89-144 WNITE -'CITV CLERK � COURCII
PINK - FINANCE GITY OF SAINT PAUL 7
CANARV - DEPARTMEN 7 G
BLUE - MAVOR File NO. • /
� Council Resolution - a 3
Presented By
Referred To Committee: Date
Out of Committee By Date
i
RESOLVED: hat application (ID #15386) for a Class B Gambling License
y Trade Lake Camp at Tiffany's , 2051 Ford Parkway, be and
he same is hereby approved/d�ee�.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
��g [n Favor
Goswitz
Rettman CJ
Scheibel A gai n s t By
Sonnen i
Wilson
�Eg — ; '��89 Form Ap oved by ity ttorney
Adopted by Council: Dat ' /�'
Certified Pa s y uncil S tar By �L L�D
By
A►pprov Mavo •
I EB r � ���� Approved by Mayor for Submission to Council
B -"" BY
�r �
PU l�� ~:� i 81989
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DiVISION OF LICEN E AND PERMIT ADMINISTRATION llATE � g� / �� �
INTERDF.PARTMENTAL KEVIEW CHECKLIST A.ppn rocessed/Rec ived y
Lic Enf Aud
Applicaut r L(�,,� �,� Home Address � � C�1'Y� Q✓Y(��
Rusiness Name Cl� �I �,11 S Home Phone
Business Address aQ�� 1'��� 1'Q.✓IC.Lc.�l� Type of Lic.ense(s) �� GQ$S .�
Business Phone C �irn b � � , -Q�
Public Hearing Dat ( �� '�b 1 License I.D. 4{ , �S J Ol�
at 9:00 a.m, in th Council Chambers,
3rd floor City Hal and Courthouse State Tax I.D. �� 1J�f4
llate Notice Sent; r�rl�I�� ���� Dealer 4/ ��/.�
to Applicant � [
I'ederal Firearms �� �U�A
Public He�aring
DATE II�SPECTIUN
REVIEW VERFIED (COMPUTER) CUMMENTS
A proved Not A roved
�
Bldg I & D �
N�
Health Divn. '
���} �
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Fire Dept. !
; ►�I� �
, ,
Yolice Dept. I
�I � 4 K..
License Divn. '
I f�'IS � ! o�L.
City Attorney �
���Zz �, b�C�
D te Received:
Site Plan � � G
To Council P.esearch � � � t
Lease or Letter � Da e
from Landlord ��
I
' ' • � .�N �,,1 � �/��
'�:�:.:'�!�c� Cha itable Gemblin Controi Board
.� rr..., 9 FOR BOARO USE ONLY
�" ��� `•,�� Roo N-475 Griggs•Midwsy Buildin�
a-�'",c`�!. .�F. 'rE� 182 University Avenue �O'"""""i0i
'�` x St. aul, Minnesota b5104•3383 PA�p
;�,,,;;��'•', (61 1642-0555 AMT .
��' ' I CHECKX �
� DATE
, � GAMBLIING LlCENSE APPLICATION ,
.
�
q�18TRUCTION8:• I' .. �.'
A. Typs or print in ink. I'i ,
B. Take completed applicati n to locat goveminq body,obtain:ipn�ture sM dats on sll copies,and leav� 1 copy.Applicant keeps 1
copy�nd sends oripinsl t the abovs address with�check.
C. Incomplete application: ill be returned.
Typ�of Application: ,
DClass A — Fee i 100.00 IBi go,Raffles,Paddlewhe�l�,Tipboards.Pull-tabs)
,�Clas:B— F��i 60.00(R fftet,PsddlewheN:,Tipboards,Pull•t�bs) M�Oh��P�Y�N�o:
O Cla:s C — Fee i 50.00(Bi go only► ��et���a�^�w�o^�+�
OClass D — Fee 1 Z5.00 IR ffles only►
CYs o 1. It this applica ion ior e renewal� Ii yes, ive complett license numb��
Y�s�7No 2. If this is not a spplication for a rene�wat, has or anization been licenaed by the Board befo�e7 If yes,pive base
license numb r Imiddle five digits► l U 1 7
Ys=ONo 3. Have tnternal ontrols been submitted prsviously�Ii no,please attach copy.
4. Ap�p�nt (O}ficial,Ieqsl a s oi or�ization) 6. Business Addreys oi Orpanization
- � E
8. Ci State,Zip 7. Co 8. Buaine::Phone Number
�a s ( 1
9. Type of organization: r ternal ❑Veteran• GReligiou� ther nonprofft•
•II orp�nustion i:�n"other non rofit"orpa�i:�tion,�nsw�r qu�st�ont 0 ih�ouph 13.N not,po to qu�stion 14."Oth�r nonprofit"or9�niiationi
must doCUment iti tax-dx�mp�ttiiuf.
Yss�No 10. Is orysnizat�o incor oraced as s nonprotit orpenisaiionT If yss, pive number assipn�d to Articls�or pape�nd
book number: Attech copy oi certificate. •
Yes�No 1 1. Are aRicles�il d with the Secrecary of Stetel •
'Yea�No 12. Are articles fil d with the CountY7
Yst�No 13. Is oryanizstion xampt from Minne:ots or Faderel income tax7 Ii yes,pl�ass attach lattsr from IRS or�epaRment of
Revenue decla in exemption or copy of 990 or 990T.
�Y�s No 14. Mas iicense ev r bean denied,susp�ndsd o�revokedt If yes, check all that e ly:
ODenied Susaended ORevoked Give date:
16. Number of�ctiv�mtmbers 18. Numb�r of y��rs in sx�stsnc• . Note: H less thsn four ysars, actach
svidence of thn�y�us
1� � S existence.
17. Name oi Chie(Executive Offi er 18. Nams ot tressurar or pe�son who accounts for othtr rsvsnuss
ot the rqani��,j,Qn.
�� �
/
Titl• r� .
/ " Q� .
S ��RRc1 oF � s �7La MiN�r raq7'o
8usi�ess Phone Number 8u��u Pho�s Numbe�
1 �D� 1 �7� � � / ( 6 1 -� s22
19. Name of estsbliahment where y mblinp will be 20. Street sddrsss lnot P.O�ox Numoe�!
conduct �
=- s �e � D ' � ( �v
21. C�cy,Scate.Zip 22. County�wnsrs 9amblinp pr�misea is lowred!
G ►v � ''S �w,se
. CG•0001•02 f8:Foi hne CopyBard CanarvAppUCSnt Rnk•Local vovunmp Bodv
I� �
I�i .
3 .
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II
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.. . . . . �� .
Gsmb0�9 Ucsns�Apppcsd ' p�p�Z
Typ�of Appllastlo�: OClaa A �lass 8 OCf�ss C OClasa�
Y�s ONo 23. I� �mblin r mii��locat�d within city limitt7
Y���No 24. An all 9�mbll p �ctivitie�conduct�d �t ths premi��s list�d in +119 0l thi�application7 If not. compl�t� � s�par�t•
spplication 1or each prsmi�es lexceot refflesl es e separete licsnss ia requir�d for e�Ch premises.
CYss o 25, Ooes or anization own the amb��n pr0►niS03? II n0.attach copy of tt+e Ie�ae with term�oi st 4ss=t one resr.
�Y�� o Z6. Does che orpan':scion Ies�e ch�sntlrs premi�e:)If no,�ttach a sk�cch ot Z7. Amount oi Monthl Rent
the prsmiies in icacin9 whet portion i�b��np Ites�d.A I�as�and sk�tch 1 /�,/�D a d
is not rsquired or Claas 0 epplications. "/ v • ^--
CY�s o 28. Oo you plan on onductin9 bi�qo with thia license?If y�s�Qivt d�ys and tim�s oi binpo occasio�s:
� TMnw ,
Yss ONo 28. Has the i 10.0 fideiity bond reQUirsd b Minne:ota St�tut�s 348.20 b�en obtsin�d�Att�ch cop ol bond.
30. Iniu���C��pany Namse • 31. BonO Numb�r O�
32. l�saa N�m� E• �oNl�L MoN�pea'Q'�Q" 33. A�naa �- � 3�5����, ��. //
L �
3b. Gsmbll M�n�p�r N • � 38. Addre�a � 37. City,Stat�,Zip �
38. G�mblinp Mansper Busi�e�s hon� 38. Date pemblinq mana9e�bec�m•
( ! 7 member of organization: 7 ,
GAMBLINO SITE AUTHORI2ATION
8y my si9nature below,local la snforcement officsra or agenta of ths Board are hereby authorized to enter upon the site,
at sny time, Qamblin9 i• beinp c nducted, to ob��rv� ths 9amblino and to�nforce th� law for iny unsuthoriztd flamt or
practice.
BANK RECOROS AUTHORIZATION
By my siqnaturs below,the Boar is hereby authorized to inspect the bank rscords ot ih�G�ntril Gimblin9 Bank Account
wh�n�v�r n�c�asary to fulflll re uinment�ot curr�nt p�mblinp rvl�s and I�w.
OATH
I hereby dscia�e that:
1. I hsve read thPs spplication nd ell infonnatlon aubmitted to the 8o�rd;
2. AIf information:ubmittsd I� rue, accurete and complete;
3. All other required informatio has been fully disclosed
4. I am the chief executive ofti er of tho o�ganization; �
5, I assume full responsibility f r the fair and lawful operation ot all activlcies to be conducted;
6. I will femiliarizs myseli with t e laws ot the State of Minnesota respecting gamblinp end rules of tht Boerd and aqree,
11 licensed to abide b those laws end rules in ludin amendments thereto.
4 Ofiici�l, �pa1 m�of Orp ation ^ 41. Si • at b� ipn�C bY Chi x c iv�Oflic��l
X
� Tit1e t Sipr�e► p�t� .
f' -� � 7 ��j ,
ACKN WLEDGEMENT OF NOTICE BY LOCAL OOVERNINO 60DY
1 hereby acknowledge receipt of copy of this application. By acknowledging receipt, I admit havi�g bse� aerved with
nocice that this applicacion will be reviewed by the Charicable Gambling Control Board and if epproved by ths bosrd, will
become etfective 30 days from th dato ot recoipt Inoted belowl, unlesa a resolution of the Ioca1 poverninq body is passed
which specifically disallowa such ctivity and e copy ot that resolution it recsived by the Charitebls Gamblinp Control
8oard within 30 da s of the below noted date.
4Z. N me of City or County ILocal G verrnn9 BodYl I(site i�located within a township,it�m 43 mu:t M compl�ttd.in
� •ddition to tM cou�ty sip�atura.
Sipnatun ot p r• n ec�ivinQ applic�ci n 43. N�m�of Township
� X � `�� �/��
� �t Date rec ived(30 Cay period ' Si9n�tu��of p�rson rtc�ivinp application
- ���� r�� beQin�fr m thi�dat�)
: l J X
44. Neme of P��son d�blrvenn9 apphcac to locsl Gov�miny Body Title ,
Ca•0001-0Z (8/861 h�a Copr-8oard Canary•Appli�ant piya�pul Gowm,,,o gopr
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15��.�
. , City of Saint Paul
_ � Depa�tment of Finance and Management Services ;
I I License and Permit Division C���—/�
� 203 City Hal1
� � St. Paul, Minnesota 55102•298•5056
! APPLICATION FOR LICENSE
iCASH CHECK CIASS N . New Renew
� a �' !ri X
c� o oate J- �, �� ,9��J
. ,
' Code No. Title of License j I 'Y' �'� ��; , f
� From i�� 19_To !, ' % 19-' I
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i �3q3 � �=;<-...� �c, �,-�ol, ,,� ��C, c'J ------
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�oo i�G��2 2 � �-� !��l t�
� '�'� ;�i (x ."N � �(%.� APPlicantlCompany N�a_ f,
,� ._.___..- �r�-�e l�-
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100 Bualnsaa Name
�. �
�oo c:�` 5/ �-n,-� 1"�; r ,��cJ�:i ,�
�` li Business Address Phona No.
f 100 -^ � �
j I �`'�� ' �? :.C1 � ���j t j ��� jr'��
� t00 Mail to Addrea Phons No.
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� � 10� �J F�� U //�af c_� �'J`I '� �1/_
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( ManaqerlOwner•Name �J-�i
100 -� . �� �/
I i-+ ( �i {���' � i;:'�-) j� �C.�
n
' 100 AlanagerlGwner•Home Address Phone No.
i 4098 Appltcation Fee 2. 50 � � ,�
Recelved the Sum of 100 � + �
; r., c�l��, �� �»o, r,� .�. 5oy�
j ����J� ManagerlOwner•Ciry,State 3 Zip Code
{ 100 Total 100 �,..,., 7����,�
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I` � 11 (�^ � �. �����.�_�L�LCII �
; LiCense InspeCtOr `�' � By: \ ��(,��_ $fynature of Applicant
f
i
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Bond• "
Co pany Name Policy No. Expiration�ats
Insurance:
Co pany Name Policy No. Expiratio�Dete
Minnesota State Identification Na Social Security Na
! Vehicle Information: I
� Ssrlal Number Plats Numbs�
f Other
f THIS IS A RECEIPT FOR APPLICATION
� THIS�S NOT A IiCENSE TO OPER TE.Your application for license will either be granted or re�ected subject to the p�ovisions of the xoning
ordinance and completlon of the in pections by the Health, Firs,Zoning andlor License Inspectors.
S
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� $15.00 CHARGE FOR ALL RETURNED CHECKS
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.��"'�� ll—o����'
, Cicy oc Sa�nc Pau1 ���1���
, �I Deparcmenc of Finance and Management Services
' , Division of License and Permit Registration
LNFORMATION RE UIRED ITH APPLICATION FOR PERMIT TO CONDUCT CHA.R.ITABLE G?u'•iBLIVG GAME I't
Sa2NT P�UL -
—
1. Full and complec� name of organizacion which is applying for license
��� � � � ���
2. Address where gaa�es will be held ��j�� ���I �KC.J �u����,�/Vt� . ,�J����
II
Yumber Screec � Cicy Zip
3. Name of manager signing this application vho will conduct, operace and manage
Gambling Games I�, I�Date of Birth 77(�,/7 /�J�v�—
(a) Length of tim manager has been member of appl!canc organizacion S/NC�C 4 (o
4, address of Manage "/ 7 ( 'tlhf�l4f�aA� �19KP CLIr►a.ly�� .�J' ��a�
� vumber Screec Cicy Zi�
5. Day, dates, and h�urs chis aoolicaticn is :or ���,/�/, ���i� c>B-�7'��od�v1 /D �1%30�N1
6. Is the applicant �r organizacion organized unde: c:�e Iaws o= t:�e Stace o: .K.*t? -7�
7. Date a= incorpora i�n �(�� , ��, � CJ�..3
, -- ---
8. Date when registe ed with che Scace oi :��znesoca ��� 3� , �q� �
9. How long has orga iza�tion been i.a esiscence? � �6}Y��
10. Hov Iong has organization been ia exiscence ia St. Paui'. / `7' Qf�2-S -
11. What is the purpos of the organization? �p��%2v�Z �i�}nd� ��I L'�,Ped
� '� rt- MM�°f2 I�Ur �es U � J C'.eS
I2. Officers of appl.ic nt organization
Name �C� SG'0 J Yame � CYv �J��°L��
Address �( 3 � n�t t ; �j� s�C�wL �ddress a23`�7 �1 L_L_ l i�I1(�G�.�
��..
Title `�S DOB ��� ,$-�-- Tic1e� \i�. � � 70B ����
Yame I1`?�►'� D � Yame j�J �?v t 1�
3 � ►�� � 'K�-
Address � �n� � � L.- �ddress �t� �•L- 1 rU , , f4- C
Title Q y ��PS. DOB � �`/ � "i�'?e �.�, s�C, � 70B ���� .�O
_3. Give names of offic rs, or any oc^er �ersons aao ?aid :�r serr_ces co _`:e or3ar.:�ac:cr..
`ame � �J V 'P� �iame � O�'�
Address �� �aX�U ��N��IZG.�l� - :►ddress I�4'U L�//�S�N 17�P� �� �
Title ` �lL "__�Ze E�I�. �U �ISD/�—
(Atcach separate sae�' . ..- ac�__:or.=: -___ . ' �
Y+ ,./�����V�, ' .. - . . .II .. . .. � � . . . i ?'' �� �4 � /��, ''f �.-.
.P, � . . ' � I ` r. JD { f'-��� ' -J:aV^ �.T,���
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� 14. Attached hereto �s a list of names. and addressas of aIl members of the organization.
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15. In whose custody wiil organization's records be kept?
Name . . Addrass �.21 a 'r✓�!T v� [-• .
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16. ��Persons Who will be conductin�, assisting in conductiag, or opernting the .gamea:
Name `1= - .- �� Y : Date of Birth � �o
Address � � ,�(�►� 11 S� u �lif/�
J
Name of Spouse P Date of Birzh -
,� Dates when such p rson will conduct, assist, or operate �Ulv, %��V SHH�T, - `f'.'oo�i�1
'T
�� �� : Q , S S �14'•r ' . V S GS _.
Name Date of Birth
Address
Name of Spouse Date of Birth
Dates when''such p rson will conduct, assist, or operate
17. Have you rsad and o pou thoroughly uaderstand the provisioas of all laws� o dinances,
and regulations go erning the operation of Charitable Gambling €ames?
18. Attached hereto on the form furnished by the Cizq of St. Paul is a Financial Report
which itemizes a1.1 receipcs, t:cpenses, and disbursr�eats of Che applicant organization
as well as all org nizations wao hane received fuads for the precediag calendar year
which has been sig ed, prepared. aad nerified by �, �ns,�j¢ue2
• . Nama
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5 S �t �� �oN 1� — w►- N. S S b� �-- .
� � Addrdss
,
who is the ��I�3L1 rJG- �!¢W1q.G�t2 of the applicaat Organization.
Name oz Office
-
19. Operator of premise where games will be held:
. � .
Name - e T •
Business Address I l S �9tZ t► 921� ,s p,c{ ��r,J• Sf�'t-� � p/. S��l
Home Address
20. Amcunt of rent oaid y anplicant Or3ani:.acion =or rent oi che halZ; specify amount
�vLL►��'3 S Nl-'� �� DD,�-�
paid
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' . 21. The p'roceeds o� the games will be disbursed after deduccing priae layouc costs and �
operacing e:cpec�ses for the Lolloving purposes and uses:
� �r � L�e,�a c� S v � �� � �.�zA �.s
2nlG' 1-� nl r V-'� .
22. Has che pre�ise� where che games arz co b'e held been certified for occupancy by the
City oc Sainc P�u1? ye s
�
23. Has your orgar.i�ation ril.ed =ederal Form Q90-T? L° S I: answer is yes, please attacn
a copy cric:� chi� applicacion. Ic answ2r is no , xplain why:
�
Any c:�anges des�rea �� �ae a?oI_c3^.c 3ssociac=ort a�a� be ,:.ade on1� wich che conse.^.t o� che
City Counc�i. � y�
►� L�K� �,�� .
�i Organiza ion
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Date j � � 3y: , � /�
. :zager in cnazge of game
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ONE011�lATOFF • � DA,Ie.NiNT� pA�E CO�ET� ���/�-!
Mr. J. Carchedi. ��`��� ��� .No.���4 7$�
. .�, : . : . DEPARTMEM DIRECTQR � . . .. W}�OR/OR AOBIBTMiL) � : �:
. Gl�ristine. Rozek'. � �,� — �e��� ��,�
; . , : nours«� �� �� � �Coltnci l Research
.Fa nance & M t. 298-5 �6 , °�" ' T �m�� —
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Appl i catf or� for Cl ass B Gamb1 i ng Li cense. L�l(-ha-bs��-�-�Pb�a,rd 5�
Notif�+cation Dat : 12-i4-88 Hearing Dates i-26-89
�t!�vw�»c�U«�t�n) cou�c�.n�n¢PORr:
PIAWM�10 WIMNBSION. � CNIL BHiVf� .. .8310N �DATE W � DATE OUT � NW.VST . '. PHdiE N0. � � .
�ONN�O OOM118810N � . - ISD E26�9CFIOOL. D � . . . . .- .
. .. . STAFF. �.. � CqMilR OOIi �ION. . . . . COMPLETE AS IS � :AODL'IKO.ADDED* � RET'D TO CONfA�T. . . 'CON87ilUEN[ .
_FOR AOOi MIAO. . _FEEOaM�C I4DDED*
. dBTIMCT Oq1NCll . *E7�LMNTION: � . . . .. . .
. �� . .BUPPOFiT9 VMiICFi.QOUNCIL OBJEC7IVE? . � . .� � �. . � . . . � . � � . � -� � � .
NfIMiMO MOSLlYr�,CPPOR7tlM1TY tWlw. When.MRMre.WhY): _
E. 7homas Bauer, on behalf of Trade Lake Ca�, requests City Council app�va�
of i.ts a.pplicati n for a C1ass B Gamblinq License at `Tiffany's,�
`2�31 Ford Parkw . . Pro�ee�s are used to serve retarded handicapped youfifi
with a�hletic a sumner camp activities. ;
�I�CA7i0N-�.Advard�p..,R..uM.): . , ,
_ A11 fees and ap licatians have been submit�ed. A11 i0� paymen�s #�ave _
been received..
�l++r�.c w�..ra Tc.wnor�: .: . _ �.-. - : , .
If Cauncil ap�r va1 is given, Trade ;Lake Camp will sell pulltabs at
T�iffany's.
K�w►m�: : rnos ca�s:
.
Co ncil Research Cent��
JAN 1 '�'`►�89 _
�,�,►,��:
This wi�l be t second pulltab location for Trade Lake Camp. Trade Lake Camp
has been� sellin pulltabs at B.V: Peppercorn's, 1174 ArcacCe Street, since
� . 9-23-88. Their o eration appears to be running smoothly at, that 1Q�a��on. ,
�w.�s: � t� �