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89-321 WNITE - GTV CLERK � COUIICII /'� /� PINK - FINANCE G I TY O�Ia' SA I NT PA U L // / Q� CANARV - DEPARTMENT QVJ,�. �/ BLUE - MAVOR File NO• r ` �• o n�i Resolution ��, � �?�� Presented By � Referred To Committee: Date Out of Committee By Date I I � ; RESOLVED: That application (#D 13277) for renewal of a State Class A Gambling License b S . Mary's Romanian Orthodox Ladies Auxiliary at 1494 N. Dale, b a d the same is hereby approved. i � �I COUNCIL MEMBERS Requested by Department of: Yeas Nays Dimond �, �� � In Fav�r Goswitz Rettman O B �be1�� _ Agains Y Sonnen Wilson FE� 2 �� ���� Form Appro ed by City tor y Adopted by CounciL• Date ' . Z '�'� Certified Pas ed y C uncil Se ar BY By ' Approved Mavor. �at�-•-- — F�� ^ �'�'��? Approved by Mayoc for Submission to Council `'_� � B �-'.' �' �r'��"�—* � gY PUBiiSNE9 M�+t� - 4j 19 9 , owa�uron . �r � ����. . , a►�r w►a oo�ra.c� . ��� ����"r# N�l.�O 0���� � J. Carchedi Ernrr�Cr vE�soN � a�r�a,.�Kr a�c�cn ru�va��on,�sr�wn . ° Christine Rozek — �8��� �«�«� ��: �. — ��� �ounci 1 Research Finance & ; t, 298-5Q56 . � �R,� — _ su ; . , Rpplicatior� for renewal of a la s A Gamb1ing License (all forms). Notfification Date: 2-3-89 Hearing Date: 2-23-89 ��ae�s;t�vo►evs u►►«�cF») n�r: � . ��L.ANNiN6 COMMY8810N � CML 8ERVICE COMMISBION DATE IN DATE 04JT � MIALYST � . .. PEfONE NO. � . Z()PMNfi�hMA1S910N �826$CHOOL BOARD . . . . � . . . . � �.STAFF . . . � f71MTER CO�AIS&ON . � , AS IS� . � -ADDi INFO.AODED*. ._�FOFDAD�D'L N�O� - ��F�* � . . .. D�TRICT OOUiCIL � * . . . . .. . ffiJPPORT'S WHKkI COINIqL OBJECTiVE7 . � � . . � . . � : � . . � . . � � � . �. /rT1A7N10 Pp�1,EAA,�811E,G�POR'i1MTY(YYt�o.WtNt.VYIIBII�VV11l1^!,Why): - Eileen Valento, on behalf of he St. Mary`s Romanian Orthodox Church Ladies Auxi1iat.ry, requests Council � p val of hEr app'ticactior� for renewal o� a, Sta�e C1ass A Gambling Licen ( 11 forms) at 1�94 `N. Da1e. GambTing s�ssic>ns �re held�Tuesday evenings be� ee t�he hours of 7:30 PM artd 11:30 PM. Proceeds are used ta assist needy pea` e ithin the parish. - ,ws,�wemaN i�owe.�.��ahe�ao...fl.a�s�: _ . , All fees and applications hav b en submitted.. A11 10� contributions to tfte ' City, You�h �ur�d have been ma �F�UpI�'lWhed�When.�nd To Whom): . - : . •, . ! If Counctl appr.oval is given S Mary's .Rqnanian Ortt�odox l.adies A�xili�rry � will continue to sponsor a: bfi g session at Fdea1 Hall . � . . i �T�u►�res: . : . caro . � �. aaTwtrt�ac�rrts: FEB � i:���J ��: � � � �9r�/ . � DiVISION OF LICENSE AND PERMIT ADM NI TRATION DATE � � � / ` a'3 0 � INTERDF.PARThfENTAL REVIEW CHECKLIST Appn P oc ssed/Received by Lic Enf Aud Applicant ����h ��e"�_ , Home Acldress (�1 � S�� �Qc.� �e/Y). I'�r y��'j(�C!(a � � ( Rusines5 Name , M S �p � Home Phone 4s'�'" �/ ]� oe // Business Address 1�y� u, Type of License(s) R-en-�u� " (r�Q,Ss Business Phone �' �j/h �/CeYJ 5� Public Hearing Date �, � 1 �' License I.D. �{ / 3 a77 at 9:00 a.m. in the Counci Chamber , P 3rd floor City Hall and Courthouse State Tax I.D. �� ���' llate Nutice Sent; ,� Dealer �� �/�' to Applicant � �Q , I Federal Firearms �� /�/ � Public He�.iring DATE IN PE TIUN REVtEW VERFIED CO UTER) CUMMENTS A proved No A roved � Bldg I & D � ', N1 A- ; Health Divn. , , N1�, � � . _ , , , Fire Dept. � � ' Nl� � , � sen� � Police Dept. �1a3 8.�1� 1 3o d l�. � License Divn. � ' Z� �1 ; 0 K City Attorney � � �1� 0 l�. Date Received: Site Plan N(� � G To Council Research O � � Lease ar Letter I Date from Landlord � �� � '� � . . . � . � G� �9=3a/ Charitable Gambling Control Board Rm N-475 Griggs-Midway Bldg. For eoard Use Only � 1821 University Ave. Paid Amt: - St. Paul, MN 551043383 Check No. :•••••:�� (612) 642•0555 " • Date: GAMBLING L'CE SE RENEWAL APPLICATION LICENSE NUMBER: _ ,qT _ � /EFF. AT : ���1!gg /AMOUNT OF FEE: f1��,�, 1.Applicant—Legal Name of Organization 2. Street Address �. n r i C $. a� Q rl 3.C�ity,State,Zip 4.County 5.Business Phone �' , � �, ?a�se �i: a84-;b18 6.N�ame of Chief Executive Officer `` 7.Business Phone " �, .:.,i ' b:2 33�-+1238 8. N'ame of Treasurer or Person Who Accounts for Revenues 9. Business Phone *;�, �., '�� tl: a84-�6C9 � 10. Name of Gambling Manager 11_ Bond Number 12. Business Piwn9 =� � F� oa�� �,ita `--�-_..... ?]F:t�_.95018�:� , " � 13. Name of Establishment Where Gambling Will Take Place 14.Counry 15. No.ot Actire.ulembers__ ' �latl S� ?aul Faaszr 2b 16. Lessor Name • ' 17. Monthly Rent: p ;; ;i s�aa 18. If Bingo will be conducted with this license, please specify d$ys a d times of Bingo. Days Times �is Times Days Times �i• �� �;,� • ..J • � _ . ' ' _. . _ .. .. , _ f � . _ . .. _ , _ .._ _ . 19. Has license ever been: ❑ Revoked Date: j Suspended Date: ❑ Denied Date: 20. Have internal controls been submitted previously? �Yes ❑ No(If"No,"attach copy) 21. Has current lease been filed with the board? ❑ Yes �7 No(If"No,"attach copy) 22. Has current sketch been filed with the board? es ❑ No(If"No,"attach copy) GAMBL�G ITE AUTHORIZATION By my signature below, local law enforcement officers or agents f th Board are hereby authorized to enter upon the site,at any time,gambling is being conducted,to observe the gambling and to enforce the law for y unauthorized game or practice. BANK R�CO DS A1ITHORIZATION By my signature below,the Board is hereby authorized to inspect�,the ank records of the General Gambling Bank Account whenever necessary to fulfilf requirements of current gambling rules and law. ' ` � OATH I hereby declare that: � ;L,�j�� 1. I have read this application and all information submitted to th�Bo rd; ���J (, 2. All information submitted is true,accurate and complete; 3. All other required intormation has been fully disclosed; /� f� ' 4. I am the chief executive officer of the organization; ' � � �,;'`��t 5. I assume full responsibility for the fair and lawful operation of�il act vities to be conducted; ; � �' 6. I will familiarize myself with the laws of the State of Minnesota'�8sp cting gambling and rules of the boa and agree,if licensed,to abide by those Iaws and rules, including amendments thereto. �:i �23 Official Legal Name of Organization Signature(Ch�ef E ecutrve Officer) . Date Title• o� `Ir .�.�/' � �! � - � =1 ;; ^ _ , ,t � �' . �, ' i � Xi "%�% , �f ��.- ACKNOWLEOGEMENT�N TICE BY LOCAL GOVERNING BODY (� ' I hereby acknowledge receipt of a copy of this application. By ack�}owl ging receipt, I admit having been serv�d�th notice that this application will be reviewed by the Charitable Gambling Control Board and if app ved by the Board,will become effectiv 30 days from the date of receipt(noted below), unless a resolution of the local governing body is passed hich specifically disallows such activiry�a copy of that resolution is received by the Charitable Gambling Control Board within��days of the belo ,not date. 24.City/County Name(Local Governing Body) + ' I Township:If site is located within a township,please complete items 24 �� .� t. L�: � ° and 25: Signature bf� rson Receiving Application: ; 25.Signature of Person Receiving Application . 1 . � � t ( !��1�✓ Title� ,� ' Date Received(this date begins day peri ) Title: ' ' ; ? -a �-.: v '� Name f Person Delivering Application to Local�Governing Body: Township Name . X CG-00022-01 (5l8� � ite Copy—Board Canary—Applicant Pink—Locat Goveming Body � 13a7� . Cit ot Saint Paul � ��y�,r��/ � Department of Fihan e and Management Services a'7 Licen�e a d Permit Division City Halt . SL Paul Min esota 55102•298-5056 APPLIC�TI N FOR UCENSE ' CASH CHECK CLASS NO. N w Renew � a o o ., � � Date 19� ` Code No. Title of License ' From � 19-��To �� 19��' � � �o� Z �.`�C���, }����,;r., ��c.�?m 2 — •�� • ,. ,� , . ;�1 G� � ��,;-,<, ,,,�, , c�Y���< <�1�; i �1 ,(c,c ; 1 W � ApplicanVCompany Na e �G �I.f�j !�L� 1�� �r�,1'� ' 100 � � l%�l.� �.`�� �,D 100 Buslnesa Name �\ q , 100 �� • ��( C� � �l't ✓� ��/�7 Business Address Phon�N0. i 100 � , 700 Mail to Addresa Phone No. : , ,00 � , 1 �� ,� Ur� IQ , � ��� y;�'��� , �! ,_ ManapeNOwnsr•Nam� � /. f� I ' 100 1 � � � ��! 9�k'��� � �C n"�J/lG�� ��ir�•� i 100 AlanaqenGwner-Home Address PHOn�No. � 4098 AppliCation Fes ; � � 2. 50 � ! Received the Sum of _ �00 � � � ���C,� �+ (� �� �� `�� i �� .Q� MsnaqedOwner•City,State 6 Zip Code 100 ot I 100 � >"�� " � � , -„ J � � � 1 �� . ��Ja.� � i %�/��/ �/�� . Ltcense Inspector By: Siq�ature ol Applicant Bond• ' Company Name Policy No. ExpiraUon Oate I � Insurance: , Company Name Policy No. Expiration Dat� � Mtnnesota State Identiffcation No Social Security No. � Vehicle Information: � Sarial Number late Numbe� ' Oth@f: THIS IS A RE EIPT FOR APPUCATION THIS IS NOT A LICENSE TO OPERATE.Your application t r li nse will either be granted or rejected subject to the provisions of the zoning o�dinanCe and completfon of the inspections by lhe Heal h, F re,Zoning andlor Licanse Inspectora. $15.00 CHARGE 'FO ALL RETURNED CHECKS . I . !a�� � � ' � �� � i ,,� Cit�y o Saint Paul ��',�� , � Finance and ManagementlSe vices%License & Permit Division INFORMATION REQUIRED WITH APPLICATION FpR ERMIT TO CONDUCT CHARITABLE GAMBLI�IG GAME IN SAINT PAUL (To be used with the follow'ng New A & C application, renew A & C Licenses, and new and renew B in Privatl� C ubs.) 1. Full and complete name of organiza�io which is applying for license rJ ` ` i�4/�/t lC � � �� h��r iv !�l�` l�� H� �L�� _!� �/ /- : (i � 1 � �f l�2 i :. / �. 2. Address where games will be held � /V�.`%1 f� �� �L=.�,�- •���/,'!��— C�// '7 umber Street City Zip 3. Name of manager signing this appli�cat'on who will conduct, operate and manage Gambling Games i ,L C' �'^'� 1-�' �i�--C f�' T�' Date of Birth/ � /�`Gl n � (a) Length of time manager has beean mber of applicant organization f�S/�-- ��h'C'���=%y ��� r n • ,�� r.� ' ' N �r' /!�� � 't"� ����i��'�- / /I� � �� j �i 4. Address of Manager ,1��/ J !. � ��%l�, �!. , Number � Street � City Zip ; � ' ��=; f/�.?, 5. Day, dates, and hours this applicati is for �i_,�"j l.�/3 i�.� `,,` .�C�' ��' � 6. Is the applicant or organization drg nized under the laws of the State of MN? � � 5 � - � � `3 "7. Date of incorporation 8. Date when registered with the Sta�e f Minnesota �5 `�" � � `— � l f� 9. How Iong has organization been inlex stence? / ti K 5 10. How long has organization been in ex stence in St. Paul? ,.5` ��/� /Z�S 11. What is the purpose of the organi�at on? � /t5�s i'S L /llt�`�� P c�o�c (�'��./;�i i" . ./ � � I /���I�� � � �� �lZ �1;� i L C •f�" �� �� '� C I( �� C��� �� /f J J I� /� l�' ��•G' 12. Officers of applicant organizatio : � Name /��%L� rY C� � �Z � Name ._>�l/_"�/`�/t �� '�'� i % � _� Address:��l� =�1�� �i'�i�� ��rz.' i'/til! �`- Address ��/�-1. F�,�_'r. �� /-,��� i:���� ��—�/��,L .� , .i' �.- Title �f r` : i T,C't�-'�DOB •� � ,: 1• Title / k�It;v h';`f< DOB � /�� �`% � • � j Y Name '�l � 1��.�f� r CX' %i !� i ! �- . .., Name i • ,. ���/ Address�-��r/ �>i�ir.l/{i:�r".;i' �it r�'z�.• j�•��- �'�l�� Address '� ^ .. / ; Title : = � �r.� �'r�`� DOB k' /�/ z � Title DOB 13. Give names of officers, or any other persons who paid for services to the organization. ' �� �� ,� Name /f - �t•�� Name Address Address Title Title (Attach sep at sheet for additional names.) � � C� 89-3a/ r, 14. ACtached hereto is a Iist of name� a addresses of all members of the organization. . � , , f� �/ , �� �!� - � � � � � ,,.,_ 5 --�� , � .J `=;_ � � ; �'�l � , //_� �� t /i 4 15. In whose custody will organizatiort's records be kept? �"���•� � .� �^ ' � � Name 1' � � i_ lv' �i�i'f�.�" !�,' 'c� Addressl%//���� ������r�':;�'.�!E� ���w� � 16. List all persons with the authorit�y o sign checks for dispersal of gambling proceeds: ` - . � Name ` � �,'' �: Iv i� Le �% (G� Name�� ��l��C:�rF .• ��l���r�i�/�_! jN Address��! .�� ." � h�'� �`/����%�<�! �l!�� ��� � Addressr-ry'--,� L i}5 �� ,'i=/� ,+ .. ; �� n.l Member of ; � , . Member of �,,.,ft' . Yy9,� DOB � %-� �.J; I `h� Organization? ' I �� DOB ,�,.��.:� z' Organization? _,;�hi�llr'r�; � � Name Y'S '' Name Address � ���1 �� ���G� Address Member of � Member of DOB Organization? ' DOB Organization? 17. a) Does your organization pay or �.nt nd to pay accounting fees out of gambling funds? yes ', no b) If you do pay accounting fees, ito whom will such fees be paid? , R � � NameFJ���I- �er�''�;;���-:t� �1 ����� Address ��/F �/��Zi-:f�i Oc�� ��'� ''` �C"' �� `v �,�/ ,�,'. DOB Member o� 0 ganization? ',�i � c) How are the accounting fees c ar ed out? (flat fee, hourly, etc.) r 1�i�� �� c 18. Have you read and do you thorough y nderstand the provisions of all laws, ordinances, and regulations governing the ope at on of Charitable Gambling games? f.� C.d 19. Attached hereto on the form furni he by the city of Saint Paul is a Financial Report which it .emizes all receipts, exp ns s, and disbursements of the applicant organiza- tion, as well as all organization w o have received funds for the preceding calendar year which has been signed, prepaXed and verif ied by �Q� `p/\.,S t�l.t� v��e . � � J; 1���u2- � a�.w ���V SS I`�-3 Address who is the I of the applicant organization. N me 20. Operator/of premises where games Iwil be held: l j _ � Name _.,; C C (J �=- I` �{ �G' �,�`" ff ' . , Business Address ' ��;�- �f l.�; /' ;� ; � i � �' /' � .`- ;��� i�.' .0 �" �' P . • .i � � .-� ' Home Address ��t:'� _ �� K ; ,� � �, �_ :� � �� ;.,� `' � !"t f` � � � � I �, � O �v�/ � 'L�1. Amount of rent paid by applicant �,or anization for rent of the hall: `� c�G � 22. The proceeds of the games will b� d sbursed after deducting prize layout costs and operating expenses for the follo�in purposes and uses: �(��C�L � � � ������S�T ,"1 Ct..� � ' � ���' �N��� 'V]�f•�,��J� // ��'�l" �i �V �--C � I. ;4��� (�l �/�s C' !� �:,� � i•�- t.' k��,I c .. � � ��S. �f , 23. Has the premises where the games �re to be held been certified for occupancy by the City of Saint Paul? � � !� ' 24. Has your organization filed feder�al orm 990-T? 1✓.% If answer is yes, Iease attach P a copy with this application. Ifl an er is no, explain why: l��} j'� '�'i P(� f: (12 r !� `��i'✓ ' � �C r"2 v ��C��4r �ff U . 4` (� I Fj�i!V��C v ��C t���•� ,'�h'' �- ��.L Ivl,� ( ��'��l I N-'�- ��'�) f���t 1 r R P�S,�i�t= !�/r.'J f/1 �( ��31,t I r fJc�v'il rC=� T��'�fJ C�y �'� �� 1��}h�:� �i,�/Lt'C'SC- /N 'j�-t�t� �v��� ���/�I� li� r/atir��=9,r1{-C �ih � ; � Iti�' �:<',c�i,:r�::_� �r�' Any changes desired by the applicant ajsso iation may be made only with the consent of the c// City Council. IL c� - 1�+�1 '�c� � '�o�-i,c� -'��re.-�� �,c,p�....��{- ";� �I� i Organization Name �Date gy; � "'"' � � Manager in charge of game U V � ��������w �Q Organization President or CEO ^ r ^ . 7 7i � 9 � � I I`• � � � '1 31 '+ ? n r► r0 �r � S � a � � ^ f9 c� � 7 ti I CA !* r9 7 � :i �9 � •�; ,� 9 O � +o r - n 3 'e � � _ �e 3 ^ �e .. � 3 . � � ^ � T �O r+ C � � Q �. .< �O �+ r� A r.. � n � a T � = • 3 1 .. � � 1 7 � � 7 � � - Z � r. �, � � 7 r* ;9 = 3 _ r► 3 n � ''' r i r O � '� . �. I � � _ � P► R ,7 !1 . � ( d d � � � 3 � � y � � � � R � � � r. � r0 3 � � � A �� � ' 'J �l � �f � ;9 �d •< � � .9 t. I '`G � ..i ..i ,� .�, _I •'v, � r. ' - ; I rI n 0 "" � � � A / ! lf Ir "f � � . T � l /� A A !9 ' " 'e � 9 � '�\ � ! fe C� 3 =�� �+ �� `� I S n � � = 9 \ G� � C' r+ 9 I • �' I r � ^ � � A � �' > > _ „ ; I �i � I �• � �e I .., � - � � 9 ! -; I g � 3 n ^ i = i ' �e t �+ = � A 1 ' I I T a 9 ` � � D 'O I I � � � r. A I \ � .�.I ' , a � -9i � 7 a � 3. ti1 ' � t .. � � � �e � � � � ; i � � a .• i i � � • � • C ty oE Saint Paul Page i Department;oE inanee and Hanagement Serviees Division o� Li enee and Perwit Adminiettatioa � Q��,�a/ O • ' UtiIFORH CNARIi LE GANDLING FINANCLAL RBPORT Date�K�l-✓�)� ( 1 V I (, Nase oE Organiaation .�,� �or'itp.n•,n•.� �-�ttt S ��I i0.1''� 2. Addrea• vhere Charitnble Casalin is eondueted L� �F� 4� 3. Report foc petiod covsrins �g�thcough N,J �A l9� � 4. Total number of daqs played 5. Gro�s receipts Eor above p�rliod ; ��:-�6��0 " 6. Cross p�iza psyouta for aboqe p !od (inelud� cash short) _ �US��� �U 7. Net receipts - line S minus ilin 6 = �/ ���� 8. Expensea incurred in conduc iag and operating Ssae: A. Groas vages paid. Atta�h v tker list vlth f� names. addreases, 6ross�,va6 �. number of houra = ��� �+�'� vorked. an�amount paid!psc hour. ; ���0' B. Reat foc � weeke �O � .J�L10 .00 C. Lieensa fee D. Inauranee S . _ /Da DO E. Bond = 3po .00 � i. Dlshonoced checks not rpcov red - ; ����_�Ov C. Aecounting Expense H. Fmployera F.L.C.A. ; I. Pulltab Tax Paid to Dep�ac nt o[ Re�enu� ; � J. Hinn. U.C. Tax = � , d5/-/S R. Federal Exciae Ta�c b St�aap � T�s s�.ob1�� : �5�3.i� L. Stata Cambling Tax �/�� 3�7+ 7�`' ' H. Hiecellaneoue Expensest I entif� eh� oount . and to vhoe paid. �.�w►iT4.lo`�u.�-4,. : yoaa•t3 Z. M�,sc.S.�ppi;es' : q3-�� ,, E��p -�d?ca� I��1 � SIS.Uo e.�� C�lte.k C�' C : �4•!oa- ���. : a�]��eO.ys 9. 1ota1 Eapenses ' �3'('I '• `, , 7l� ��"� 10. N�t Ineos� - line 7 �inu� �lin� 9 ; `` �.G� 'I u 7 U 11. Cheekbook balance be6lnnin� ot period �', ��D.� I2. 'foul of Line 10 and ll : •• 13. total contributions (irod �att hed worksh��t) : a.a, '1 sq.y� . 14. Checkbook balance end ot depo ting period - ; 8� ,�, �� line t2 lees line l3 ' • UNIFORM CHARI !AB E 6AMBlING FINANCIAL REPORT ��� "� �, LAWFUI PURPOS� C TRIBUTIONS - WORKSHEET � � � � �'� i � Line #13 - Total LaNful Purpos@ C ntributions. E aa.����-y� � List below all checks wri�te from gambling funds which are charitable lawful purposelco tributions. The total dollar amounts of these checks a�st match the amount claimed in line #13. Use additional-�sh ets as necessary. CNECK # DATE � PAYEE I CHECK AMOUN PURPOSE oJa� 3� +r� 's�t o a►v�`�. u�rc1-, �sc�� y�'�,Clo�� �Ass�s�J�cU� 1. 13(�°I � "" '� 2. �387 �'ebas �E �� ` �� �� �,000 o� „ �. �, � � �, . , � , .� , . .. , , f� 3. I y I i U�ta.�r.i�3u i� �, �� �i� �,5oa� a. ��I3a �pr. 30 �� � � �, �� 1� Soo.00 �, i. � � „ ► � � � 5. 1453 �v►o� 3I � � �� �� ' ' �, 500.00 � � � � � � -� .� „ Y 6. �y 7�- �,�►c �9 ►, „ " ' ' ��SUd �o �� � � , � .� „ � ► 7. I y 78 �u.ly ay C i o�� S�.�a I I 3,(c(,� �o.�o�i o�n �b �-' .�� � s. I4�10 .lw� ay �.(Y�a,�S 1`�w�owi+l��. l�u,� aacn.oa s„��j-�,C b�r��(�ss�s-�a ll�eda 9. �5�a A�3a C•i� � S�.�t-�,,,Q �ao 33 d.,��o,n -b C-�-�`�1 �o. �s��� A�3o �.n�,irs'� � , �a a�7s� y�,eb-�;����s.,6 NQ��; ii. 153) � G� � 5� a�,�� o.�-rvH -fa C� � �2. ,�3y s�p�3 o sf 1�x�'s K��a�� Ch� a�m.c�o ,,,�A►r��C�a�r;�j J�ss;s �a ti�tc� �3. � �37 0�: �► s�.rn�,�- k������ e��� �.� �. ,� , � , . ,. , . � TOTAL C�IEC ANpUNT � NOTE: These expenditures r+ill be pro ided to Council Members at your Council hearing. Be sure that your financial, re ort is complete and accurate. < <. . �J , ` + ., •• � � : r 3 ' � � = _ L � � : -+ _ , - � , e . r � � .��1 � � � �1 A ` „�j� , 6" . y � . ILu`�+ � � � y 6 � � : i � � e > � r ! � _ � • � ((�� yl � 3 `� s s � � � "� ? ! Z C (� J w � r s � N� �.� s � A � � � � O '� _ e, � � f � .4i � �� � \. w ! � O ! � � � � � � ' ' �^ T � i e � + � � ` � 1 • ; �c � � � � .;.._ . . � r � � s � ....., a : : • � A .�v►v • n � � � 7 r • � Q • V w � , 1� � \ � �~ � � � + � � • \\\�.- . d � , • . ; � • �"' w w • ; � �i s� � .1 � � � ~ r =� i ' � � � � i . �i al e •` � � A � W ' = j • � , i � } � � � � I 1-f = � E� � ' . , , f z � ; � z t I � . � 1 . ' � _ � � UNIFORM CNAR TA LE GAMBLIN6 FINANCIAI REPORT � ��� � LAWFUL PURPO�E ONTRIBUTIONS WORKSHEET _ � . . . . . . .G f" 8'r1,,3� � Line #13 - Total LaNful Purpo�e ontributions. � a°�, ��, y 1 � List below all checks r+rltt n from gambling funds which are charitable lawful purpos� c ntributions. The total dollar amounts of these checks �us match the amount claimed in line #13. Use additional s eets as necessary. CNECK # DATE � PAYEE CHECK AMOUN PUR_ ____— � i. �S Sy Oc�- �-1 C�� o� S��a tSSy� �a�io� � C:�� 2. 1 SS7 �- � `.�.(Ybu �s 1���Pan uxc.0� a8)S.vb �-�ao�1C'-I�Ni���Assis �NPCd � p� 3. �s�p� Il�o� a��. ��� tyt �a.!�1'a ,,.JI �S.�8 a�a�`i o� �a C''� � r 4. �Sr1�1 Il�ao 3 o S�,rv�a.r�k�owutnl C��u.�r.l� �S�•c�o 7�oc��e�o�ii�+��SiS. 76 l�ke� 5 . 6. 7. �!i 8. ; 9. . I . 10. i 11. ' 12. . ' 13. ' TOTAL �NE K ANDUNT �o� ���y NOTE: These expenditures will be '�,p vided to Council Members at your Council hearing. Be sure that your financial r port is complete and accurate. � .� � �+ � � : s - ,� � � I�+ a � � "� ?„ : � s • � � ? � Q w � + � !i G � � � .. y !� • .�.. � � '�� M !� ` . I A � 4 4 ` '� y '� I � ; ♦ Q 1 • O Q > � � O � �► � � � � ♦ � � • = v � v ? ! � • i � = r w '� '� � A f � • 2 � . � ;.... � ; ; �.� M s � � V � ' :�� ; . .�' .. � n" ' � 1� M + � • � � � q � > ! . � � .Qi � • s � w � -s ^ � • � � � • � e1 • s � � • � O � � � A ! � � {■ � � A � .r.►.r i � � : � � w � b i 4 .►.r� •� A � i w � i i !� ' = . y ! ^ ' � � � ' ; v t • A � • + • f � ,� O .di � + . . � ! ^ I � � r � • � s . • ! � 3 ° i � .� ,.;.a► ,� � I I � w= ( � t 1-' T � � i i ; � ; � � -� i I � i � � �