89-255 . , i
WMITE - C�TV CLERK
PINK - FINANCE G I TY OF SA I NT PAU L Council [//���/y� �'/( Lf
BIUERV - MAVORTMENT ! Flle NO. �+ � V'r� —
! Co�n 'l Resolution �,
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #52718) for renewal of a State Class C
Ga ling License by the Guadalupe Youth Council at 408 Main Street,
be and the same is hereby approved.
�
i
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
��g _�, In Favor
Gosw;tz
Rettman � B
s�he;ne� _ Against Y
Sonnen
Wilson
�EB 1 4 i989 Form Appr ve� by C' orney
Adopted by Council: Date � �
/-z��8�1
Certified Yass ounc' Sec ary By
By
Appro y 1�lavor: Date
�B � u �g�� Approved by Mayor for Submission to Council
By
tSt�fD F�� 2 51989
. ��a�
, U�,VISION OF LICENSE AND PERMIT ADMIIvISTRATION DATE � I3 / � � 7 O �
INT�.RDF.PARTMF.NTAL R'VIEW CHECKLIST A.ppn roc ssed/Rece ved y
Lic Enf Aud
Applicant C ►�1-� Sn r/" � Home Address a y �� � . � li �p�PnTQc,(►""
Rusiness Name l., pl.t'tl"� l.L►U/1�t �Home Phone � 1� � � 7�2
Pusiness Address �� ���i 5 � Type of License(s) l��l�'SS � "
Business Phone �1C�m C���n L� (�� � �2n �!'.�f
Public Hearing Date �- ��'� � I License I.D. 4{ �a �� �
at 9:OQ a.m, in the Council hauibers, 1 ,
3rd floor City Hall and Courthouse State Tax I.D. 4� N �/9'
llate l�otice Sent; I �� ���r^� Dealer �� ���'
to Applicant W
rederal F�.rearms �� N Il�'
Public Hearing
DATE II�'SPECTIUN
REVtEW VEKFIED (COMPUTER) COMMENTS
A roved Not A roved
�
Bldg I & D 1
� 'q' ,
Health Divn. '
__
, , �C�. �
,
Fire Dept. i ��� I
i
i f
Police Dept. � I O �
1� �
�
License Divn. '
' �a� �� d K
City Attorney �
I s��� , 6 K
ate Received:
Site P1an IU !'l / �� �j�
To Council Research 6 b
Lease or Letter f � � � ate
from Landlord
��-��,
.
.,:'�� Charitable Gamblin I Control Board
'`� '�•5� Rm N-475 Gnggs- idway Bldg. For Board Use Only
� 1821 University Av . Paid Amt:
= St. Paul, MN 55104 3383 Check No.
":•••••:� (612) 642-0555 Date:
GAMBLING LICENSE RENEWAL APPLICATION
UCENSE NUMBER: �-�aggbi�- $? /EFF. DATE: aqj�:;gq /AMOUNT OF FEE:
1.Applicant-Legal Name of Organiz tion 2. Street Address
CNURCi' �F hUR0�l�1VE 'lOUTH C09N� l ST �MUt 4C8 lain �tr2et
3.City, State,Zip 4.County 5. Business Phone
5t Paui, MN 55:/' 3aas�y 6!: <<�-ilA1 �
6. Name of Chief Executive Officer 7. Business Phone ' -
fr J 4acken�uelier ( ..'- � .'�%rr
�
8. Name of Treasurer or Person Who ccounts for Revenues 9. Business Phone
�ian? 3�;�r ( �?'' ) 751-544?
10. Name of Gambling Manager 11. Bond Number 12. Business Phone
� , .
�df!!' �lY'�0( `�'vh:•'.� r-, 7° _. , � i.
13. Name of Establishment Where Ga bling Will Take Place 14.County 15. No. of Active Members
{lA��.y �.� 11it: �t:il�� (L s��: 119!'1?.j �( �
16. Lessor Name 17. Monthly Rent:
9or�h �i.5( Gl�� �a�a
18. It Bingo will be conducted with this license, please specify days and times of Bingo.
Days Times Da� Times Days Times
19. Has license ever been: ❑ R voked Date: ❑ Suspended Date: - " ❑ Denied Date: �"'
20. Have internal controls been submitt d previously? .CT'Yes ❑ No(If"No,"attach copy)
21. Has current lease been filed with th board? C� Yes ❑ No(If"No,"attach copy)
22. Has current sketch been filed with t e board? � Yes O No(If"No,"attach copy)
6 GAMBLING StTE AUTHORIZATION
By my signature below, local law enfor ement officers or agents of the Board are hereby authorized to enter upon the site,at any time, gambling is
being conducted,to observe the gambi ng and to enforce the law for any unauthorized game or practice.
BANK RECORDS AUTHORIZATION
By my signature below,the Board is he eby authorized to inspect the bank records of the General Gambling Bank Account whenever necessary to
fulfill requirements of current gambling ules and law.
OATH
I hereby declare thar
1. I have read this application and all i formation submitted to the Board;
2. All information submitted is true,ac urate and complete;
3. All other required information has b n fully disclosed;
4. I am the chief executive officer of th organization;
5. I assume full responsibility for the fa'r and lawful operation of all activities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota respecting gambling and rules of the board and agree, if licensed,to abide by those
laws and rules, including amendmen s thereto.
23.Official Legal Name of Organization Signature(Chief Executive Officer) Date Title
I.i� ` _ � . .-6i' •
��. .. !� f . �1:� . �f . � J� A� . . . . _ . ..L'.: . .. ._.�
ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy f this application. By acknowledging receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gamblin 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 local overning body is passed which specifically disallows such activity and a copy of that resolution is receivecl by
the Charitable Gambling Control Board ithin 60 days of the below noted date. ' r
24.City/County Name(Local Governing Body) Township: If site is located within a township, please complete items 2d
� . , , � and 25:
Signature of Person Receiving Applicati n: 25. Signature of Person Receiving Application
. �_ - . ` ,� . ;i
± Title,, _- Date Received(t is date begins 60 day period) Title:
;.� - -� . . , ,
..,�7.
- Name of Person Delivering Application t Local Governing Body: Township Name
CG-00022-02(8/88) White Copy-Board Canary-Appticant Pink-Local Governing Body
I
Sa�7�8'
City ot Saint Paul
Department of Finance and Management Services �G�a�J�
. License and Permit Division
203 City HaU
St. Paul, Minnesota 55102•298•5056
APPLICATION FOR LICENSE
CASH CHECK CLASS NO. New Renew
a r� --� o o � .3 ,9� r
� oace
Code No. Title ot lic nse From } �� + 19'�To ` ( �I� tg y�`
a3�`r' �. �GSS C ambl�•, a 33,�s ` 1 �
100 � G( ! �.�l '�,, L'1'� � 1 /1 L( `f'� ��)L(i7 Cc �
LI (,L,y, c.Z� 'wl-c.��a,.� ' APPUeanUCompany Naine 1
!
100 r Q' ^ '
� l..% V P-�`: �'^ `..�U.� %L i(� l � 1 ��
100 Business Name ,,.\
100 � > i !1 �
I C+ �` . 1
Busineas Address Phone No.
100
100 Mail to Address Phone No.
ioo �r�'.�t,Z SNL� �p ✓TJ ��� � 2
ManapsNOwner•Name 1
100
I � `� �'{� � � , (A 1(=P i 1"''Q✓�
100 AtanageNGwner•Home Address Phone No.
4098 AppliCetiOn Fee � •
Recefved the Sum of Z 10� �( ��( �t r 1''� ��,��� v5
� ��':
p�� `� ManagerlOwner•City,Slate d Zfp Code -
100 Total 100
�i
J�. � �� �����. �: �' ..�,�.��
liC8�5e InspBCto� By: �— Signaturo ofGApplicant
Bond•
Com ny Name Policy No. Expiratio�Date
insurance:
Com ny Name PoNCy No. Ezpiradoo Oata
Minnesota State Identlfication No. Social Security No.
Vehicle Information: � __ �
�iial Numper Plale Numbsr
Other.
THIS IS A RECEIPT FOR APPLlCATION
THIS iS NOT A�ICENSE TO OPERA E.Your application for license will either be granted o�rejected subject to the provisions of the zoning
ordlnance and completfon ot the in pections by the Health, Fire,Zoning and/or license Inspectors.
$15.00 CHARGE FOR ALL RETURNED CHECKS
II .
��:��'��� /-/��9 l� 7` � ��.
� � ��a�
City cf S4int Paul
� Fina ce and Management Services%License & Permit Division
INFORMATION REQUIRED ITH APPLICATION FOR PERMIT TO CONDUCT CHARITABLE GAMBLIVG G��fE IN
SAINT PAUL (To be us d with the following: New A 6 C application, renew A & C
Licenses, and new and renew B in Private Clubs.)
1. Full and complete� name of organization which is applying for license
D ' '
2. Address where ga es will be held �� r,�-�� �� �,��!'�QJ ��'� ;Z,e
Number Street City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gambling Games � �� ' Date of Birth ',L. � � -�
(a) Length of tim�e manager has been member of applicant organization t�;$ �/;��
4. Address of Managexl' ° �'� ��.;�,.., �G� � ��. ' '� ��
II umber St et City Zip
5. Day, dates, and h�urs this application is for ��,�� �,,,(�.. �,`_3L_,S'3C�f�/�( — Lj�fj���'�
,6. Is the applicant r organization organized under the laws of the State of MN? _�„t.�
��
7. Date of incorpora ion 1 � '� /
8. Date when registe ed with the State of Minnesota / q �f
9. How Iong has orga ization been in existence? °� �,��
�
10. How long has orga ization been in existence in St. Paul? _�� X ,�,,�
11. What is the purpo e of the organization? �9� � i-,» .�_ �.1�„e- �Q�,t�c�
� � .�
. •
12. Officers of appli ant organization:
Name � � Name ���ise.�„n� _���,.��2�-x.�
Address •` � 2�c,c� Address j� ��S' �,lQ"�c,yy„�,../ (,�'�,�-L.�
Title � DOB o - � Title����;� �'',,,a_� DOB Z .;�
Name � � 1.� Name ,�f1,1� _� //Z.C.�c,/��
Address q ,�,� � Address 1 �;c.� Q �,��n��,�.vt� �'liy�.�.
Title DOB j�f���� %�, Title ; �t�,a�«,t-c.%� DOB /(o
_T��—
13. Give names of offi ers, or any other persons who paid for services to the
organization.
Name Name L/�
Address Address
Title Title
(Attach separate sheet for additional names.)
I
��-���
14. Attached hereto i a list of names and addresses of all members of the organization.
15. In whose custody ill organization's records be kept?
A,
Name �� � ,_,/ Address �c � �,�� ��
16. List all persons u�ith the authority to sign checks for dispersal of gambling proceeds:
Name QQz.,i_i Name
Address �� Lcc.�,�J � Address
Member of Member of
DOB , �� 3 i Organization? •� .�✓ DOB Organization?
�
Name Name
Address � Address
--� Member of Member of
DOB Organization? DOB Organization?
17. a) Does your orga ization pay or intend to pay accounting fees out of gambling funds?
yes � no �
b) If you do pay a counting fees, to whom will such fees be paid?
Name V= j Address �-
DOB Member of Organization? L�--
c) How are the ac ounting fees charged out? (flat fee, hourly, etc.)
�
18. Have you read and �o you thoroughly understand the provisions of all laws, ordinances,
and regulations go erning the operation of Charitable Gambling games? �
19. Attached hereto on the form furnished by the city of Saint Paul is a Financial Report
which it .emizes al receipts, expenses, and disbursements of the applicant organiza-
tion, as well as a 1 organizations who have received funds for the preceding calendar
year which has bee� signed, prepared, and verified by
�
/I� ��i/ ,Li� ;� ' t2'l� �I/�
Address
who is the �/ of the applicant organization.
Name
20. Operator of premis s where games will be held:
Name C CL�
n
Business Address /
Home Address �
I
' ' �- (',,��y'�a��
; 21. Amount of rent pa d by applicant organization for rent of the hall:
� IoS �-+ � .
22. The proceeds of t e games will be disbursed after deducting prize layout costs and
operating expense for the following purposes and uses:
,
�
v
P�aAv �
23. Has the premises here the games are to be held been certified for occupancy by the
City of Saint Pau�? �'(��
24. Has your organiza�ion filed federal form 990-T? v If answer is yes, please attach
a copy with this a�pplication. If answer is no, explain why:
Any changes desired by Ithe applicant association may be made bnly with the consent of the
City Council.
f-�L 'i�L-� i L�
rgan zation Name
� ��G����� � , �Q,c�t�
Date �
� / / 3 �� By: c.,�.�c_c._ `� '.c�
i' ' —r Manager in charg of game
� ,I
�N. i �l�r��irn,c��i��---�
OF an zation President or CEO
� Ip ` � � � n .. � ^3 ,
O b 9 � � � C � :1 b '9 ?
n n r0 � I� S � a r+ � `+ ^
A f0 '� � %1 I<'1 ' •� 7 '3 f9 7 �
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• C:ty af Saint Paul Page 1
Department of Finance and Management Servicea
Division of License and Permit Administration
� t _
UNIFORM CHARITABLE GAKBLING FINANCIAL REYORT
Date
�i` �=�►c�. ��c � � d
1. Name of rganization L+C��G� 4�.lLv
�/y,, �` y �
2. Address ere Charitable Ga�bling is coadueted G��/Y �//tkL1��-/�� /� ,� LLtLL �i(�
3. Rapost r period covering �y�7 19� ehrough fy1.�J 19� �( 'Ylt/-s%��
4. 'Iotal n ber of daqs played .y �
5. Cross re eipts for above pariod s ��3 n c � �L�
6. Grosa pr z• payouts for abave period (includs caah ahort) ; �Q � �)a, e n
. 7. Net race pts - line S minue line 6 � f ���.�.� O
S. Expenses iaeurred ia conducting and operating gae:
A. Gros vages paid. Attach vorker list aith
name � addresses. gcoes wages. aumber of hours � ✓
wor d. and amount paid par hour.
O� i
• B. Rent for �veeks � _�7��� = C% C>
C. Lice se fee � `a�C% : �� L7
D. Insu ance � � '
,
E. Bond � ���• fI�'
� F. Dis nored checks not recovered 3 1'`7. �n
G. Accto�uatiag Expense ; �
H. Empl yera F.I.C.A. �
I. Pull�tab Ta�c Paid to Department of Revenue ; �
J. Min . U.C. T� i �
R. Fede al Exciae Ta: b Stasp S
L. Stat Cambling Taa = �� J��•- ��
. r
H. Misc llaneous Fspensas. Identii� th� mouAt
. and to vhos paid.
1. �".c,� i t �_ Si`.. 1�G
2. ,�.�a-�r�✓" ; `{Q �'i D
3. -�,, U-�e-�-�-�.,$•�,j�., s /L • 1�s
4. i
9. Total E�ensea TO?AL ; � ��� c�
10. N�e Inc s - line 7 dnu• Iins 9 ; �
11. Checkboo�c balance beginning of period i � ��d� d r�
12. Total of line 10 and 11 : ,�� � � ���'�
13. Total co tributions (frod attached vorksh�at) � �. � .�i�v�� ��'l`�"�y
16. Checkboo balance end of rsportiag period -
' line 12 �less liae 13 , � r� � �� ��_���
orot�u�,TOa , orte�rtu►�. aate oorr� CA"!T�
s
J. Ca rchedi ����: ���: No,��3�J 0 2
oeP�o�ecroA w�rdn�aa�ssre��wr, ";
,. Y Ct�ristine Ro� . �� — �,��� ���
. "°� � — �� � GounciT Rese�rch
Fin c . & . : :1 ,�, --- .. .
-5t�5b. °�'` �, .,,
Appl i ca�tTon fo. ': ren�� vf a State C1 ass C Gainb�it� ;t,icense.
_ - _ . .
Not f#1 cati on te: 1-25-89 Heat ri ng �atte; �''� _ .
_
71Q�:cAVOrow t�or�(�� CouMa.n�R4�+rlErQlTr: , •.
. . PIAN�q OOA/�AI8810N � CNIL COMMISSION DA7E IN� �DATE OUT - � - MW_YSf . . . . .. .. PFibNE NO. , � � . �.
� aDNNO OOMWSI.ON . � 1�826 BOARD . - , � � .. � � - .
. � 8TAiF ��—ClMRFER OMIiB&ON- . . OOMPI.ETE AS 13. - . -ADDL MFO.AD�FD'� . ..11ETD TO COH�A�T _ .00MSTRI7E►tT . . � .
. . . . .. . .. - — —fOR'AOD'L M�IF4.. �_FE�QIICAC ADDm• -
016'TRIC�C01/iCt.- . . . _ � . .. . � .
. - •E7fPUU111T10N: � � . - .. � � . . -
. �8ll!'PORf�YNAEH OOIMiCN.06JBCTIVE9. . � .� . . . � � . . . � . . : � . . .
N11ATN9 ME��L�1.N�.OROR71JNfTY(YYhO WNd.MIMe1,VNIMr.wM): , . . ;.
,Marie Snyder, n. behalf of the Church of Gua�1upe Youth Cour►c�� , requests
Ci�y Council a p.roval..of_her app1icatibn f���renewai bf a S�ate �l:�ss � Gati�b1ing
� Licer�se (Bingo nly3 at. 408 �Main �treet, Bittgo se�sions are held or► Th��sday
afternoons bet n the hburs of 1:30 PM and 5:30 FM. A11 pr4ceeds are �ona�ed
to the Our Lad of Guadalupe Church: and Sctioo1 . � -
�: .�usr�s+►no�po,ve.A.eu.�,�: _ _ . ...
Ali fees and a lications ha�ve been subm�tted. No 10% is co�lected f►"v�t
bi n o.
_ . g :�ame'�. : ,_ .
': �rtw�w.wa.p.�,�e�o w�,>: , ,., . .. . .. � : . , . ,
If Council app val is given, the Guadalupe Yout�t�Counci1 wt11 continue to -
spc�nsor :a bingo game at 408 Main Street. -.
�c�rnves: . � nnos ,A►�. .
� �.� .
�+aroitrr�s:
v N� `� r; ens�
� :u }�
��: