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89-171 WMITE - C�TV CLERK PINK - FINANCE ' COUIICIl o // CANARV - DEP4RTMENT GITY OF SAINT PAUL /� �! �� BLUE - MAVOR File NO. v _Council Resolution ,,��� , ��� � Presented By � Referred To Committee: Date Out of Committee By ' Date RESOLVED: T at application (ID #95693) for renewal of a Class A G mbling License by The Jewish War Veterans Post #354 a 408 Main Street, be and the same is hereby approve�= COUNCIL MEMBERS Requested by Department of: Yeas Nays Dimond �� , [n Favor Goswitz ' �e�t;�� , � Against BY Sonnen Wilson JAN 3 1 1989 Form Appr ed,by Ci Atto ey Adopted by Council: Dat �Z 'Z� Certified Pas y�G� S tar BY By A►ppro d y 1Aavor: Date r�e - j i989 Approved by Mayor Eor Submission to Council By PUBlfSt1�D � �_ �~ 1 � i9�9 �w.�+►,�. _. � a,�.�►,� �►,.� u`"�!?� . . �. �. �arc � ` - GR�E�1" :�#�fT �. 0 Q3$82 : �� �� �,���� Chri`stine R - �� = �.���, 3«�,� . . _ �� �*� 2 CQUnci1 Research F � & M t. ._ -5 56 or�: }�cm�„aw�,�� — Application for renewai of a Class A Stat� Gamb1ing �t�cense. Rtotificatio Date; 1-19-89 Hearing Date: 1-31-8� qECei�liNDA��o1�F:t�vpare W«FWea tRl 1 �INICI��l►r�1 REPO�n'i .� � . . MMiNG OOI�A�IOM dVIL RVICE COA�ANBSION � � �AiE N � .DATE IXiT . , .AN116YST � . . � PFIOpE WO. .. � :v�. , . . ZCqWO COI�M+M�ON � MD 8p1001.BOARD � . . . . . . � - - _ . . .. . . . � . - � S[/IFf � . � R COMMdS3WN �� - � . COMPl.ETE AS IS . #ODi INfO..AODEO* .. '.-RET9 TO CpliA�i . CON677iUE1R . : . ,: . . . . . . _ . . - .. - � - � -FCR ADDL 11�0. , �_�OBAqC A00��. � . � DIBiAICT COUiCk . . .. . .. � •EIO+LAW�TION: � . � . � - BUPPOHT3 MNMCh1 COUNCIL OBJECTVE7 . .. . . . ' � � . . . � �. � . lRrt7w�noM.�r4�t�.,d�ro�rn�nr ,whn.Mn,«�.wns�.:wny): _ Charles Wal n, on behalf of the Jewish War Iteterans Post #354, 1^equests _ ' ,. Ci.ty Council approval of his applicati�n for renewal for a State C1ass A _ ' _ Gambl�ng Lic nse at 4�8 Main Street. G�mbling sessions wi11` b� h�ld on: ' , -�ridays,. bet een the hours of 1:30 PM and 5:30 PM. Proceeds are �tsed. for many conmuni y and social service projects. �an�c�ao�cccb.►isw,eMe,�, >: ,. � _ All applica� ons and fees have been submitted. All 10� �ayments on , _. . pulltab prof ts are curren�. . . . :: �caweouwes.r�.wn.n'.na�re wno�:.::. _ _ , : . - If Councll a proval is given, the Jewish War Veterans Post #3�4 wi1T continue ope atin� a bingo game at 408 Main Street. �,�s�a�+►i� ►nos �s: Gounc I Research Center _ . J�N N � ��8�9 �,►,��: : �.�: _ ����/ � UIVISION OF LICENSE ND P�RMIT ADMINISTRATION DATE � °�' �cl D�/ I� �o I�O INTERDF.PARTI�fFNTAL RE IEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant JC' I.l�ls�l I�VCIr �2- i(Q��].� Home Address �� "f � �lnQ,�u✓5�- �a�+�3� p Rusiness Name Home Phone 1p R I ��ps3� Business Address � L Type of License(s) �ehQL�Q,� � Business Phone � 3/.� C�,a,S� 1''1 �Yt [.j�ir�, �,ILQ��,� Public Hearing llate i ��_ License I.D. �{ 1�(0�,3 at 9:00 a.m. in the ,ouncil Ch ibers, 3rd floor City Hall a id Courthouse State Tax I.D. �� � J/�- llate Notice Sent; i � � �e� Dealer �� I.J , ,� to Applicant � � Pederal I'irearms �� �..� �A Public Hearing —�^ DATE TI�SPECTIUN REVIEW VERFIED (COMPUTER) COMMENTS A roved Not A roved � Bldg I & D � NR , Health Divn. I ' N �/� � Fire Dept. � � II �� �� � I � Police Dept. cJe n� i r/ D /� 1LZp � � � � License Divn. � 1 � ,� � �K City Attorney � ��2� �� � �� Da e Received: Site Plan A' � � To Council P.esearch � Lease or Letter �(/ Date from Landlord l� a CURRENT INFORMATION NEW INFORMATION Current Corporation Name: New Corporation Name: Current DBA: New DBA: Currer.t Officers: Insurance: Bond: Workers Compensation: New Officers: � 1 Stockholders: �-��-�7� �;;;�•.,..� Charitable Gambli g Controt Board �� Rm N-475 Grigg5- idway Bldg. For eoard Use ONy � � Paid Amt: 1821 University A . - St. Paul, MN 551 3383 Check No. ':-••••�'� (612) 642-0555 Date: GAMBUNG LICENSE RENEWAL APPUCATION UCENSE NUMBER: A-��a('; u0i /EFF. DATE: �31d1i3S /AMOUNT OF FEE: E1�9.?� 1.Applicant-Legal Name of Organ zation 2. Street Address 3E�iaN �Aa UETE'ANS ?rS' >54 �: ?91it ?t94 ?�iiehurst ava 3. Ciry,State.Zip 4.County 5. Business Phone St Paul, sR a;1lo �a�se :li 549-0539 ' 6. Name of Chief Executive Officer � 7. Business Phone �auis 4orslou ( �1� ) 5??-i�5a 8. Name of Treasurer or Person W o Accounts for Revenues 9. Business Phone nJ 7�; �Id:Vlr �.uOeVitC� ( 51= ) �. -? 10. Name of Gambling Manager . 11. Bond.Number � 12. Business Phone .,• �i13f:8: Wu��?c� 3��'=.3�1v!:r1 ) 13. Name of Establishment Where mbling Will Take Place 14.County 15. No.of Active Members Kniqht� �,t �;::lu�bus Si 'aa: �a�sev ?2$ 16. Lessor Name 17. Monthly Rent: ��1'jilt"S 'lf �OtUTAD:lS 3�2� 18. If Bingo will be conducted with t is license, please specify days and times of Bingo. Days Times Days Times Days Times r'�l �> v l :<, '?,�� -- 19. Has license ever been:�tic� Revoked Date: ❑ Suspended Date: ❑ Denied Date: 20. Have internal controls been sub itted previously? 6d'Yes ❑ No(If"No,"attach copy) 21. Has current lease been filed wit the board? G3 Yes ❑ No(If"No,"attach copy) 22. Has current sketch been filed w h the board? �Yes � No(If"No,"attach copy) GAMBUNG SITE AUTHORIZATION By my signature below, local law e orcement 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 ihe law for any unauthorized game or practice. BANK RECORDS AUTHORIZATION By my signature below,the Board i hereby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to fulfill requirements of current gambi ng rules and law. OATH I hereby declare that: 1. I have read this application and II information submitted to the Board; 2. All information submitted is true, accurate and complete; 3. All other required information h been fully disclosed; 4. I am the chief executive officer f the organization; 5. I assume full responsibility for th fair and lawful operation of all activities to be conducted; 6. I will familiarize myself with the I ws of the State of Minnesota respecting gambling and rules of the board and agree, if licensed,to abide by those 1, laws and rules, including amend ents thereto. 23. Official Legal Name of Organiz tion �S'ignature(Chief Executive Officer) Date Title ,,�- .+�.,�-;��_ y r���.;.,,, . ,vr: -^� ( ... ,--�... fi; / F � j.��l Y�t t�- +� !` ,� `f f�.., ,� ->-,� -•--,, , ;� •� .,� �i��T`� ' � l..r��� �k�'� Gr;, / r � L i�'i-,r:.J_d: /� � � � � , ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a opy of this application. By acknowledging receipt, I admit having been served with notice that this application will be reviewed by the Charitable Ga bling 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 I al governing body is passed which specifically disallows such activity and a copy of that resolution is received by the Charitable Gambling Control B ard within 60 days of the below noted date. - 24.Ciry/Counry Name(Local Gove ning Body), �_ Township: If site is located within a township, please complete items 24 - , ' � and 25: �, c-. �•., Signffiure of Person Receiving Ap ication: 25.Signature of Person Receiving Application .r _. � ?' _ .J I�' Title Date Recei d(this date begins 60 day period) Titte: Name of Person Delivering Applic ion to Local Governing Body: Township Name � � CG-00022-02(8/88) White Copy-Board Canary-Applicant Pink-Local Governing Body � � ���%�� '�.. • City of Saint Paul � Department of Fi�ance and Management Services C�0 �, � License and Permit Division � � ' 203 City Hall St. Paul, Minnesota 55102-298-5056 APPLICATION FOR LICENSE CASH CHECK CLASS NO. New Renew a � Qa Date ����% 19�� Code No. Title of lic nse From �^ �L' 1��To � -�-�� 19�l� / ' � �' �Q�� �. !�:�-.� <f� � � - �% ' �-� � �.� ` � �. , �oo ��C%��i�l�2;� , I'��2�; . '�,-'�--t � � ,:.(i;L;'v �1C E...—� _ i,�APPlicanUCompany Name,g.,,/ �� ' ��L�� 100 ' V I-- �:�'�_ -✓Y l..-C._� . 100 Business Name �` , --<. i 00 /f C�' �'_2 l_ ,�- �7` ''�.�- � ' Business Address Phone No. 100 ' , C 9�—�'J�C ��!�� ,�.�,�Ce,.lC-C��).ciC.,�`c���//� .��c. 100 Mail to Address Phons No. ,00 (�//�a-�--� LC/�-!�-frt�L,t� Managerl0wner•Name , n� _ ,00 , /, L-, . ��y;� ,�.�,i.r:_ '-.�.,Lt �,r.�� . �,����: 100 AlanagedGwner•Home Address Phone No. 4098 Applicatfon Fee •-, �/ Rec�eived the Sum of • 2 100 � ��LZ!-C-�•� r/ ;�� • �� � �%; �i- G��L�..2�' �ysL ' �j �QC.�Q ManagedOwner-City.State&Ztp Code 100 Total 100 License Inspector � By: -�� Signature of Applicant Y Bond: C mpany Name Policy No. Expiration Date Insurance: C mpany N�m Policy No. Expiration Date Minnesota State Identi#ication No. � � Social Security No. � Vehicle Information: Serial Number P ate Num r Other: � - THiS IS A RECEIPT FOR APPLICATION THIS IS NOT A LICENSE TO OP RATE.Your application for license witl either be granted or rejected subject to the provisions of the zoning ordinance and completion ot th inspections by the Health, Fire,Zoning and/or License Inspectors. I $15.00 CHARGE FOR ALL RETURNED CHECKS � � ' � '� :�ri;J�i � ��-"� � , � ���- ,4,�-����-� ��� � �L�'� � � _.--- �_ l-✓, I/. � �, ., ,- (_� i:� �._ .,_ '/�� ��� -� �l ' . . � C.c;T oc Saiac ?aui ��/ . . Depar:aenc ot =izance aad `lanagemenc Serv2ces l/�� p ���� , • . Di��'_sian oi License and Pe:-�it �egisc.acion I�IFORIwATION REOUIB� T�+I'!'ti ?►P°L=C?�TION 'OR ?��`iIT TO CONDUC'� C�.R.I?'.�3L� G�S.'!3L�1G G� TV . SdI:1T ?4UL � I. Fu17��ysd,��p1R,� ��tF^q�� A��ation vhtck is applyircg Ear license 1�a7.�,.:-'.i�f-1i�,iJ�r.'i, :i:vi�r+✓� SPrC'i4R GSi 35� �.G�', y�. F>�- �; tc 2. Address vhera g es will be held ��'� /�'1 H�/��:✓�'� S��1�'`�v�--� S'�il S� - ;lumcer SL.est Clty ZiD 3. Name ar �aaager sigrtiag chis application vbo vi?? coaduc-, ooerace aad manage Gamcling Games 1f/YL�:j '�V'ra j���/i�,{f�}ti' Dace ar 3irt� /�vC-. .;�-�. ��)FI (a) Lengzh of t�ae manager has 3eza �e�ber o= apoli.canc organi:ac�oa �-' �' / L�� �� 4. Address of ,iaaag r ,�.� "�`"/ f�i�v �=�-�vrfs� �-El'��j �j ���;L. ,5'`S'�rb Yumber Sc:eec C�c? Z=p 5. Day, daces, and �ours chis appiicacica is =or � ����'� y� �����°i�s$�-' �y'"`� 3�'�t �� 'y 6. Is che appl+canc or organizacion arganized ander c�e 1aWS a: �:�e �tate az w*i? Y�� 7. Date of iacor�ar�cion � �`� � 8. Date whea regist�red vic� the Staca e= w�esata � Q`�Y 9. Hew long has org nuacion beea. � esis caac_? 3 9�C�{�S 1Q. How 1.aag has org�nizat2on been ia zs:scsaca iz ��. 2au�? '� � �� �� �� lI. Whac is the pur��sa at cha organ��.at{oa? �/CT, �����4!'�-> G /�>l� ti�'�Lf�'i�i9i�, ,S��• ��L=lj'V iG�5 /1.N'7 ���`Y o r"1�L� Ce��•1tii viL�;Tf `ti�o��f T""/l+�.4 r- rf�L- P���;-��l�v l.7�• � I2. Officers o= aopi�canc or3an�=at:an Name �� U' � /�l c�/�'G�Si-i�o c•�' Ya�e �i�1 GL.f/IN �„Al�a� 1 T�=H address � "�/ � y i ���=1--� ��� :�adrass l G.5"� w�T'S 6 N A vt Titie C6��1/f-N Le� D08 .5 — /9:�C' L=:;a ,2N0 V1�Go�tiy ]03 / 1/9/7 � - - Name ,di4VlD ��[✓�-'�/TAL Yame TbM SNaw Address � �5� lti9 Rr�o 14L7 ..t va' 3dd.ass �.�y y �m�G''�►` A�� ricie SR. VI��s c �• Dos /� i��4 '===z 3R� ✓�cC'con���as y � 1�,t� 13. Give names OL OLL C8r5� 0: any OC�B� ]2r5:t:S "7A0 :3:= L�: Sa'.:""�==Q =� -=e O�3d�-==-'-L—On• Vame �N%��� r5 /��1?'/c��T N Yame Address �' ��''.i �-=�G�`� �'���L^F �'3 add_ass Tic?a /� C��1 Tc���' -=-= (,:��ac.^. S27'L._ce �;.a� • ' '-�===----- ••-_=-- I i ��-,�� 14. aC�ac:�ed 'aereto �s a Iisc aE names aad addresses ci al1 rsemcers ar ��e organ2zac:on. I5. In .rnose csscody vill organlzac.oa's records be kepc? : _ � Name /�L /���'�� �ti�i� address �,� 7 fS�;. i"�► 5�=�+�_ � ' �T�'U I6. Persons vho viZlibe conductiag, assiscing in conducciag, or operar:ng c;�e �ames: �iame �/��J�'L L•�S lG'��-�iy� /✓ Daca oi Birt:� /� �'�" �i ����1 �lddress ��� `�� //VL=lfli(`lS r- �vL.. S�; �J/,:jv� Name o c Soousa ��o l�L'�v�= L-� �,E,� /�-[l.�r k i�-N Dace oF 9irth � -/`� � /�� �'` Daces vhen suc;: �erson �sf�l cenduct, assisc, or operaca � Yame Date af Birth ; 3ddress ' Nane a: Spouse � Dace of Birth Dates �aen sLCa �erson sriZ? concLCt, ass:s:, or ope:ate ; � I7. Have ;►ou :aae a_c� �o ?au czarougali cincerstaud che arov�sians oc alI lavs, ordinances, .. and re�ulac:ar.s �eve:-t_�g, cae ope_ac_aa cz C�ar:tab?e Gaab�_ag ��ses? �L.�� 18. :�c�ac::ed here_� ��a c�e :o-s curis:�ed '��� cfi.e C=�7 o� St. ?ac:! is a Fiaaac:a? ltepor� whicz :�a�:zas a�= ;ecs=:cs, e_�e3sas, aad �{s�urse�encs a: c:2 3IIDI.:canc erganizac=on � as :�e?= as a__ e�aar._�a__�;cs :-i:a aa�e _sc=:rea :��ds :or �ze �r�cac'�.g ca1_r.dar �ear :7�'1fC: ::25 J2�.^. ���'.�'�� r`.'°7?_�°d� 3IIC V2����8L' ]!1 �� � ���f�(� /� S/f��'/�?�.fv ' `ame i" � �� � C;�- G�C � l�c ����= r�., 3 . �� r, r�����- ' �cc_as� ' Who is c::e 1�6��'� n' �'!�'�'r� a= c:�e appLicaac Or;anizac_on. • Ya�e 3' Oi=::._ � ; , _ I9. Operaco: ot ?-a��;es �ae}a ;;ames :_: �e ae:c: Naace �/V /Gf-fl�$ �J` G� L.U it,� 13 v � B�ssiness �.ddress 'I �"�C7 � it•�`�/�-1/ N� %� �j' F�,4 v �-. Home �ddress � 20. aasounc o� *e�c �a�ic Sv a�o:.:�=ac J:zs,:=ic:a:t :ar :_.^._ o: ;�e iatr; saec�.`;� aaount pafd ?er j-hou: s�-- _,:� �� ��i- �r� � � � ����1 21. � :'he proceads o: t::e 3aaes vill be disbursad aicer deducc:ng prize :aycu: cascs and " operac�rsg ax�en es cor c:�e rollowiag purposes and uses: `'�L�'�T�;�A.�v - !f�'�' /Z`'ff-� G'c�;ry�v� vNr i`J 1�����:.5 ��� CNILr:. rj��+-iy���iCrt� �L:��L �� �2. Has che prea�isa vnere c:�e games ara co Se heid beea certified �or occupanc; by che C:cy o� Saizc ° uI? 7 � 5 23. kas your or3ar.� ac_on �z?ed _edera_ :ora 9°0—i'. /�� I� ansver is ves, pLe�se accaca a cooy vic� �::: a�a?icac:on. L: ansu�r is :o , es�Lain Jny: , ��!l c�tv ��/3� '� �/-' /N6 L:.f'Mi��-- -V�'N v�' �c.0 G,- (.=Y L Mi i�;s k��!✓��-+, l�/-t'a F i j s �51� ��L'T�r1'.� r� �F�6=hN i"Z--,4T/ci+� %Y�6M jJ✓GoyiC� 'T,vX ��"}'^�.,f�r! ��lt•i' • �:-;c:(j�,�t �j9 a !S j^lL(�C� l'E'� ��f'S7>" ANO�V�., i�.¢S r \�C-'A.R.J Any changes desi=zc b T .ae a�??:ca�c :sseciac�on aa.� be -.aae onl;� c:icz c�e conser.c o: che Ci�y Cc+unc?I. QPJnl+,ial�n�rr+..� :�.... .�.� ,l.i:.. .. . : ..-,.�. '.! 1 ,-� _ ... . : . . �. ��, - .... 0:3a�_zat:an �7 a t e /��/ .��l F � Bv: �7,l2�(-al,.� �f/�'�- �iaaa3ar � cnargz oi gaae c a _ � =� I �� _ — - — c: cn . � 3 � : '� •� � � 7 �(� O r� r► ^ (7 .T� A\ � S � ;1 rT � 1�\ � r . (p tp .. . ' VJ .0 ;p .�. � � V � f'.• � f0 � � � . .� �' � ;� � fJ � A � '< ` . '� ' v � � 3 — T •• r� ' O � + � t� r� — C � � � 1 a � v :9 'r r" r0 .r � A 7 'C � � :7 � `C � 3 � � v ^ � 3 � .7 F+ � .. —1 � 7 3 � T '7 a 9 � rr � ': I — '� T E 3 � � � �.. '� � � � � � � ' rr � I ce m i :� —; A � = i � � �1 �e a r- - g = '� � . (((��� rr � � 7 � '` n . . � 'a i�� � � i A �9 �. �4 �9 t � ; � , ' Z � f9 3 '<: �9 £ � `�C v v v . O � � I ±� .. Q ^ � M N I� R � �' T � �A I � 'J7 h� �9 A � � R I V � A �OK r7 � �� l0 C: � i .'��� I � I� A � . J � ? ^ � � � n r., � � ' 1 � �_ � 9 n I . ro � n �/' .� _ ,a i ,:. .+. : � � _ _ m = i n � _ � � ^� � Qy i ' 'a S n — ? ? ~ , ,� � � 0 A� •� � I :S� � �YA = = � = (9 � � • ��1 - � � � i � • 7• �:� I � `a e -e � � a ( � I �� �' �(,Z o� � �a .� — I ^ �� �m _ � � � i � r N Z� ? � � rn� OOi o0 5 � px x`.'r y'M~ . CITY OF ST. :�AUL PQ�� � . UNIFORM CHARITABLE GAMBLING FINANCIA[. REPQRT J��g_��� � � LAWFUL PURPOSE CONTRIBUTIONS - WORKSEfEET Line �13 - Tot�al Lawful Purpose Contributions. $ � �� �'� � � List belo ali checks written from gambiinq furtds which are charitabl lawful purpose contributions. The totat dolTar amounts o these checks must match the anrount claimed fn line #13. Use additional sheets as necessary. CHECK � DATE � PAYEE , CHECK AMOUN - PURPOSE 1. A I 19 � � //`��il� 1 ��/C 1�%L� /��"�ri(.f'�qAJ��-G�.rN,' . /p�� �- L�N��(J�t� �- ; - =� ^ , ��� a . � �°- r-� �� u� _7 i , ;; �,u,��' �,v.«,L� ,�-•C l r ���.�-, , �1`-��� ,�` � �� � 3. , �� �,,,�,, 'f ? l� `�,;-?��=� �,�-��� /-� j�S�' ?��.�.�.C�,; -, :�u_ ;,..e.., - (2,�,:�- 4. -� 5 `� � � �'/��.�.+,..�.-:.��.�'.�.�1�.� , .. .. . _ � ��/`� ,wc,�t,�..,��s.�� �,y+-�_ ��ry!`"JL� .C�'<-���-,. 5. f 7 S� �;r,/s� 5����.� 1��.�-� ��.. o �' ` , 6. � � `.il�c+2 C..-t.sa-e" �.�`'.� . �� � � �.�-���� �v�r.�� l��a��c� -� �— 9- ^ ��. - � c::J�-,.�, �!"i(`J �"x �'�..,-,a� f..�--� . �. j�y � s ;��`��� ' ����' ;,,,;`� 8. 1� �y ��%�� � � .� /� _ �� j �,� �.' . 9• � l �l� �7 �� ( / Q �- � -�u,��-�° ?�►�-'-� ��( •� � lo.���� �l� ��� ��� '�. �(����` 4�.,��� L � cw� ii. 1 j�� �� ��� �� t< < < <� << � � �3 12. �a %'"% l%`�I �,.t.. �`. � R �p �"�Gv ,r(7-6�..�,.c�'�- 13. l� 3 � � �" �z��, �,./'�� 3{? �,...� Q-��c-`�,.�" -�`°'G ���� _ TOTAL CHECK AMOUNT $I�� 1�� � NOTE: These expendi ures wi11 be provided to Councit Members at yaur CouncTT hear�nq. Be sure that our financial report is complete and accurate. ' .�. .. a► .. e� a. a. r •� rt : a. �►� � �� � ,_.. � � i C > � Q � ! t S C A � �. � •�i .� .=i A � .� 1 A .� + } '�,,tt���. � � • ^ •� p � �AMnMnNI � + '�' i 4 � �a �s L4 � i w � - S �✓�.� � � o � � G > ,\ n s � .0�. 7� + s ���%�.r � 3 � 2 � � ,� � �� .. _ � � � Z � Q � �`Y' � .. i = 2 a 1 > �J � � A n � � ! ,� O(7 � • i i � A s � � � y- � � A 1 ' � ~ � • � � �O �, A ' y �. . . � fi � �� Q � n � � Z7 Z = 1� � � � �`. . � O � � . r ��A �1 � O ± v.rv � _ �• �1�-�.� A .�wv 7� � '=J : � 7 > > ; �N W Y ! w • • � 4 T � . v � � � a = o r z v • = � .� • � A A e a � .� D C ,� � ; � .� � o � � �rn .. � `� � • F, . � I � � - � _ `r � , � � f � Z� � � � — T � � � � m s i� , � 7 �� - . ` I._. .. .^.. A . � � ' O O � + } � � � A D � f i � �• � r_(�1�( i t � 1 0.�� t � CITY OF �T. �AUL pQ� 2 UNIFORM CHARITABLE GAMBLING FINANCIAL REP4RT C��9/�/ . LAWFUL PURPOSE CONTRIBUTIONS - WORKSFtEET line �13 - Tot 1 Lawful Purpose Contributions. $ ��>�%°`' List belo all checks written from gambling funds which are charitabl lawful purpase contributions. The totai doilar amounts o these checks must match the amount claimed iR line �13. Use additional sheets as necessary. CHECK � DATE � PAYEE CHECK AMOUN • PURPQSE 1. I Ss/ 9/j� �5 �,��.-�'► -c� C.�. �4� 1 ao�� �- ��'.��.�.�..z' �,�--� 2. / �s�,{},�, ° t, � c+/ /� -- �! /��`�[ ,Cif4rl.:!�'9�G ,/f�d'•I �.?�; r(��(J r>� ' 11."�i�/ 3 ,7 � � �y S � %'o �� _ C"���• .�Z°' �' s�t,r�,.�.a., ,, �• 1,� 4,� `�oj�r „�,�,�,,�- ,�� � J�� ° ,�.,.,.�� �,�-., r��,�.. � 5. l�, �, p'��� . � /�,�� �- � G..Yr,�G.�t;2w����G'��4"�c" '!i U 6. /�i�� 4��,/�,�1, � , .�-� � c�� �- ���w�-�` _ m.,�.�.��,�xc.u�/ (���- / c�v � 7. ( ��� , '-��J/�� - J� c�J � - ; -��a�� �G � . C s�. / � 8. i Y �� ?S l'�c ;;'!� r=`; �� � � ��3�' `� ��- 9. � ;� �-� �'/���f- , ;���. ��-vN`L��- ; �..0 � . io. 1 � �� "� �/g� .,�,���. �..� l�� �- i i. (�'� �t /.� �.d { �.S'. �. � fo� � . 12. �� 7G� �'��� ��C�,�'Lt�r,� �- � ���' �,'�"��, r� � , rr� v ( ✓ \�� �O � � i3_ ,� �, 9 - � TOTAL CHECK AMOUNT $I�i � �n�� NOTE: These expendi ures wi1] be provided to Council Members at yo�r Cauncit kearing. Be sure that ur financial report is complete and accurate_ -' .: : T S � = _ � = " " = ��_ � � � � i f �� : e • z > � Q '� : s'� � 1 � ��_ w .. .� l7 � � s .~s ��� � '��'� . � � 1 O � �.. Q. y '� `,. � i w- +�i � ..�., r i w ; � O s � - � o � `� � � � � �r �'' = � = ' � ? r� � s L i �_ Q F s ^ ,- w • Y. A � N` � � \ � �. � O i � - s � i 4 C7 1! v' �� w � \ w i i � C O � . �,. � 1� � r � � � : � � ; o � 2 = = ; :� v � A , . v � �\� � O - � w .��v w. 3 D-G N A v�►v a s � : a ' � .�► � O w•�� � i a s �. s i �i� .� • a � '_.rnm� � " � � �� C � � i .. a t r' Z � , � .. � a 3 � n = •. . �= . a + ' i a ' • ' c �R' _ � ► '= ,? ^ �� � • ' w '�-� �� s �� 7 � ^ v m � >C� C_ � � ; . i s�� ` � O Q Y� N\` � ? \ } ? j�` �1�, i t 1 � -�( y y�.�.�;� ,r . _' .,,.. � ��_�r City of Saint Paul Page 1 � Department of Financa and Management Services Division of License and Permit Administration UNIFORM CHARITABLE GAMBLING FINANCIAL REPflRT �-_ _ . . - , �. Date �'V�i��/'f��� t �. _ _. .... . _ .. _ . 1. Name of 0 ganization � p.:� �1i/r<l//!� .> ��• '� /1:/`'/l�l% 2. Address ere Charitable Gaabling is conducted � t 3. Report fo period covering .�,/�� f 19�through � � 19�' 4. Total nu er of days played �s� � J / �v 5. Grose rec ipts for above period ; T� yL G� �� 6. Gross pri e payouts for above period (include cash short) � �..,7 �J �� 7. Net recei ts - line S minua line 6 $ ����jl, G� 8. Expenses ncurred in conducting and operating game: A. Gross wages paid. Attach worker list with / names, addresses, gross wagea, number of hours ; `� (� �C .C C worka . and amount paid per hour. �� B. Rent or .J'� �eeks J"1 (:,�c,� ; � �%C•C C C. Licen s fee s ��C' -�% G D. Insur nce $ / .� ��%, C C E. Bond S F. Disho ored checks not recovered � �,�j C,�%C � � G. Accou ting Expense � -.� _� �- �=�= H. Emplo ers F.I.C.A. � � �.J 7f I. Pullt b Tax Paid to Department of Revenue a/V�Jl��4� 3 � J"�7�• C%� J. Minn. U.C. Tax ; �/�. .�v' R. Feder l Ti�ai°� Ts•• f -r /�,C. ru,x S /,,. C! � L. State Gambliag Tax $ �'��j�� -�6 M. Misce laneous Expenses. Identify the anount and t whom paid. �. s������s � s 3a. aG 2. / l�r�ST�r.�c� S � 7G(c. ��;� 3. ; _ 4. � ��7�� �3 �.�..� . ._�� 9. Total Exp nsas TOTAL ; 10. Net Incom - line 7 mimia line 9 : /� �r3. y� � 11. Checkbook balance beginning of period ; /lo, G L`J.�(� 12. Total of ine 10 and 11 s � �_�6 :�� S/b 13. Total con ributiona (from attached worksheet) ; �� Z��g •(���`" � ���� �� 14. Checkbook balance end of reporting period - / �e- � 5������ �� \ line 12 1 ss line 13 , S /�, ��-b�•� �