECORDS AUTHORIZATION
By my signature below,the Board is hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to
fulfill requirements of current gambli g rules and law.
OATH
I hereby dectare that:
1. I have read this application and a I+nformation submitted to the Board;
�2. All information submitted is true, ccurate and complete;
3. All other required information has been fully disclosed;
4. I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and lawful operation of all activities to be conducted;
6. I will familiarize mysetf with the la s of the State of Minnesota respecting gambling and rules of the board and agree, if licensed,to abide by those
laws and rul�s, including amend ents thereto.
...a.�...___ . . . . _ __ _ . _. __ ._._.. _ .._._ ..
23.Official Legal Name of Organizati n Signature(Chief Executive Officer) Datey Title
�f�, ��` �/.I � � y
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`�� � �/�' /(CI�ISOWL�k?GEIfA�yOF NOTICE BY LOCAL GOVERNING BODY %'�� �-r
I hereby acknowledge receipt of a co y of this application. By acknowledging receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambi ng Control Board and if approved by the Board,will become effective 60 days from the date of receipt(noted
below), unless a resolution of the loc I governing body is passed which specifically disaltows such activity and a copy of that resolution is received by
the Charitable Gambling Control Boa d within 60 days of the below noted date.
24.Ciry��out-tt-y Name(Local Governi g Body), Township: If site is located within a township, please complete items 24
�.c.-�,-�," /� ;t _ and 25:
Signature qY Person Receiving Applic tion: 25. Signature of Person Receiving Apptication
V� .
Title Date Received(this date begins 60 day period) Title:
- , :
Nam�of Person Delivering Applicatio to Local Governing Body:` Township Name
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/ CG-000�2-02(8/88) i White Copy-Board Canary-Applicant Pink-Local Governing Body
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' City or Sdint Paul
Departme�t of Finance and Management Services �.��t{�
i License and Permit Division
203 City Halt
St. Paul, Minnesota 55102-298•5056
APPLICATION FOR LICENSE
CASH CHECK CLASS NO_ New Renew
a � .�... ao . � A
Oate '=' f-�� 19 �
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Code No. Title of icense From �O�` �� t��To �"�'-'G 19� (
3 ��i m,r � r,.;, �,� �P�-� t�� Lt'`.�;`, �"—r) ,•� � ; -;
r ,00 ��:U •��1 �� ;�.�j,_, ±, 'h; i�f.i���Ci,
AppliCanUCompany Name '
100 `��1 tl i,j� L.+� ��i-�'%
L� � �� ���)i�, � ..-T r: �
100 Busfness Name
�
100 � 1 �--u ! ;_ ( r""'1 - ;
Business Address Phona No.
100
100 Mail to Address Phone No.
_.. 100 �����1 ,�,+�i %`,C' .:i,'7'.., ' G I .. -
. � ��
ManaperlOwner•Name
__ �oo i � , ' j ���"
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�� . . J� 6 f / �f� l; ��E'-� %,.� �
� 100 �tanagedGwner-_HOmeAddrcss PhoneNO.
4098 ApPlicafion Fee 2. 50 . .-� � : ^� � -/
Received the Sum of !, 1/�010,1 �i. ��� �� 1 �v; ;j �JJ �,`� j
_ c.� u��V • VV
_ _ ManagerJOwner•City,Stale 3 Zip Code ��7
_ �� 100 Total 100 � j'
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License Inspector v�--� By: ` � r ,�____�� /Signature ol Applieant
i ,
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Bond:
v/
C mpany Name Policy No. Expiration Oate
Insurance:
C mpany Name Poliey No. Expiration Oate
Minnesota State Identification No. Social Security No.
Vehicle Information: I
Serial Number ate Number
Other:
THIS IS A RECEIPT FOR APPUCATION
THIS IS NOT A LICENSE TO OP RATE.Your apptication for license will either be granted or rejected subject to the provisions of the zoning
ordlnance and completion of th inspections by the Health, Fire, Zoning and/or License Inspectors.
$15.00 CHARGE FOR ALL RETURNEO CHECKS
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. . City of Saint Paul ���-/�
Finlnce and Management Services/License & Permit Division
INFORMATION REQUIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHARITA.BLE GAMBLI:IG GAME I:t
SAINT PAUL (To be u ed with the following: New A & C application, renew A & C
Licenses, and new an renew B in Private Clubs.)
1. Full and comp e name of organizati whic is applying for license
� L�`��
� �✓
2. Ad ress where ga�mes wi11 be held �G��'{� �O.Z
� Number St eet C ty , ip
3. Name of managerlsi ning this application who will conduct, operate and manage
i �
Gambling Games Date of Birth � � �'���/
�
(a) Length o e manager has been member of appl'cant organization
4. Address of Manag r /�� G � �7 ���
� umber S e t City /• y,i.P O f�G
6 � 30�
. �
5. Day, dates, and ours this application is for 3 /� � G� (�f
6. Is the applicantior organizatian organiaed under the laws of the State of MN? G��—
7. Date of incorpor�tion �/'� �
8. Date when regist�red with the State of Minnesota �
9. How Iong has org nization been in existence? �i .
10. How long has org nization been in existence in St. Paul?
lI. What is the purp se of the organization?
12. fficers o appl cant organization:
�
Name Nam
I
Address� L d � � Addr ss/.3 �� �
.�— � � - l
Title � DOB � � q tle e���`+�/�DOB —
/- ^ �
Name � � Name
Ad ress Z. Address
Title ` DOB ��O Title DOB
13. Give names of off�cers, or any other persans who paid for services to the
organization.
Name Name
Address I Address
Title Title
(Attach separate sheet for additional names.)
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14�Attached hereto is a Iist o names and addresses of all me ers the o an' ation% /
' d�'
15. In se custod will o ganization's r cords be kept? f3� - / ,
i � � .✓J/
Na Address � O ,
16. L��t 1 ersonl wi the authori to si n checks for dis ersal of amblin roceeds:
P � $ P 8 g P
, '
Na ' Name
dress� . D Address
D em r of �' /�gi Member of
DOB v� �� �Organization? DOB Organization?
Name ` Name
�
Address/ �I �Address
� ember �,l�f' Member of
� DOB �+'� � , Organization? � DOB Organization?
17. a) Does your org nization pay or in e to pay accounting fees out of gamblin funds?
yes no �. �u�',. /�����
b If ou do a accountin fees to whom wi11 ee e aid?i�`O�
) Y P Y 8 � P
� �
Name Address '^
DOB �----- Member of Organization? ---�—
c) How are the ccounting fees charged out? (flat fee, hourly, etc.)
18. Have you read an do you thoroughly understand the provisions of all laws, ordinances,
and regulations overning the operation of Charitable Gambling games?
19. Attac�ed hereto o the form furnished by the city of Saint Paul is a Fina cial Report
which it .emizes a 1 receipts, expenses, and disbursements of the applicant organiza-
tion, as well as 11 organizations`who have received funds for the preceding calendar
_ _" �
year which has e n signed, prepared, and verified by
,7 �/��
� Address
who is the of the applicant organization.
Na
20. Operator of premi$es where games will be held:
. /
Name
Business Address I Q �� ��
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Home Address �
�� �-�'���
��
/ �
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. �
_ ��� ��
"L1. unt of rent paid by applicant organization for rent of the hall:
� D`� � � s;o�
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22. The roceeds the games ill be di �ursed after dedu ng prize layout�costs and
operating expen es f he following purposes and uses: / �
�
� � /
23. as the premise w ere e games are to eld been. cer e or oc atfc the���
City of Saint P�uI?
�
24. Has your organi ation filed federal form 990—T? � If answer is yes, please at a
a copy with thi app i tiA'o�n.p�O answ�r is no, lain why:
/ , � J� �
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!
An anges sired b the applicant association may be made only with the consent of the
City Council.
.
Organization Name �
I .
� � � / � �
Date g
Man in c rge of game
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� Organiz�ion President or CEO
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• C1Cq ot Saint Paul Page 1
� � Department of Finance and Management Ssrvices
!�1 � Division of Lieease aad Permit Administration — /�/
.. �� �,
� I� UNIFORlS CHARITABLE GAlIBLING FINANCIAL REPORT
I
K II Data
'��� 1. Name o� Organization ��
� � �f•��0/Z.
� 2. Addrea where Charitabls Gambliag ia coaducted � • • �
^� � 3. Rsport for period covaring . � 19�ehrough '(J-�i. �� 19�
`\ � � �1p �+'
N 4.J 'fotal �umber of daqs played V 0
` ::: �
� 5. rose �eceipcs for above pariod /�� S �O� '
� �0
� �� 6� Groaa �rize payouta for abova period (includa cash short) ; � ,
� � > et radaipt9 - line 5 ninua line 6 S �
� • I
1 � 8. Expens s incurred in coaducting and operating game:
� � A. Gro s vages paid. Attach worker liat vith �� .
na s. addresaea, gross vages. number of hours �
wor ed. snd amouat paid per hour.
B. Ren for �� ���_ _� � � �� 1�� •
/� fn.�r
C. Lic nse fe � �� S �'
D. Ina rance � � G���'�`^'�v ; Q
� E. Bon ' t f �DT �
P. Dis onored checlw not ncovered � � S �� �� `
G. Acc untiag Expense� � i � � t
��
H. Emp oyers F.I.C.A.
I. Pul tab Tax Paid to Department of Revenue � �_T���
J. Minn�. U.C. Taz ; �
R. Fede al Exeise Tax 6 Stamp ; � � /O '
L. Stat Gaabliag Taa 3 �� w
� H. liisc 12aaeous F�c easss. Identify ths a�ount
� �� a o whoa pai .r � �
1� ' �,���' �- 9
�
�� 2. I, � �
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� ` 3. I i
� `. '� �; �''�
� 9. Total ansea '�� ;
� L0. Net Iac - lins 7 �im�s lias 9 � �
• � 11. Checkbook balance begimiing of period S � /�
��
12. Total of ine 10 aad 11 ; � /
13. Total eon ributiona (froi attached worksheet) �� 8 ��
/
14. Cheekbook balance end of reportiag period - �
line 12 l�as line 13 . ;
. _ � _•,! ��
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UNIFORM CHARITABLE �AMBLING FINANCIAL REPORT
� LAWFUI PURPOSE CONTRIBUTIONS - WORKSNEET
. . . . . ��d�'`/fy
. Line �13 - T�tal Lawfui Purpose Contributions. 5
• List be ow all checks written from gambling funds which are
charita�Te lawful purpose contributions. The total dol�ar
amaunts of these cttecfcs must match the amount claia�d in
line �1 . Use additional sheets as necessary.
CHECK � DATE � PAYEE HECK AMOUN PURPO E
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TOTAL CHECK A NT
NOTE: These expend tures wi11 be prov ed o nci ers at your Council hearing.
� Be sure that your� financiai report is complete and accurate.
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