89-219 WHITE - C�TV CLERK I COIlI1C11
PINK - FINANCE GITY OF SAINT PAUL �'�j�'".719
CANARV - DEPARTMEN T
BLUE - MAVOR '. FIIC NO•
�
ou cil Resolution �
�
Presented By
Referred o ' Committee: Date
Out of Committee By Date
I
RESOLVED: Th t application (ID #14876) for renewal of a Class A
Ga b1ing License by the Friends of St. Peter Claver at
14 4 No. Dale Street, be and the same is hereby approved.
i
'�
�
COUNCIL MEMBERS Requested by Department of:
Yeas Nays '� �1
Dimond
r-� In Favor
Goswitz
Rettman a
� , Against BY
Sonnen
Wilson
�ES � � �g�� Form Appr ved by City Attorney
Adopted by Council: Dat� •
Certified Va s ouncil , ret By —/��
By ,
,€Br�
� i: ��J�9 Approved by Mayor Eor Submission to Council
Appro d y Mavor. Date _�
By BY
P B�1SI�D r�-:�=>' 1 � 1989
a1�ANU►roR� � w►�amu►teo nA�E car�.eno V 4 �,�
Jose h E. Ca chedi ��� ���� �tb. �3�5 2
cO�rACT P�o�+ o�,�r.�r a�ctnR µ+voA�on�sr�wn
�
, CMristirte Ro ek �Foe � ���,��� ��«.�
"-�' � . � RouTx,o — �� �Counci l Research
Finance & t.. . 298-505�., o�a: � �,►„�, _ — , .
Applica�ion or renewa1 of a State C1ass A Gambling License.
Notification Date: 1-2�-89 Hearing-[�te. 2� 89 `
IIECb�lID��710Ni:(Ap�rovs(A)a Re�sr�(R)) COUNdL IIEEEARCH REPOAT: . :
��►a�tq oo►�saH Gwl �cE c�nisswN o�rE�r D��axr �vsr r+�+OME No.
m�+�rvo c�ow �sa aa scHOa eo�Ao
: aT,�. caYw�ssan co�ai.�ns is �oni�+w.�oo�o• T�rvn���r ���oo�
— � �
oie�rwc�r caxrc�
*Exn�noH:
surPOr�w�cM oa�as,�crnr�� .
NRtl1�0�O�L�1,IfBt1E.O�ORTtMKiY ,vW�et.v1�t�en.whaa wMf: ,
Jt�ne Huspek, n behalf of The Friends of St. Peter Claver, �equ�sts Coanci_1
app.raya]. of h r .application for renewal of a Stat� C1ass A Gambt'ing L�cer�
. � at 1��� No. ie Street. Gambling sessior�s are heid on Thursday e�en��ngs �
bet� ;the h urs of 7.:3Q _PM and 1�:30 PM. Proceeds fr.an the gaa�linq s�ssiat�s
are used for he support.of St. Peter Cl aver churcFt & sck�oo� . .
. _:._ ;
�ns�c,n�oN�.�awr�ar.. r. , ., , , . , , , .. _ ;: .
All fees and pplications have been submitted. Al1 10�. payments are curre�t.
,
: . . .,,�
�lwna.r�.o..aa To wdom�: . : _ . .. , ;:::
if Council .ap roval is given, Friends of St. Peter Cl.aver wi�l continue to
sponsor a gam ling session at Ideal Ha11 . _
. ,u.,�,n'� . • r�es co�s
Co r�i; Rescarch Center � ,
JAN 2 51�8�J
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_ ;
; _ .� ._ ,_ _
�wst+ortr oF�a�t��au.s:
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STA1(�IOLDERS(LIBt) PO&f10N(+.-�Oj � r wLL.TE971FY1(V/M RATtONALE(Surtunarize Main Arguments)
FINANCIAL IMPACT �r�n�sr.n o�3 s�a+o r�►n raorEs
oa�w►nHU euoc�er: _ ,.
�v�+uES�reo ...........:.... ::.:.:..:...::::.........:.....:..... , „ ;. ,
nc�s:
_ 'seie�ies/Frtrqe sei,elqs , ,. ,,' : - . �
�..............................................................................
��� .. ....... ................. . ................
CoMraCts for SBrviCe............................................................. . _ '
Olher '
�PROFlT(Lf�S) .. , :.....
FUNWNO SqIIRCE FOR ANY LOSS.(Neme'8nA M�ouMI. :.. _
CAPITAL IM�Rf1YEMEMT BUDI#ET: -
DESIGl1 COSTS..............................................................................
_. _ ; . .
� _ _
ACGIA&iION COS'f8.......:............... .,.................:................... _
. .. _ , , : ,. .
CONSTAIJCTION COSTS ......... .......................................
TOTAL... .......................................... ..................................... � '
_
' SOt1RCE OF FWIDINQ(i�ne apd Armunt)` _ , - : , :
MAPACT ON BUDdET:
r_ , . . : �'
AMIOtlNT CURRENTLY BUD(iETED...............: .....,;. ..,.,;. •
AIAOUNT(N EXCESS OF G`U(IREN'f BUD(�ET ....... .......
SOURGE OF/tMOUNT OYER BUDGET ....................................... .
PROPERTY TAXES GENERATED ILOST� .:...:;: ° ., :` _
_ IMIPL�MATION RESPONSIBILITY:
DEPT/OFFlCE ° . .. -,.�. . `. , - '.. . ,... DWi31QN=. ,.� � . . ..�FUNQ FfiLE � ._, .��� �..._. : .
_..
���BUDOET ACTNtTY NUMBER&TI7LE � ... - - :�.. .. . ., _. . . ... . . `�,-' � AGI7VITY MANAGER..... �:. � . .
NOW PERFORMANCE WILL BE MEASIlNED?:
PROtiAAM OBJECTIVES: PAOtiRAM INDiCATORS . :13T YR. 2ND YR.
EVAWATION RESPOi�8181U'fY`: .
pER9pN DEPT. PHONE`NO., ; TOiGOUNClL OF DATE
RRST QUARTERLY
_ ,.. . . . . .. . . .. . . _. ,.._.. _... .. __. .. ....-_.., BY
. . ��a�9
DiVISION OF LICENS AND P�RMIT ADMINISTRATION DATE �a- ,3� o� 1 J J �
- INTERDF.PARTI�fENTAL EVIEW (;HECKLIST A.ppn Pro es ed/Rece ve by
Lic Enf Aud
Applicant �y ��QYI S -1" ��`�f'Y'�ICI'(�PrHome Address �v � N� /V'G /` ��y l� -� �2�
Rusiness IvTame Home Phone � �� ` �, y 7� �
Business Address � 9� N� f� Type of Lic.ense(s) l.. l Q 5 5 A- �')�-t h1 �j ��d��
13usiness Phone �lC'PnSC'i ��'vJ2 k�� �
Public Hearing Dat �, g License I.D. 46 � � g 7 /O
at 9:00 a.m. in th Counci Chauibers, � ��
3rd floor City Hal and Courthause State Tax I.D. 4�
llate Notice Sent; O � Dealer �� � / �
to Applicant Z� �, q�
� rederal Pirearms 4� �U '4
Pub.lic Hearing '
DATE INSPECTION
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
IJ[flr ,
Health Divn. '�
I���� �
Fire Dept. �� �
� u��
� �
! s���.�- (
Police Dept. //�`�-91
License Divn. � '
�yl�� �
� �
City Attorney �
' 1z �`� ' � /�
Date Received:
Site Plan � ��'
To Council P.esearch � Z�¢ �
Lease or Letter f at
from Landlord � Z �� ��
�
i
o-
r
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
f•',
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
. . City of Saint Paul �/`�'��J�o���
Fin nce and Management Services%License & Permit Division
INFORMATION REQUIRED ITH APPLICATION FOR PERMIT TO CONDUCT CHARITABLE GAMBLI;JG GAME I:V
SAINT PAUL (To be used with the following: New A & C application, renew A & C
Licenses, and new an renew B in Private Clubs.)
1. Full and complete name of organization which is applying for license
, �• .t�.��
2. Address where ga es will be held >c.l Gj ,.,� �. �,� ���„1J. ��;/ �
� Number Street City Zip
3. Name of manager �Signing this application who will conduct, operate and manage
Gambling Games � Date of Birth �� -� -�.�
(a) Length of ti e manager has been member of applicant organization '7
4. Address of Manag r i k� /(J, (7� �,il�, ZiZ ,� ,!�it�L� ��! / c
Number Str et City Zip
5. Day, dates, and ours this application is for.,+�u.`,, �i'� '��3v - �I•�v �/ �-Q/.
6. Is the applicant or organization organized under the laws of the State of MN? �a�
, 7. Date of incorpor tion � q�p
8. Date when regist red with the State of Minnesota �'�'�-u--�� � '�.�-
9. How Iong has org nization been in existence? � '? .�_�
10. How long has org�nization been in existence in St. Paul? ��'7 —v�?�/.
�
11. What is the purp�se of the organization? .�> -���--
�
12. Officers of appl cant organization:
Name �� �-a�-�-�a�..cJ Name C .
Address � p 9 ,� � �--C�. Address i S�� ,�
—�'
Title G � DOB � - il •- 3� Title �-� . - DOB S _ � -�U
Name Name �GZz.L�.C- �����
Address /& � /(�, ��� 4� . Address 'Z �- a G � , �
—T �'
Title DOB ,� _ � ._ �,.1 Title �a�� �.n�j''� DOB �- i G-i!'7
J
13. Give names of of icers, or any other persons who paid for services to the
organization.
Name Name
d Address
Ad ress
Title Title
(Attach separate sheet for additional names.)
. . ����9
14. Attached hereto s a Iist of names and addresses of all members of the organization.
-15. In whose custody will organization's records be kept?
Name r , I � Address /g� ,(>. �'?����'�
�—
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name �� Name J . �
0
Address ; � / . �c c.c� Address i$�j
Member of Member of
DOB Organization? �-�!{�'-a1 DOB Organization? _���¢/
�T- ��
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
17. a) Does your org nization pay or intend to pay accounting fees out of gambling funds?
yes _t � no
b) If you do pay accounting fees, to whom will such fees be paid?
' Name '� �Gix4�G�.�G- � Address .�(v i ry i�� � �•
( � `
DOB �p . iG - � �Member of Organization? i�'
c) How are the ccounting fees charged out? (flat fee, hourly, etc.)
r�
18. Have you read an do you thoroughly understand the provisions of alI laws, ordinances,
and regulations overning the operation of Charitable Gambling games? �-��
19. Attached hereto n the form furnished by the city of Saint Paul is a Financial Report
which it .emizes 11 receipts, expenses, and disbursements of 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 by ��� 4[� `
/'� � N. c � �.- . �a�a ��'�� �� 5� � �
�---
Address
who is the '� G��a�. of the applicant organization.
Name
20. Operator of prem ses where games will be held:
�
Name ��
Business Address �'�cL 9z �lJ- � �.6- .
Home Address 7 �� � . �7�-c-c-�
�
� I
. - ��'-�/9
21. Amount of rent palid by applicant organization for rent of the hall:
. � � � �'S •
22. The proceeds of he games will be disbursed after deducting prize layout costs and
operating expens s for the following purposes and uses:
�� �--�--�--�-�t_� � � ��J �
23. Has the premises �where the games are to be held been certified for occupancy by the
City of Saint PauI,I?
24. Has your organizajtion filed federal form 990-T? `� If answer is yes, please attach
a copy with this �application. If answer is no, explain why:
i C�ir ' � o �L'c� ' �-,�.,J
Any changes desired by the applicant association may be made only with the consent of the
City Council.
iJ it.c_.�uL�i� .�
Org ization Name
Date I� By: _�
, Manager in char e of game
t
C�� �.��,.�� � c �� �'
Organization President or CEO
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' • City of Saiat Paul ��j��p�i9
Department of Finanu and Hanagement Services ��
'I Division of Lieenaa and P�rait Admiaistration
� . ux�rosx c�air�►at� c�L�� r�cW. �roRr � a/3o 1 �
C� Dats
1. Nans �f Organisation ��t CJIt��LS Q� �"� ���e�/� n!?� w' ( C�ta.��
2. Addre a whar� Charitable Gasblin� ia conducted �r J�L1�J C'��( ' �i t+�-�X � � N
� 3. R�por £or p�riod eov�ring 1 19� through �dU �U 19��
4. Sotal nueber ot dapt pla��d O
� 5. Gro�s receipes for abave p�riod ; ✓���' �/
i ' 6. Cross prizs pqoaes for abwe pesiod (iaclud� caah sdort) ; �`� /i � ���v
� 7. Net r ceipts - lin� S aiaus liae 6 � _�TI /�� ��
8. Expen es incurred ia conductin; aad opsssting gau:
A. C os• vagea paid. Attuh wrker list vith ���O ��
n a, addr�ss and groea wages. S
B. R nt for � vseka i
, C. L eenae fee 5(J� Cj`� �`L�d .aTV��E' � a��- � �
. �
D. Ic�aurance �
E. B nd � �� ��
' F. D shonored checks not reeovered f �l�- �v
' C. Adcounting Ezpease ;
_— .
H. E loyers F.I.C.A. �
� I. lltab ?a�c Paid to Depart�ent of R�vemta S � a�`•v�
� J. . . . .� �r,�.l I Ta,Qo �t ✓o��' : %�"�7 �- �3
. R. F sral Eseia� Tu � Stamp f O� Y' /� b�
. �.1 L. S u� Gambliag ?u i �✓ 3 /� T �
M. M sc�llaneous Expsnsss. Identify the aaouat
' a to vho� paid.
� ��,u:�� t�e�.Pl Y�ee�.l ��I , ��00•00
,
�r.��S��$:2a.ci..o�.�'k'.;,�, z. l�ro wr o�'i� s l 7 f� �f 0
3 'B�.-�! � s g, a-S _
a.To�dtQ ��SC. s :- (v ��0, �S
9. Total Expenaes '�'r� ; ��/ ���`���
�' • 10. N�e I coss - lia� 7 sinus lina 9 ; �v 1 �0�i ��
11. Ch�ekl�ook balanee begianing of p�riod �
a a ��.av
is. ro«i of isn. io �a ii . = o? 7�SS3-/S
13. Total coatributions fra� lia� 17 � 0�������
14. Chac ook balanea e�l of rspotting p�riod - ��8 ��O�
� liaa 2 lsss lia� 13 �
15. Speci y use aads of a�ount on Iins 13:
. S ��- � C�` c�ln Sc.Mo . - r �va.�,�' .
. �
��...
:
�,
UNIFORM CNARITABLE GAMBLING FINANCIAL REPORT ��y�ai9
LAWFUL PURPUSE CONTRIBUTIONS - WORKSHEET
Line #13 - To al Lawful Pur se Contributions. 3 .��� �� S G�
Ao _�
�, List bel w all checks written from gambling funds which are
charitab e lawful purpose contributions. The total dollar
amounts f these checks must match the amount claimed in
line #13. Use additional sheets as necessary.
CNECK # DATE � PAYEE CHECK AhlOUN PURPOSE
1. 'u��5� �e-� 1 S�': P�-�zt'C�.UQ,�.�-l���el (R�`7.:�t% Sc.:,�(�c�} �,c S��i�c� ��lc��1,�;u1�,�
2. (�cf'S-� /I1��`�h 3c' t f �` i E ' � 1 y-19.�G , , � � � � , � � I
3. _�lJ' �y.�S it
� � � � , � v'�GS3-G�L t � � � , � t � r �
/�/ r � � < < � � ► i �
4. 7:�5 �urtr_}`�
r i � 1 1 1 � � /TS�'U 7
5. �- �1 ' `� �+"�, �';� �•j-: pLu� /..g3. �z.�- , , < < �„ +� ����i�, o.�f,�
? � z--�,
� `�� l��,�f �lla.�.:�fC{u�.t��. � �-3`�- ��-' S�'��°�-4 �� �:.�:�i A �.,�:.-��j�t`�.
6. '�3c `� f
7. r] '3 `� �- �� ���' u-� 5��� ��c� � ��,::C�t�or-?� �:'t �;�"i� �'��w�Z� (�r�:�,
, '� ' � / i
a. >>3� (�.�; �� ��.��: ' y c�:�r c��.r�.� 3�y���� s�{����- �� �����1 a y�w-�'�«;
9. � 4(,:: ��- ?� L'i � vr S�-.��,,,� I i 3 c'�(� S�o�� o �' C�� �.-��,�;,��1� }�G.�
10. �y�� ��- 3 G S�-. P�-�-C I�.�c4►.��, ��5�'�. �.,� 5��:�- U� ��;1� y�����y
il. '�5� �C,�"�� L�-� e� S�-. 1�4:.,.�' 1 `�c:�. 3� S�.y���:-� �r C.� ��w-h� '�,z�j .
�-� c�� �7 � � � � 5� �:�{- �'�5�,�.i� y�w�,����
12. 75 .��-. 1���C_.k!�x'-��.4�,.�,�� 3�(�
f
�3. ��� n��-�: � c�;� o� s�,��...,s� ���. �9 �s�:p,��<f �r c�.�� yoti:+� ��:�.�
��(�, n;�,; �`7 S�. i�w�e.,- c(�a.�,�-u-��.L. ,�3'3 r 3 i `���%iK��f ��5�:,..1 a y�,.-�t, t��z�,
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TOTAL CNECK AMOUNT E�,��•�7
NOTE: These expen itures will be provided to Council Members at your Council hearing.
Be sure tha your financial report is complete and accurate.
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