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89-342 WHITE - C�TV CLERK � PINK - FINANCE G I TY O SA I NT PA IT L Council /�(�. BLUERV - MAVORTMENT File NO. �+�_ ��� y Coun ' Resolution , �-:;, � i �' Presented By �-_- �----°°� Referred Committee: Date Out of Committee By Date I � RESOLVED: That application (I # 7081) for renewal of a Class A Gambling License by Th Department of Minnesota Jewish War Veterans at 106 ' U iversity Avenue, be and the same is hereby approved/ ' . � COUNCIL MEMBERS Requested by Department of: Yeas Nays Dimond Long [n F vor Goswitz Rettman � B Scheibel A gai S t Y Sonnen Wilson r �"EB L � � �=� Form Approved by C' Attorney Adopted by Council: Date ' ' Z:-iN-� Certified Pas e ounc.il Se t By By f�pproved avor: Da � — � Approved by Mayor Eor Submission to Council By � W� By �U�itS1�E9 f�����t 1 ? 1 8 . � � �- ��� ; UiVISION OF LICENSE AND PERMIT A.DMINI T TION DATE � 3� ( / � � � 5 INTERDF.PARTI�fENTAL REVIEW CHECKLIST A.ppn Pr ce sed/Received by Lic Enf Aud Applicant � /'� yY�,Q� 0 �� Y) �Home Acldress ,� () �/(� t�- �U � � 1/o v..2. T�t.Vtsh r Ve �c S _ ! Rusines� lvame Home Phone � 3S a. � �� �j Business Address �O �D'O Yll l/�P1rS -�� Type of License(s) I\�1'1Qld��`-� � }3usiness Phone �`�}A,� �,L�SS � �14w► �D�iT l CQ,f�S.e, Public Hearing Date �c� g License I.D. 41 g ��� � at 9:OQ a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. �t � '�" llate Nutice Sent; � f � Dealer 41 �l �.�^ to Applicant � g� (� 1 rederal I'irearms �� ,IL) /q- Public Hearing DATE I1�SP 'CT UN REVIEW VERFIED (C MP TER) COMMENTS A roved t roved � Bldg I & D � N I/� � Health Divn. ' , N��, � � Fire Dept. I � I � �� � ! se�� a[� (� Yolice Dept. I � � � � License Divn. ' � I����' o� City Attorney � � ( �� , �/ �L� Date Received: Site Plan � � �" � y To Council P.esearch � � � �1 Lease or Letter ¢ D te from Landlord � I ��. � 6 � . � $�-.�a Charitable Gambling Control Board ' : Rm N-475 Griggs-Midway Bidg. For Board Use Ony } 1821 University Ave. Paid Amt: - - St. Paul, MN 551043383 Check No. �� (612) 642-0555 Date: � .. � � GAMBLING LI EN E RENEWAL APPLICATION � „' ��, , LICENSE NUMBER: _� � /EFF.D TE: , � $8 /AMOUNT OF FEE: 161.81 � 1.Applicant—Legal Name of Organization 2.Strel3t Address ,�• o ��+�.y .. . . . .. �� 3:City,State,Zip 4.County 5. Business Phone � r t Qa se 512 64A-6751 :;,,.: . "� '.- 6. Name of Chief Executive Officer , � � 7. Business Phone�„9 9� �`;; � � , �' 8. Name of Treasurer or Person Who Accounts for Revenues " 9. Business Phone _. ^ 0 7 10. Name of Gambling Manager U. Bond Number 12. Business Phone �- i • tN� ;�311� : 13. Name of Establishment Where Gambling Will Take Place 14.Counry 15. No.of Active Members • ^t a � v.a o 541 16. Lessor Name 17. Monthly Rent: * i :t �+ n 18. If Bingo will be conducted with this license,please specity d ys a d times of Bingo. D� Times � a s Times Days Times O �a^ �'?:���-.� 19. Has license ever been: 't�Revoked Date: Suspended Date:�' enied Date: � 20. Have internal controls been submitted previously? � v,�Yes � No(If"No,"attach copy) '� 21. Has current lease been filed with the board? I �es ❑ No(If"No,°attach copy) 22. Has current sketch been filed with the board? ��es ❑ No(If"No,"attach copy) .. __�,.. _ : .. . , . .:=:. _.: _ '�^1E:.::.. -. _ _., . ..,, � ` GAMB NG ITE AUTHORIZATION By my signature below, local Iaw enforcement officers or agents f th Board are hereby suthorized to enter upon the site,at any tlme,gambling is being conducted,to observe the gambling and to enforce the Ia for ny unauthorized game or practice. BANK DS AUTHORIZATION By my signature below,the Board is hereby authorized to ins the ank records of the General Gambling Bank Account whenever necessary to fulfiii requirements of current gambling rules and Iaw. , ,. ,, . .. , . . OATH '_ .. .....:. .. .,. . I hereby declare that: - 1. I have read this application and all information submitted to t e B rd; 2. All information submitted is true, accurate and complete; 3. All other required information has been fully disclosed; 4. I am the chief executive officer ot the organization; 5. I assume full responsibility for the fair and lawful operation of�II a tivities to be co�ducted; _ 6. I will familiarize myself with the laws of the State of Minnesot res ecting gambling and rules of the board and agree, if licensed,to abide by those laws and rules, including amendments thereto. 23. Official Legal Name of Organization Signature( ief xecutive Officer) Date Title ' �/��'1- �✓�I� r /`� � —�-,- • � .�n 1` ''), ���� �� �' � � � � _` �-� ; ' "� )^'' ry_ �,,� -�,v � '' ^ ACKNOWLEDGEMENT OF OTICE BY LOCAL GOVERNING BODY ; � I hereby acknowledge receipt of a copy of this application. By a no edging receipt, I admit having been aerv�ith notice that this application will be reviewed by the Charitable Gambling Control Board and if a rov by the Board,wili become effective�days from the date of receipt(noted below), unless a resolution of the local governing body is whi specifically disailows such activiry nd a copy of that resolution is received by the Charitable Gambling Control Board within�Gdays of the bel n ted date. 24.CitY/County Name(Local Governing Body) �.O O Township: If site is located within a township,please complete items 24 �� �� '��L-c �.�� and 25: Signature of'Pe` n Receiving Application: 25.Signature of Person Receiving Application �%' � _t�. �� � I � �-i �-:..'-i .. � _ Titie Date Received(this date beginSF�-da{y riod Title: �-=� � .'r .a-t �-�'1�� "•..�P ¢Ui!. � � h� Name of Person Delivering Application to Local Goveming Body. Township Name * CG-00022-01 (5/8� White Copy—Board Canary—Appiicant Pink—Local Governing Body - ' ity (Saint Paul ��C��/ Depa�tment of Fi anc and Management Services /•1�- p'�(}r�� Licens a Permit Division C,.�j D 7 2 City Hell St. Paul, inn sota 55102•29&5056 APPLIC TI N FOR LICENSE CASH CHECK CLASS N . Ne Fie�ew 0 0 � a , ; 19�� Date Code No. Title of License From � ( 19"�To � ^� t9� � � S(� ar3la. c�,ao � ' a l,„ �7 �� �� �� �� �� ��� �,�.�� �,�.��J��J ' Appl UCompany Name � , ,00 �c,t>�S 1'� l-C���' U e�,�a nS I D oC �;� � �p► 5,���r 100 Bu�lness Name 1� � ' • '���- // f"/n ± ( Busineas Addreas �� 100 ,. 100 Mail to Address PhOne No. � •�-f � K-z L�e b , f- ,� �� ManapeHOwner•Nsma �� ��� „ 100 �?aa� i/�,e K �-L� s� � 100 Alanager/Gwner•Nome A dress Phont No. tpgg Application Fee 2. 5p I,� Recslved ths Sum ot �� /'` p I5 r �h SJ'�'�7���� 0 .� MlanapKlOwner•Clty,Slate 3 Ztp Cod� . _t00 otai 100 i ` `��� l J /� � L(cense Inspector � By: �� �I ' S� na�ure,o nopiieanc Bond• Company Name Poiicy No. Expirstion DaN I�surance• Company Name Pdicy No. Expintion Oate Minnesota State Identification No. Social Security Na Vehicle Information: � — Strial NumDer i Plats Numbsr . .. Other. THIS IS A EC IPT FOR APPLICATION THIS IS NOT A LiCENSE TO OPERATE.Yow application f lic se will either be granted or rejected subject to the provisio�s of the zoning ordinance and completion of tha inspectiona by the Healt , Fi ,Zoning and/or licenss Inspectors. : . i - ' J ' . • . . . $15.00 CHAti�6E FOR ALL RETURNED CHECKS _ I . � :, � . ;" I � .��� � .� �-�-�% .� � / � � � - � r � �� ' " City± of Saint Paul � ��� Finance and Management Ser ices%License & Permit Division INFORMATION RE UIRED WITH APPLICATION F P RMIT TO CONDUCT CHARITABLE GAMBLI.IG Ge�KE IN SAINT PAUL (To be used with the follow'ng: New A & C application, renew A & C Licenses, and new and renew B in Privat C bs.) 1. Full and complete name of organiza io which is applying for license l`� ' rf/��� � �"� - e���12 r 1��rai►l�s � 2. Address where games will be held ` �� � � umber Street City Zip 3. Name of manager signing �this appli at on who will conduct, operate and manage Gambling Games ', .�irl� o � Date of Birth�p� '`� �� (a) Length of time manager has bee m mber of applicant organization �a2 `g 4. Address of Manager A � �� c� � Number Street C ty Zip 5. Day, dates, and hours this applica io is for ��J��i�l� l � � '' •-�`�� 6. Is the applicant or organization o�ga ized under the laws of the State of MN? � 7. Date of incorporation ` � 8. Date when registered with the Stat o Minnesota ��!� 9. How Iong has organization been in ex tence? �� ��'�]"� 10. How long has organization been in ex' tence in St. Paul? �r'r}-- ��(�� c � / 11. What is the purpose of the organi�at on? ���p�'�� C��.�%��s � -!i 12. Officers of applicant organizatio : Name � � ��G�- , Nam�G=c��'-- ��4i�'l2�-i`) _ Address '-`?��`�v Address�`Z�L����� � � - i Title �/� ,,1/��'. noB /-- — � , 1 Title ��,P noa �'—''���`"-- Z� Name . '� �G!��/ / Name Address �� �� G�, - Address Title !�� j/L�� DOB Title DOB 13. Give names of officers, or any ot�er persons who paid for services to the organization. � Name �� -G' � � � Name �)''�b;-c/� .��/��('/I�� � Address � � �?'L! Address. �'�� � � � � �� L Title �� ���� ' Title (_c�%� (Attach sep ra sheet for additional names.) I . . : ', c.� 8�-��a , 14. Attached hereto is a Iist of namel a d addresses of all members of the organization. 15. In whose custody will organizatio 's records be kept? � C�/��,� k I �� � f Name � Address 16. List all persons with the authori�y o sign checks for dispersal of gambling proceeds: Name ` � � Name �fijaj('`�(��f��;�'is�/� Address o�o�-�� � `4- Address��� ��/(�l�� ►��� Member of �— Member of DOB L Organization? DOB � Organization? � Name QfI? �� Name � Address y �/��� Address Member of ' Member of DOB ���;.����b��rganization? DOB Organization? 17. a) Does your orp,anization pay or nt nd to pay accounting fees out of gambling funds? yes � no b) If you do pay accounting fees, to whom will such fees be paid? � / l Name /�c�i'(� � �r' Address � �� _ DOB � �� Member o 0 ganization? � c) How are the accounting fees c r ed out? (flat fee, hourly, etc.) �� 18. Have you read and do you thorough y nderstand the provisions of all law , ordinances, and regulations governing the ope at on of Charitable Gambling games? � 19. Attached hereto on the form furni he by the city of Saint Paul is a Financial Report which it .emizes alI 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, prepa ed and verified by ��}^�(/�.a2(`d ��i�1�'Iv�� _ � �� a � �l� � ���� Address who is the ('��c�r �� Y� of the applicant organization. � N e 20. Operator of premises where games lil be held: ,�. � Name i � ��-� I �; � Business Address �� -r�'� r � -- � i Hame Address � i � . . � c� �q- 3�a � �1. Amount of rent paid by applicant �rg nization for rent of the hall: ������ � ��� � 22. The proceeds of the games will be di bursed after deducting prize layout costs and operating expenses for the follow�ng purposes and uses: — I G C..� G� � - �2�t��r�' �" ` - ,�..-- ��c�' 23. Has the premises where the games re to be held been certified for occupancq by the City of Saint Paul? 24. Has your organization filed feder 1 orm 990-T? /f;�p If answer is yes, please attach a copy with this application. If an er is no, �lain why: �2� �cJN � � ��2-�'Ce � ir m � r �• 0 i .rlS Any changes desired by the applicant a�soc ation may be made 'only with the consent of the City Council. I� � Organization Name � � i Date ���� gy; Manager in har f game Organization President or CEO � b '� 9 < � �� � .� � � 31 '0 7 n rr A �r I{ S � a n � � � A ff '� � 31 ^ I� A � � 9 �:( = � .� T 7 7 � � � � n� ,� = A = � aC n 3 'e �--:-, � � ,� r. _ - � � ; � � �� ;�.> � ; '9 ; _ � � � ��� = � � ° S � 1 3 ��-�� � y ti � � -� � �� a Ty 3 n '� S' �- -� � 3 � r. �e m � � I : . .. . r 3 , _ `9 � � 0 1 � � ti � s � N =' -,I a a 3 I T ? �e f ,�. r+ � s� � -- = r. � rs � C` �' � � � A x'� � � . - � � � ' ,9 m � �o j I � 91 '0 'a '< ` y _ I � ,9 = `�C .� .� v �7 ~7 -I I ^ � I p �.. � � � ' � '� � '� I � �.. .f � � w ' , � �O � r� A '� � r'f '9 � j v., _ � .e i � _ '7 ff f': " -- �r i ' - � � �� rf I S � �l� � tJ ��� � 7 � � � 9 n .. 9 ��. i 4% � � �r � :� r0 �n = A ;�- I �-- wwv�r� , � I � � -� �`� � -. x � � 3 3 � - � ^ I�� i I �e t a = o � a i ;� � ' r► � 9 < ( D "O ( I � ? 7' r• A I ., ' , S � i � I� G�1, a = � � ".�'1 v I ^� A 1 = � , � �J � � � r a .• I t 7 . � � 8 9 3�a ° C ty Saint Paul Page 1 Departmsat of ina e and Management Setvices Division of Li ena and Permit Adminiatration UHIFORIi CHAAIT�BLE GAliBLING FINANCIAL REPORT � nace .J c"/7.�5'/%X f 1. Nasa of Organization ��v�5 G�/' (�l/truslS ' LJ , o � /l. 2. Address where Charitabla G�ablin� is conduct�d `�(GV (�/rf��r�LT��' ;/� 3. xeport for period covering �c /� 19 G=�through ��'c: 3� � 19�� 4. ?otal number of days pLyad 5. Cro�a zeceipta for abova period j � / rG,' "�J� '�J, JC 6. Gross priza payouts for abmra p�si (includ� easd shor�) ; � �1 9 7� Y L I c . 7. Net raceipts - lins 5 minus lin� 6 i �,�C / �t-'. C� 8. Expenaes ineurred in conductiag and opsrating gaa: A. Grosa usges rsi�. Attac�s r�R list aith nam�a� address�s� gro�s vag s. umber ot houra f � L��G,�' C worked, and anount paid psslhou . B. Rene for veeka i � / / ,:' J, G�C% �.r-- c. Ls��nBa t�� I s �/ Z.2, 3c� I / D. Insurance S ,L,r�� � / n �� E. Bond-'/r/, j71//15✓i�¢./c � F. Diahonorad checka not reco ere j ,-1 �� ,�=c' G. Accounting Eapensa : 3J��'•o C� i H. Employera F.I.C.A. � ��� � 5 cs/►�+ �/ . I. Pulltab Tax Paid t�D�par �nt of R�vanue i _,����. �7 J. Minn. U.C. Tu � _ �2 � �'� iC. led�ral Exciae 'fa�c b Staap : <' L. Stat• Cambling Ta�c I ; / .g ��, ��" !i. Hiacellaaeou� Papsnsea. den ify th� a�auat . and to vho� pdd. i. `r�� �'c F��,�d: s /�/� 1Z s, 5�o��/.�s � ; .�'j. e o 3, ;:��,�,�c<�<«y{s : �,. L�j:.^^ 4./�i��<,I'��� `� ; ( 3 j.3, `/� ) 9. ?otal F.xpensss 'fOTAL : �� C C-�J, 7G' 10. N�t Inao�e - lina 7 sinu• 1 � 9 = � C�� �I �� , 7p� 11. Checkbook balaace be;inning E p riod = 1,�,� -� ��� /<<' - • , 12. Total of line 10 and 11 i = �� �I `'. �� ' 13. Total coatributions (frod atkuh d vorksh�et) i � 7 C' C• �� I 14. Cheekbook balance end oE rap�ort g period - �i �j�"'�� � lina 12 less liae 13 I . i � � i � _ � I I . � I � .. . I . . . � � t �r �� . ���� '� 8'9-.-��? UNIFORM CHARIT 6L GAMBLING FINANCIAI REPORT �j , LAWFUL PURPOSE CO IBUTIONS - WORKSHEET I . . . Line #13 • Total Lawful Purpose Co ributio�s. S [�lk �� •. List below all checks writ en rom gambling funds which are charitable lawful purpose on ibutions. The total dollar artrounts of these checks mu t tch the artrount claimed in line #I3. Use additional hee s as necessary. CHECK # DATE ' PAYEE ' CHECK AMOUN PURPaSE i. �G�� 1—� �rr /�X �s— �. � .�/- � . � _ z. ?� �3 l�� r� ��i�'�O � 1/'' '4`I'% � ' �-� cf��'r � !� �' /�e�iY- i���y'�� �y1e 3. ���a � �� ����" 3��— ✓: �� �- a. j 7l j v Y' ��-� �/=�� 5.`�` �� �N�� .J - � . � ��'/�?-� '2' f�vj �` �� ��i.�� 1� 6. ��- y G �`��✓ / �� �/�� � �l� , 4�� l�i�N'� Y��. �. ��� �---�3 ����� r ._- ��v� � � � ��� a.�70�� ��� ��r� �C� ���li✓ `�/�1� y m� � � 9. ��� '°�� ��� _ � vn�� ` ������s � io. �'�-� �P�GS�i �� ._ � 17�� � Y.�, �/ �� ii.���� ��� 1�vN'�S � � � ��S � �. — � �z. l��� —` �l�i � �3.��� �---� ���!�� La ���"��� �'�'.� �� 1� \3 S= V �-{'evztinS ���''''�� TOTAL CHE K UNT �C� �� Ublun�Er Servi t � NOTE: These expenditures will be p vid d to Council Manbers at your Council hearing. � Be sure that your financial r po is complete and accurate. ; _ _ � = � : r 3 � = .=_ � � .+ !�,�nn•.�•. ,, ^ . + � i a s �. � e • i : � e� �'�- � : • � � � � .. � w ` �� ; � � �. � � • � ♦ �• ` ":S�+r�r � ( • � yO � � • a � Q ! _ � • 1 �n s � � • � I� = r A � A .�i ! � �3� . _ - . - � s T 7 I� i A s � ' :' � 71 : • ,n • s ° .�i � • • '� s � - ^ � � i�. M � _ � � r �s � �. ' -� � ~ � � � S � l }G� A + � �� . � ' � A � e � ., l � ' � � A v� • I•` � ; '� =7 � A ' '�.1 ; � 7 � f w � - w vrr.r 7� � � � ' • . r • ♦ �r v � + r 7 i 7 � ' •� � a - : � - i w • � s ' � s .� s + , � � � S, . •� v • i� � - t .{ � . .� i 7..� _.t .�i ` O � a • � _. � O .� � U - - � � � � � � 1 � i .� • i � ... � � � w - ` • I w � I • � � : s � r � ! � ,21,�� S � � y � i 1 � t,(- _ C � � Y wv�,w�w�. , e� ( � �: 1 � _ �,,,,_ : . r ` i �� `� J f � J � � � � �. • � ' I } � I � � � i , � i I ,�, I _ , l. I i 1 r �i . F'Au L �/ O 7 � �'�o�- UNIFORM CHARITA LE GAMBLING FINANCIAL REPORT �,;� LAWFUL PURPOSE ON IBUTIONS - WORKSHEET I . . . Line #13 - Total Lawful Purpose on ributions. S � � �C� .•. List below all checks writt n rom gambling funds which are charitable lawful purpose c nt ibutions. The total dollar amounts of these checks mus m tch the amount claimed in line #13. Use additio�al s ee s as necessary. CHECK � DATE � PAYEE I CHECK AMOUN PURPOSE . �. ���7 3� �/�-��� l� �,3-- �- � ����� 2. 17�� �—!�' �s� `,(J�r� !� — �er�/�cc����5' ��es�/`f�-' 3. ���� � �- c�'�r � �— /��,'r.r�'- r � r� �,�� ���„r. ��r d �� /yI�/I�/l�� V��✓'�/v`S -fa�1� 4.`�1�� � .. . �.�Ya/1� . � � �ry' � ' � /� /�>N'�t/' V �/Ll 5. � � � � � � � �� � .� ��3 -- y��`���D��f� 6. � 7�� �-�.� �"�o� _ ! �. � � �3 2� �hl�� �T�� r�/ �? -- 1/�,�-�-�S - . j7�� � . _ s. �7 � -v� �vy�s i �loZ— ?� �,✓� � 1� I . � �— �/'��r�ir�� �/�--� 9. � �S� � � ��r�s� . e�h ��� L��— Sy�o�o�`'-� ��v�,, io. �7�0 �--� � `! ��. � �� .�r� ��"--- ��re� ��!��� 17� / �2. / �� �-1�-� � � � �{°' 1/�'A-rY'-� ' - / � � , r 13. 1 �� ��"( �uJl�'� �l(��Y' �d�� v'�'� /�a�7o�(/a! ,��b � TOTAL CH CK NpUNT a c3 NOTE: These expenditures will be p vided to Council Members at your Council hearing. � Be sure that your financial iep rt is complete and accurate. _�,-,..,.. : � » _ • • 3 � • �'= � � _ . -� a � � • s „ � � �"=� _ " � : e > � e ' � '�' : s '� .. •,:,A'' • I � .. � � � ; i 4 � � .... ` � � � ' � O � ' � i e � �y r -. ' ; � • • � � s v � � � = O s ! _ _ • • � � � w ! _ � � !� . ' . � �� ? ' � s v .. • � 2 � ,r � � M A � !� � � � M � ! � � • �s � •- . a ; O • .. • ! �` • '� � a r'• � � � .-• � � s � - ` � > - �. s � i � �. �' 'J � � O A - � s � ��' t 1�' • � w � �. � � � A �- • � � � �rr�r a ti� � � ` ..... � � � � s a � . . �ay =_ � 7 s y � . � s w ! • 1 � � � i . � � r • � • n � ,� • � � \ s c cn i s ! p w ` _ -. � � .� . � � • i i , .� � � � 1. � � � +� • � a� I ' � ; 1 VVVtiW'�.ti����.�. � n I •' � O, � ' � - � i .. _ � � � : - _ �, � � � -� -�-� � • ; �� •�� ��''� ,� . � �� ;� `�� ' I - � I � _ , 1 � r ur �� . Nau� � g9'"��o� . -- - UNIFORM CNARIT BL GAMBLING FINANCIAL REPORT �� , LAWFUL PURPOSE CON IBUTIONS - WORKSHEET Line #13 - Total lawful Purpose Con ributions. E���6 ,� �. List below all checks writ n rom gambling funds which are charitable lawful purpose ont ibutions. 7he total dollar amounts of these checks mu t m tch the amount claimed in line #13. Use additional hee s as necessary. CHECK # OATE ' PAYEE ' CHECK AMOUN PURPOSE i. ��7;3 �� cfP r ,�ce� d �' /y1i�'�v'- �.�r��r�s�il-� 2. l 77 �-� ,� c,� ��, � �3 - �j�i�' l�e���'s��-� � 3. � -�g,� �-- � ��r /�C � �"�4�' �' � �'� � �eN�� a. ����3 �---�1 ��r��el�r �' 3 �r✓�r�'��'� 5. �7 �� t��rr �x d �t�� t�-� i/�'�'_ � � � � 6. l7��` _�� �.e��i� - ��f� 1�-�-1�� � " � �. _ ;��"�°�. 02�-- l%'���er��i�� . l �g�' � � � ��_ �.,�., ����. 8.��� � -� �r�-��f � r d � � �_ �,�, �, 5 , 9. l�oz� � -� .�vir'�s io. 06 �-,� /�?�; ��o.rr ���' ��� �?v��'���� �� !� -- �v�ll�h �o`Na��� ii./�a7 � -,� cS-/���, �� J � 1Z. �''O� �i �02� c���'�' �C �' /��/y'/l�- ��r�✓'S t�'1E l � �3. ��p `�/ � -� ��2�r/ � . ��-- j1 f�%��' l��r����i�'.� TOTAL CNEC A UNT a � NOTE: These expenditures will be pro id d to Council Members at your Council hearing. � Be sure that your financial re or is complete and accurate. ; . � � .� 3 � • w s � . ? r i T � � � i C > � 3 ,. �. • � , a = � a C � : _ • � .. � . �s + � � a � ~ � • � : � + t . e • .' � s � � _ •i � � • _ �a . . s - • • `� w I. � ! .. ^ � r � � s � � r � 4ae : � .. w ° i � � � � � � . -.. ^ � � ; y � � �� � ~ � 1 a � ' - ! � ., • • I � Y `` � ! i . s 1 O • ` , i � O � � �� �`� � � � '! t ` _ " � A � � ` . � + ! 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CNECK # DATE � PAYEE ��I CHECK AMOUN PURPOSE �. 1�'��' �� �.�r �c�,� 3s— 1/-�. �'- � - � 2. ��l� �- .� ��.v��s i � - 1/'.�, 1�'-� _ s. ,l�'� 7--/� ���^o`� r. �o— V'�/�, (�'.�_ a. ��� ��� ���1 ' l�` � �l_' '(f'��-- 1�,�- r- � � s./��� ��� �,t�1" � �.��— (�-� I/�' � , � � r � � 6. ��' � 7--� �.�le/� � �� �2,.Y�t ����'� ���1-e / � �. � �� ��� ��' � ���' �� �'�- � /J� � C [� 8.` // ��/ �C�/�� � �/�� " i� ' " ��`� /�� • � 9• ��- g'�� �'r�f�/. ��1 �� ��! �_� s �� _ , Y, �-, �o. 8'�� �-`� �an� ' r � '� � � � ��` � r , � � �� 1�. `��`.�� �'—�l �2r /`�C Y' c�- �� '� �=}' 1� '� _ , �- _ �2. g`�3 �'-�7 �� 1��� o� 1�'- /� Y L � �� v'��, �. �', ls.`�`�o,� ��U L�'r� �� TOTAL CHEC A UNT � �� NOTE: These expenditures will be provide to Council Members at your Council hearing. Be sure that your financial re rt is complete and accurate. _ . w �s� '' � : T • � : : i � � w � � ,�. � .. • > � a � _ � a e + , .. . _ .� . . . = .� � � � ` . � • + 4 d ` �r 1 , .. � •�i f � O � ` � i i = � � � � ? �.� . .- -'�;,;:." . w .r .� . ; I� s � a =' � � 71 D t _ - . f . � • � � r '� � � 1 M S 1 . � �� � � � � • _ J � '� � ! � � ' i • � � i `!� w > a � A � e � I � I � a ` � � ILr 2 f �� � .. - � � w � j • a e �-.. -F � � � + v�rv � _ o : '� � + `+� .'� ! � i 7 s ` � _ 7 �� 7 � � s w s • � 1 Ca.� . • � `� � ' r� � � = �, . �f' r • 11 � ! 1> Z ; i ! � . I,.. + � 1 t � 0,`0 �� `� 7 7 '• • O w � ' � 3 � �v� ��f. .l � A � I • I � + � A a� ' A � • ^`'^1 ' ` � � �� ' I s� ,r = �� � a � r A � I " \� +�,1, ` �J� a � � ( � ..� ,r� ',J �i-y � 1[WwWV�y�,� � s ` S a;�`• i : s II � � s s � a . • I � s j I �� � s �' i �I L� ` I _ 1 i Uh �i . NNUL � o���'� - UNIFORM CHARIT SL GAMBLING FINANCIAL REPORT �i� LAWFUL PURPOSE CO TRIBUTIONS - WORKSHEET Line #13 - Total Lawfui Purpose Co tributions. 5=��0'� •. List below all checks writ en from qambling funds which are charitable lawful purpose on ributions. The total dollar amounts of these checks mu t tch the amount claimed in line #�13. Use additional ' ts as necessary. CHECK # DATE � PAYEE CHECK AMOUN PURPOSE i. `�'�L� �'.-�� �j• , ����` / 7— �o.N'�►���/��/' � Z. f��� �—� c�.zr d �— ��� ��. '� ._ f _ s_ 3. ��� `�' �'—lv � � c_...�� � l�'1� (c'_,'i"Yt,L — , - �' a. . �'(� � �7 ��i�� �' �-c�o 1�'/� Y / 1 _ � ' ..r , (i �'. �, �.� c� Cd r�/"L! � , s.1�� � � �� � � , 6. - ` �� v/ 1%� � ���a�/ `�'�� � � �?� � �. ��� �—a� � ��x � �— ,�� ✓� � - . � �� ~.� • , ���� �� $.���� �--�� /�✓ �� . � /���� �/ � 9.� �'S c� —� cf�r �� � °�� �"���" �' � � — ��� � �, io.��'�`� b� �a�r ��' �c� � i�.1�1'� �� -1/=f�- � �o— t�'-� I/�' �. �2. ��� a-� us�`��s a�- ��-� �- �_ � � _ �3.��`��' o�� J..e r /�c r ��_ �/'<�� 1� � �j. C� �R C �e u.�►`s� - � • i TOTAL CHE K NOUN7 3.=.J��� �Q Yd11rM�.ur1 e�'�C �+��4.'M"�Cv�S �.`Q(.l..h C.► � b NOTE: These expenditures will be p vi ed to Council Members at your Council hearing. � Be sure that your financial r po t is complete a�d accurate. _ ♦ ,� � � - � ,._,, � ? : : r a � = - ; : � > : ; = : > .. - • � : ; • - � : :� � �.� • � w .� !� ` . � + + { 4 ` ~ � � � • t � � `,-�`i i � i O � ! i i � � 0 � ; s • • +� ,� o v • _ �,. = I � . � . 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The total dollar amounts of these checks mu t atch the amount claimed in line #13. Use additional he ts as necessary. CHECK # OATE � PAYEE CHECK AMOUN PURPOSE i. ��'�� /b_ G�! ` a�� v� �— �o����J��^/ � � 2. �m d �D -�� t�r � - /�irY/t/' � ���� � � _ � 3. ��a o �/ c� d � �� �'� ' � � r �����/�� � �� /I�/ ��ao� 4. ��`� `�-�a -��'� � . ������� � �� . �� �,�� V� 5. ��i� �1 � �� . . _ . , -� - , � �� �� � 6. 9� �� �d ��;� � l�-�. ��,f}-�'-�- �.�y� /�--� �'�,/�2�� �� �,�.- �/'��,^a� � s. �� /��� ����'_��r �� r �� �,� �S 9. a �' l� � v�r � !� � � ��— , , �,�': �, � �� 1�� �o.���� ��-� �� . _ � �-� - � , �� � � � � ��.`�� �-� g/��d ` �. � �-�- - . � �� � _ �2.� � /�� ������� _ � � . v�y- �` �, �� �3.`��y /�-� ���f��/ x TOTAL CHE K MOUNT E �O � -� NOTE: These expenditures will be p vi ed to Council Members at your Council hearing. � Be sure that your financial r po t is complete and accurate. _ � � ,r s ' � _ �. �. T ;a � � • . r 3 � = = = .. . e > w c� ,� � • e .>i a � ° _ � + r • , � ~ � • . �^ i i � � � ~i x ��.n,,.. � I • � _.�i �''� o � � i e � '� � O � � .i' ��,��� � s • • � '� S r w r w � ! � =s S .i:' .. ` ? 7� ',� � a : ,,,� � a = � � i s � • � � v • • ^ • C, �. .. - �� M A � :� Y 1 ! c ` . j ��i 0 � � � � _ i , � a < _ - w s w ! + � • � C^ �/', i i s � .-- " .� s � � I n + a � � ""� � � � "J <, � i s � � • 7 A � s .r�rw 7� � 7 � T r w � '` • �,.� � n . 9 ��. i ! . a ' � � � � s .. s • , i : • � `� w � � �� v � • � �, ) � � � G � � j � � � � . � a - w ; � w � � -� w . .= � � � I � 3 � ] � w • �� r � � � ,�,_ v � � � � _ � � � i � _. . S ` w/ �1 .� t �� � -.]. ' � � ^ i �. � i ! � ' � • „ J . 1IVV`r"vv,, � � .. I ! i J( i � -' .. . �� � $`9'-�� � � ( Ur J� . NAUL � -- -� . UNIFORM CHARITA lE GAMBLING FINANCIAI REPORT � LAWFUL PURPOSE ON IBUTIONS - WORKSHEET , . . . . Li ne #13 - Total Lawful Purpose on ri buti ons. �✓'iQ�A�� -- List below all checks writt n rom gambling funds which are charitable lawful purpose c nt ibutions. The total dollar amounts of these checks mus tch the amount claimed in line #13. Use additional s ee s as necessary. CNECK � DATE ' PAYEE - CHECK AMOUN PUR_ - 1. L9�� �0'��5 �l � �� l �'�'" �o�i/��7�i1� 'I �� 2. `�'�/ 1�--� ��'�f �` �'�' �" ��: 3. � !a-� ,��y� l� - �-� �'��- ��� (� / ��- �;;��r�'�� ���-� 4• /�—�� (J2/ Y' ��i r ����Z��1-�' � ��� �` ��_ �;��1/� r� � �o,� �'� . 5. `�.r✓ � �� i�,?�_ ,� -r�/1/� �o� ��c� %� 6.����� l�-����v���� — , �. s. � � � 9. . 10. 11. 12. . 13. TOTAL CHE K hqUNT � � � NOTE: These expenditures will be p vi ed to Council Members at your Council hearing. � Be sure that your financial r po t is complete and accurate. _ . • 3 • � _ � � � -• � • « ,• • r ~ � += .�f.��, .. � . e� > > �• � � + � • _ .�i ! � � • � A ` y� �'��.:ir'�`. • �.. �-.. .. a • I o, • � • ti ''.i� �V' • � ♦ • � + d � ii � w d ' 1 • 0 • Q> .��—�a Li� � � � O � Z ! � � � _ � •• -aw� � s ' � � � � •� w '�t A � 1 � 3 s � � A `� � � � = A + � i = � � � + '� • �..• ] '�1 � 1 N 1! �� .. �...7 ` .� A a '� � /'� s � � r �y a 7 � � O '� � s l �� � � � -�� - . � t � � � � T'- � i � � A - s + � I � � a � � � � � •7 - =� � � s � a w i. .�r� � � i n r � � r� • ` � r �r �+ A rj '1 � i ! - � s !� .,•., � . r � � ' � ' r � � � = i � i 7 � � .�i O � s a • � • Z � � 7 • � 4 • s Z - i • � w r ^ ( � • • � I � s , � . _ � � � � � � _ � ?�,'= � � � a � � � + a� �, < < � ( � wl � ,�.,v� a ^�I �. „ � • • ' a{ �k-+. � s � I i, I , � � f y �