89-220 , '
WMITE - CITY CLERK I
PINK - FINANCE COUI1C11 Y/'�(//1
BLUERV - MAVORTMEN7 CITY OF SAINT PAUL File NO• `� " /���
� C ncil Resolution 15
Presented By
Referred o I Committee: Date
Out of Committee By I Date
�
RESOLVED: Th�t application (ID #75615) for renewal of a Class A
Ga bling License by Friends of St. Josephs House at
14�4 N. Dale Street, be and the same is hereby approved.
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COUNCIL MEMBERS �
Yeas Nays Requested by Department of:
Dimond
c--�e� ' [n Favor
Goswitz
Rettman
��,� � Against BY
Sonnen
Wilson
Adopted by Council: Dat G
FEB - 9 198g Form Approved by City Attorney
Certified P�s e Council , et BY � Z� /
By.
A►pprove by avor. Date ��8 � �" ���� Approved by Mayor for Submission to Council
gy _ BY
P� i'3y�D . : ,i �r 1989
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. DiVISION OF LICENS ANB P�:RMIT ADMINISTRATION DATE � � O / � � p �
INTERDF.PARTMF.NTAL 'EVIEW CHECKLIST Ap n P ocessed/Receive by
Lic Enf Aud
�►cha�d �luP�
Applicant �}/'1� ,S S Home Acldress � (o(p QN
L�n��-�
��tts� � � 9�9��
Business Name Home Phone
Fusiness Address > ���/ ti� �jQ� Type of License(s) �,�QSSA —
Business Phone �mblr �1C�prI$2� �2Ytpc.v��
Public Hearing Dat VI � License I.D. 4� / � �� �
at 9:00 a.m. in th Councl Chambers,
3rd floor City Hal and Courthouse State Tax I.D. �� �f,�}-
llate l�otice Sent; /�r Dealer 4� /t.�//4'
to ApPlicant Z Q � "I'� � )
rederal F�.rearms 4� ���
Public Hearing
DATE T�'SPECTIUN
REVIEW VERFIED (GOMPUTER) CUMMENTS
A proved Not A roved
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Bldg I & D I �
N �}-
Health Divn. �
' N 1� �
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Fire Dept. �
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Yolice Dept. I
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License Divn.
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Ga i
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City �ttorney ' �
'��Z���/ � bf�
Date Received:
Site P1an � Q �'J
To Council P.esearch � Z�e �J
Lease or Letter � � � D te
from Landlord
CURRENT INFORMATION NEW INFOKMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
i � �
. . ���-�
..� Charitable Gamb ing Control Board For Board Use Only
�� Rm N-475 Grigg Midway Bldg..
, �� 1821 University ve. Paid Amt:
� � St. Paul, MN 551 4-3383 Check No.
":•• : (612) 642-0555 Date:
' GAMBLING UCENSE RENEWAL APPLICATION
UCENSE NUMBER: �1-:3Q3�:-4'dl IEFF. DATE: a�jy1�Qa /AMOUNTOFFEE: �Sa.gr;
1.Applicant-Legal Name of Orga ization 2. Street Address
FRIE40$ i)F ST 'aSEPN� 40US� 1?66 �a�weod 'itr�zr
3.City, State,Zip j 4. County 5. Business Phone
St Paul, �N S51t1 ' ���se ol: 4d3-:954
6. Name of Chief Executive Office 7. Business Phone
ilarp :iarr;s ( 012 ) di5-yh5?
8. Name of Treasurer or Person W o Accounts for Revenues 9. Business Phone
Mary .}� ��i'lny ( �i< ) �99•�"a�4
10. Name of Gambling Manager ` �11. Bond Number 12. Business Phone
�1C�i�f� `3i'%tit' '','�i:^ )
13. Name of Establishment Where ambling Will Take Place 14.County 15. No.of Active Members
Ide.; :iaii �, �a�l �amsev "
16. Lessor Name 17. Monthly Rent:
�os:�h :'2r-iu:�i�ri ' tid9
18. If Bingo will be conducted with t is license, please specify days and times of Bingo.
Days Time Da�s Times Days Times
,,._. - _._-
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19. Has license ever been: Revoked Date: ❑ Suspended Date: ❑ Denied Date:
20. Have internal controls been sub itted previously? ��Cl Yes ❑ No(If"No,"attach copy)
21. Has current lease been filed wit the board? �Yes ❑ No(If"No,"attach copy)
22. Has current sketch been filed w th the board? Yes � No(If"No,"attach copy)
GAMBLING 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 the 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 ha been fully disclosed;
4. I am the chief executive officer o 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
laws and rules, including amend ents thereto.
23. Official Legal Name of Organiz ion Signature(Chief Executive Officer) Date Title
!,
�w,�i" .�,. '.�f _- .�wc.J�; � 1.� Y�� � 'i t �. � !��?��.� � l��i� - 'Jts�J'�
' ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a c py of this application. By acknowledging receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gam ling 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 lo al governing body is passed which specifically disallows such activity and a copy of that resolution is received by
the Charitable Gambling Control Bo rd within 60 days of the below noted date.
24.City/County Name(Local Gover ing Body) Township: If site is located within a township,please complete items 24
- ,� and 25:
Signature of Person Receiving Appl ation: 25. Signature of Person Receiving Application
Title Date Receiv (this date begins 60 day period) Title:
Name of Person Delivering Applicat n to Local Governing Body: Township Name
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CG-00022-02(8/88) '!� White Copy-Board Canary-Applicant Pink-Local Governing Body
7.���s-
, . City of Saint Paul
' Department of Finance and Management Services /�(��,a°? �
License and Permit Division �,
, 203 City Hail
• i St. Paul, Minnesota 55102-298•5056
APPLICATION FOR LICENSE
CASH CHECK CLASS NO. New Renew
a o -�-�- a a �.
Date � '� 19
' � � t
Code No. • Title of Li ense j ,� �; �� � / � � `'
From 19_To 19 �
� !�' ���� � - �� �� ,, ;�I�:,, yc 1 , �� � ' .
' � � 1�� �. <•; jcJ > `�+ �'� • ..'U:.�',;�r y-�lt�
;` `y p�� � �-�.. ApplicandCompany Name . '
� 100 ^ -�
J�;�, :� ;��. L�� i;��
100 Business Name
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' � 100 �_: + ' ��� :,l � �:,j�_
' Business Address Phone No.
10Q
,
100 Mail to Address Pho^e No.
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100 � - - � -�j"i.
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ManagerlOwner`Name '
100 1 -', , ,
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: r � .. .:J �, ;� �i ' r _ �:l- �. ��
100 AlanagerlGwner•Home Address Phone No.
4098 Application Fee Z 5� �____ - -� _ �
�_�. . �� `_J 1% ',;
I Received the Sum ot 100 \�-:v', � , �/;.,r � �-�% ��
� j GO�u0 ManagedOwner•City.State 3 Zip Code
,
� ioo roc� �oo
t' 1
% 7
License Inspector �'`", By: �� �� I l�`��� - � Signature of Applica�
Bond:
C mpany Name Policy No. Expiration Date
ItiSUf311C2:
C mpany Name Policy No. Expiration Date
Minnesota State Identification No. Social Security No.
� Vehicle Information: Piace Number
Serial Numbei
' Other:
� THIS IS A RECEIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OP RATE.Your application 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 RETURNED CHECKS
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III
_����. 1-�-� � �, i -- -
. - I Ci:•j oc Saiac Paui a�
. • • '� Deoart�enc oi Finance and `lanagement Ser�lces ��'J�-a�
. , D:v'_slan of License and Pe:�it �egist.ation
� IiIFOI�ATZON REOUI�ED 1�iI'*?I �P°L�Cr1TI0N �OR ?��MIT TO CONDUCi C�.RI'*rL3t? G�S.`'!3Li`.1G G� T_*1
� Sd,INT PAUL
1. Full and complece name of organizacioc •.►hich is applying for liceasa
�0 � d F ��' c,�H s �S�
2. Address vhere g es �ill be heLd ��'f� �: ��Z,� � ���i4-t,r�� ��J^//�
�- � yumber Streec City Zip
3. Name of manager �igrcing t:�is applicacioa vno wi?1 coaduc�, aperace aad aanage
Gambling Games �� �j�-�!� Dace af 3irta 1 '"�� �
(a) Length cf t' e manager has been ae�ber o= aoplicaac oraanizac�on �/
4. Address of Manag r s f}'v� .� /
Yumber Screac C�c? Z-?
5. Day, daces, and ours chis aoplicac�cn is :or � t? n ���%c> %� S�00 P�
6. Is the applicanc or ozganizac�on arganized under c:�e lavs o? c�e State o= �21? ���—
.7. Date of incorpor tion /�/d9L(i� /-�f"��
8. Dace whea regist�red wich che Stacz oi w.�:.aesoca ��.1�- ���
9. How long has org nization beea ia exfscenca? �l VJ�'rLs•
-• _ .
L0. How I.ong has org nizacion bee� ia �Y�scance ia �t. ?au�". �� y��-�
LI. Whaz is the purp se of the organ��:ation? `(�� f20V10� �D�u�� 1' C��R � ���-1��
�I�6E-i�u - o� n G r O�,u�' �D2 /J�'�d2.2'� GUE)�'! ��ls'�
I2. Officers of appl caac or3anizacion
Na�e �2.R.1 Va�e �-u �v �l�l<Z�/�
Address � d ti UJt�2!}- �L O 4ddrass �2�11 �-'�-rJ %2j l�6,t�
Title �j/ T1t� DOB �/L� i:�:= ��G2�?7 ]09 - _
vame �"� �N �. Vame `_
Address ?J p Ct?t�� S� 3ddrass � � /Ki�li1/vrd'a � � /
'ritle VdC� DOB b^��'-I,� '"_�_a Qe�14�U,2s'7� 70B L�'/rZ� ^ 3�
13. Give names oi oc: cers, or an;i oc;e� �ersar.s �rao :a:= �a: sar:'_css ::. =:e o:3ar:::st:�n.
Vame Vame
Address add=°ss
Ticla ! --===
% (.:��ac^ se?z:aca �:.a� . - :::c----r=- "-_=-•
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14, attached he:acol�is a Iist of naaies and addresses oi alI memoers oc che organizac:on.
. I5. ' In waase csstcd vill organ2zacion's records be kepc?
Name L�f � �(,► �/� Address .� i J "'
. �_
16. .Persons vho vill be conducting, assisting in conduccing, or operacing che games:
v�e 1� � � Dace oi BirtS �f��,� ��
address ..
Name oz Spause �� �-(LQ Daca of �irth �- 3"' 3�
Daces vhen suc� �erson vi� coaduct, assisc, or operace }�e-�.�.._�
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Name Da:e oi Birth
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?.ddress i
I .
Naae os Spouse I Dace oE Birth
Dates -:aen suca aerson •.ri?? conctct, ass=s�, or ope:ace �
I7. Have �►ou raac a�e �e ?au chorougal� ance:scand �he orovisiaas oE a�I lavs, ordiaances,
,• � �
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and regulat:or.s g�sve�_^.g. cae operac=an ci C�ar_tab?e Ga�b�i^.g gaazs? �C��'
18. �t�a�::ed hereto o#� �:�e :o:= ;uris:�ed 5•� c'�.e C_t� or Sc. ?ac:I is a Financial Repart
vhicz ?�a�i�es s?� :ace±:cs, e�easzs, aaa 3{s�urse�ezts o: t^e annl?canc organizat_on
' as :re?. as a'_1 or�ar._za�_ozs :aa aa��e _ece:re� :s�ds :or cie �recec.�g ca?aadar year
:�hica ::as �eez s-��ed, �-��ar_d, and va:__:ec ��� �p �,(.J
�ame
l� � �-- ��� � s��'r�
, :�cc__s� '
vho is c4e �{�-/V��r� o: c:�e apolicanc Organizac:on.
' Y�e �= Oi::�s �
I9. Operaca: o: p-a�_,'�es �ne=e 3ames ::�: �e ieLa:
N�e Jos� r ��-�ov�Gt�
Btrsiness �.ddress ( �J. � '�J�? �A-trt...__ ��//
Home 2�ddress �2 �I�IZI/�- �(�i� �jp
20. �,mounc o: =er.c �ai � �y a�o:::,=nc Or�s:s:_ac:an '�r :s.^.c o: c�e aa1?; saec:�;� aaounc
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paid per =►-hour se�,:�a �7�
I
ZI. The roceeds oc c^e 3aAes vill be disbursed aicer deduc�:ng pcize Iayouc cosc n�a��
?
operacing ex�en es ior �he iolloving purpases and uses:
!J r s � .z. Sl�csL? �!-vTk/�v �-j2.c:T' �� G��n�T ��Z.
�AA'`�7�+'J �'M LdF/�D2ek3 �5r�ff �S u3ss �J T�A�.a l�
IUPLS.Nn. .S�tEo�- I Q'�` ta�L(.f-u, Y�'vztF� A� 4a���e� � �rz� U�i=4,�,��..L�' .
22. Has the prea�isesl vhere che games are co be hald been certified for occupanc� by the
I
Ci[y ot Sainc °aul? �t�`�.
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23. Has your or3ar.� ac:on �=Led :edera: :ora 9°0-i° �� I,' ansver is ves, please accaca
a cocy vic� cc::,y- apcZ?cac:on. Ic ans�:ar is ::o, ex�lain ahy:
�p C�t►z+�ti n-w� • •o - (�u��4��..- it l�-�-- �►�� �� f�fat'�- l c1�C�
Any changes desi:ec � T ��e ap?L'ca�c issaciac.on aa� be aade onl;r vich c:;e conser.c o� che
Cicy Cc+unc?L.
.1'21�u0 S D ts � �Sc�vi/�S ��c!uS��
, Orga�_tac:on
�ate d� d Bv:
G Z�, � � .
�iaaagt: ia cnar aL game
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� City of Saint Paul Page 1 ���—���
, Department of Finance and Management Servicea
, Division of Licenae and Permit Administration
UNIFORM CHARITABLE GAMBLING FINANCIAL REPORT
Date �'27��
(' / �r
1. Name of O�ganization FI���%�� a� JZ' CS�!'� S �Uc�C
2. Addresa v�ere Charitable Gambling is conducted ��7� �O �/4'F—D�` S!
3. Report fo�c period covering -;f�+�s � 19� through u�V� �C3 19�O
. 4. Total num er of days played ��
• � �7�,
5. Grose rec�eipts for above period f !.� � •3�2
6. Gross pri�e payouts for above period (include cash short) � /�C� �6�
7. Net recei�ts - line 5 minue line 6 � �'� ` � 7'
8. Expenses �incurred in conducting and operating game:
A. Gross wages paid. Attach worker list with /�
names, addresses, grosa wagea, number of hours � tf�v���
worke , and amount paid per hour.
� B. Rent or weeks 3 O �o O
C. Licen e fee � �/d U
D. Inaur nce 3 O
E. Bond � ! 0 �
, F. Dieho ored checks not recovered � �`f'�
G. Acco ting Expense � �
H. Empl ers F.I.C.A. � ��_
*� /
I. Pullt b Tax Paid to Department of Revenue � /'ZS
J. Minn. U.C. Tax ; J(O
R. Fede 1 Excise Tax 6 Stamp = D`x'3�
L. Stat Gambling Tax S �`T`Y" v
H. Misc llaneous Fa�penaes. Identifq the amount
and o whom paid.
�. Q �.��a-� �`��..�. s /�3
ys I�Ji rk�v�,�)
2• ST oF P��.�7�-�5 a ��3c�
��li►Ko.v/� (��P �
3. s
4. ;
9. Total Exp�enaes TOTAL � � � �7 �
L0. Net Inc e - line 7 mirn�e line 9 s L � �T
11. Checkboo balance beginning of period � (�J 3 6�
12. Total of line 10 and 11 3 d���"�
13. Total co tributions (from attached vorkaheet) j � r°S��/
�
14. Checkboo balance end of reporting period - �G�j
� line 12 eas line 13 S �r�
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CRt01NAT.OR oA'�wm��a o��s�rr�e� "" " "����
Mr. J. C chedi ����� ����� No. d fl�4��J
� ACT RER90N . � . . . . . - � DEPAR7MENT DIRECTOR . .. . . AMVOR(�RB�tANT)� � _
. ` r' i e Roze � ass�a`" —` �a,���� �`«,��
�cr oErr. oarracr ra. NuNIBER FoFi
Roun� — ���� 2 Co�t�cil R�search
�' 1 carr Arro�v _
: Applicatian fo renewal of a State Cla�s A Gambiing License.
- Notification te: 1-24-89 Wearing Date: 2-�-Fig
. �TwN6:(Mvrwe(,�or ae�ec►ca>> cau�n�►r�nevoRS:
PIANMNO CONr�i9810N. . �. CWIL SER COMMISSION DATE M �DATE OUT� ANN.YBT -. . � � - � � Pl10lE NO. , �. ..
. . DCIlNNO COAMA198qN . . .18D 825.9C BOAF� � .. . .. . .
� � STAFF . . . . . - Cl1AATER tON � ' COMPLE'IE AS 19 ADD1 IWFO.A[1DED* � . F�T'D AD 001f�A�'T .� �!! .
. . . � . - � � � � ' _ . . _FOR A061 ItiFO.. _R'�OBi1ClC ADDED= .
. DISTRICT OOUNCIL *E7tPLANATIE3N: . . . . . .
� �� 9UPPORT3 WMId1 COUNCIL OBJECTIVE4 - � . . . . � . . . . - � � .
M1�711R PAOl1.�1r 188t1E.O�POII'iiNNTY ,Whet.WhN1�Wlfef6.WhYI:
Richard W. Falvey, on behalf of The Friends of Josephs House, requests
Gouncil appro �l: of his app1ication far renewa1 of a State Class A Gambling
_ License at 14 4 N. Dale Street. Gamb1ing sessions are held an Tuesdays,
between the h urs of 1:00 PM and 5:00. PM. Proc�eds: are used ta proVi�e
monies for sh lter, clothing, care and guidance for battered wanen.and children.
.�t�c�na+��e.�..,�awrM.o.�, . _ : _ -
All fees and pplications have been submitted. All 10% payments are current.
��AMrk Nlhen.aM To Whom)c., , _ : ;.: . , _
If Co�ncil ap roval is given, The Friends of St. Josephs House will
continue to s or�sor a weekly bingo/pulltab sess.ion in St. Paul. .
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Goun��l R �seurch C�rter
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