89-343 WMITE - CiTV CLERK
PINK - FINANCE G I TY Ia' SA I NT PA U L COUI�CZI (//�J
BLUERV - MAVORTMENT File NO. � • _ ���
� � , oun i Resolution .�--��
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Presented By �� -
R rred Committee: Date
Out of Committee By Date
RESOLVED: That application ( D 36309) for renewal of a Class A Gambling
License by The Mer 'ic Booster Club at 1060 University Avenue,
be and the same is he eby approved/�.
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COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
I.o� [n Fa or
coswitz �
Rettman B
s�he;n�� __ Again t Y
Sonnen
Wilson
F�8 [ � , Form Appr d by City Attorney
Adopted by Council: Date ����f
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Certified Pas• ouncil S t BY
B . �1����
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Approve b 'Navor: Date _ � _ Approved by Mayor for Submission to Council
By �. , BY
pt�U� �,�,��t 1 1 98
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Di�,(ISION OF LICENSE AND P�RMIT ADMI IS TION DATE / a� o-( / � Z�• O.�
INTERDF.PARTMFI�'TAi, REVIEW CHECKLIST Appn Processed/Rece'ved y
Lic Enf Aud
Applicant ,!`���/1(' lC� �pdS ✓ (d,�jHome Address �j(p � ��Q rl-P S
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Business Name (,�r� ���b(,U K� Home Phone
Business Address j � �Od � Type of License(s) ��.VLQ�U — (., �a SS A
Business Phone �� Q l�y� b�1 r►L� �.l C.¢in S-�
Public Hearing Date � a�J � License I.D. �{ 3� 3d�
at 9:00 a.m. in the Council Chauiber , `
3rd floor City Ha11 and Courthouse State Tax I.D. 4� 3�1 $���
llate Notice Sent; Dealer 1� �U '�'
to Applicant G � �
redera2 I'i_rearms �� � �1'
Public He�.�ring i
DATE II� PE TIUN
REVtEW VERFIED CO UTER) CUMMENTS
A proved No A roved
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Bldg I & D �
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Health Divn. �
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Fire Dept. �
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License Divn. �
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City �,ttorney l �
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Date Received:
Site Plan � q
To Council P.esearch
Lease or Letter � � ' Date
f ror.i Landlord � 5
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C ty of Saint Paul
Department of in nce and Management Services
Lice se and Permit Division
203 City Hal1
St. Pa I, M nnesota 55102-298�5056
APPLI A ION FOR LICENSE
CASH CHECK CLASS NO. � ew Renew
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Date 19
Code No. Title of License � F � Z � 1�To � / • 19 ��
a3�z �� ���� �- G �, �,,,G �����.5-� �� -� �.
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U �G,�,� /�-i �"L(,V•L�C,� Applieanf/Company Name
� '°° � i� �� v (.r ;, � t.-f r s,`I��
� 100 Bualntas Name
100 J { ' �l �� ! '��'/ 1
Buslneas Addresa Phon�Na
100
100 Mail to Addreas Pho��No.
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ManapeNOwnsr•Name
� 100
100 UlanaqeNCiwna•Home Addreas Phorn Na
�098 Application Fee 2 �
Recelved the Sum of 100
• 0� Mana9erlOwner-Clty,Slate 3 Zip Cod�
100 Ot8 • 100 ' %.
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License Inspector �:� By: �`�� . Stynature ot App1icant
Bond• I
Company Name Policy No. Ezpiratlo�Oate
Insurance:
Company Nams Policy No. Expiratfon Oats
Minnesota State Identificatton No Social Security No.
Vehicle Information:
Serial Number ate NumOS�
O.th@r.
THIS IS A R C IPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Yow application(or lice se wili either be yranted or rejected subject to the provisio�s of the zonin9
ordinanca and completion of the inspections by the Health Fire Zoning and/or Licsnse Inapectors.
$15.00 CHARGE R LL RETURNED CHECKS
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Ci y f Saint Paul
Finance and Managemen S rvices/License & Permit Division
INFORMATION REQUIRED WITH APPLICATZON OR PERMIT TO CONDUCT CHARITABLE GAMBLI:IG Gr1ME IN
SAINT PAUL (To be used with the follo in : New A & C application, renew A � C
Licenses, and new and renew B in Priva�e lubs.)
1. Full and complete name of organiz�ti n which is applying for license
Merrick Booster Club
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2. Address where games will be held ' 1060 Universit Ave. St. Paul, MN 55104
i Number Street City Zip
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3. Name of manager signing this appl�ca ion who will conduct, operate and manage
Gambling Games Carl Falkows li Date of Birth 3/7/23
(a) Length of time manager has be�n ember of applicant organization 8 years
4. Address of Manager 364 Charl s t. , St. Paul, MN 55103
Number Street City Zip
5. Day, dates, and hours this applic ti n is for Sundays year round 1:00-5: 00 p.m.
6. Is the applicant or organization rg nized under the laws of the State of MN? yes
7. Date of incorporation 1 6 86
8. Date when registered with the Sta e f Minnesota 1/6/86
9. How Iong has organization been in ex stence? 9 years
10. How long has organization been in ex tence in St. Paul? 9 years
11. What is the purpose of the organi at n? To raise funds for equipment, events,
and ro rams for mentall re a ded adults .
12. Officers of applicant organizatio :
Name Robert Faric Name Louellen Essex
Address a t. 555 S . Paul Address 1968 Skillman W. Roseville, T
55 O1 55113
Title president D�B 11 15 2 Title Secretary DOB 10/16/48
Name Ral h Stouffer Name Keviri Martineau
Address NE McKinl St. r ' dley MNAddress 1728 Gervais, Maplewood, MN
55432 55109
Title Treasurer DOB 11 29 4 Title CEO DOB 4/20/51
13. Give names of officers, or any other ersons who paid for services to the
organization. �
Name Name
Address ' `Address
Title Title
(Attach separ te sheet for additional names.)
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14. Attached hereto is a list of names ,an addresses of all members of the organization.
15. In whose custody will organization'�s ecords be kept?
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Name Kevin Martineau Address 1728 Gervais Ave. , Maplewood
MN 55109
16. List all persons with the authority� t sign checks for dispersal of gambling proceeds:
Name Carl Falkowski ' Name Kevin Martineau
Address 364 Charles St. , St. Pa 1, MN Address 1728 Gervais, Maplewood, MN
Member of 551 Member of 55109
DOB 3/7/23 Organization? es DOB 4/20/51 Organization? e�s
Name Robert Faricy Name
Address 350 Cedar St. #555, St. Paul, Address
Member of MN 5 101 Member of
DOB 11/15/26 Organization? e DOB Organization?
17. a) Does your organization pay or i#te d to pay accounting fees out of gambling funds?
yes no X ' It did in 1988 but will not in 1989 .
b) If you do pay accounting fees, �o om will such fees be paid?
Name � Address
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DOB Member ofi0r anization.
c) How are the accounting fees ch rg d out? (flat fee, hourly, etc.)
In 1988 a flat fee for re arin or anizational tax return for IRS.
18. Have you read and do you thoroughl�+ u derstand the provisions of all laws, ordinances,
and regulations governing the oper ti n of Charitable Gambling games? yes
19. Attached hereto on the form furnis ed by the city of Saint Paul is a Financial Report
which it .emizes all receipts, expe se , and disbursements of the applicant organiza-
tion, as well as all organizations wh have received funds for the preceding calendar
year which has been signed, prepar�d, and verified by Kevin Martineau
1728 Gervais Avenue, M 1 wood MN 55109
Address
who is the CEO of the applicant organization.
Na e
20. Operator of premises where games w ll be held:
Name Military Order of the �Pu le Heart Cha ter #5
Business Address 208 Veterans u ldin , St. Paul MN 55155
Home Address N/A
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! 21. 9mount of rent paid by applicant or an zation for rent of the hall:
$585/month
22. The proceeds of the games will be d sb rsed after deducting prize layout costs and
operating expenses for the followin p rposes and uses:
Purchase of equipment, even s nd programs for mentally retarded
adults to acquire vocationa a d community skills.
23. Has the premises where the games ar t be held been certified for occupancy by the
City of Saint Paul? Yes -
24. Has your organization filed federal fo 990-T? No If answer is yes, please attach
a copy with this application. If a sw r is no, explain why:
Merrick Booster Club files 990 which is attached.
Any changes desired by the applicant ass ci tion may be made �only with the consent of the
City Council.
Merrick Booster Club
Organization Name
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Date 1/23/S9 By; arl Fa kowski
Manager in c e
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Organization President or CEO
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Department of ina ce and lfanagament Services
Dlvision of Li ens and Permit Administzation
UNIFORM CHARITIABL GAl�LING FINANCIAL REPORT
j Data
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1. Nase of Orgaaization
2. Address vhere Charitable Ga�bli�i` i coaducted 1�6� Universitv AVC'. St. Paul
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3. Report for p�riod covering Jdri d 1 19 8 8 thsough December 31 19 8$
4. ?otal number of days played
5. Grosa receipts for abov� psriod j f 14 9 . 519 . 3 0
6. Gsoss prize payouts for abovs p�ri (inelud� easb short) ; 1 1 1,8 2 8 . S 5
. 7. Nat receipts - Iine S �inus lin 6 � 3� ,6 9 0 . �5
8. Ezpenses incurred in condnctiag and operating gss:
A. Gross vages paid. Atiach rke list vith
namea, sddreas�a, gross vag s, ur�bar of honrs ; 15, 9 3 0 . 0 0
worked. and aaount paid pes hou .
s. Rent for 4 9 weeks ; 6�615 . 0 0
C. Licenae f ee s 5�� • ��
D. Insurance i 5 3 5 . 0 0
E. Bond ; 10 0 . 0 0
F. Dishonor�d checb not zeeov�ar� ; 3 2 5. ��
G. Accounting Expsnse : 2 S� .��
x. Employera F.z.c.�. ; 1,19 6 . 3 4
. I. Pulltab Ta�c Paid to Depar nt of Re�ranua ; 7 21 .3 6
J. Minn. U.G. Taz ; 2�7 . 2 4
1C. Pederal Exciss Tax 6 Staqr ; N/A
� L. Stat� Gamblina Ta: s 3, 151 . ��
H. liiacellaneous Fspensea. Z ent �� tfu mount
. and to vha� paid.
1. Transfer to #2 ; 50 .00
z. Bank Charges i 135 .00
3. Supplies i 656 .00
4. ' ;
9. Total E:penses ToTAI. ; 3 0, 3 71 . 9 4
10. N�t Ineos�.- lins 7 aiau• li 9 : 7, 318 . 81
11. Checkbook balance basinaiag o pe iod i 2 . 5 5 5 . 3 6
12. Total of line 10 and 11 = 9,8 7 4 . 17
' 13. Total contributions (from att ha vorb6�et) ; 11 , �0� . 0 0
14. Checkbook balance end of rspo , in period - ( 1,12 5 . 8 3 )
' line 12 less line 13 �
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UNIFORM CHARIT Bl GAMBLING FINAN�IAI REPORT Gf— g�— 3�
` LAWFUL PURPOSE CO TRIBUTIONS - WORKSNEET
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Li ne #13 - Total Lawful Purpose Co tri buti ons. 3 i,�, n n n_n n
•. List beiow all checfcs writ en from gambling 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 he ts as necessary.
CNECK # DATE � PAYEE CHECK AMOUN PURPOSE
1. 1778 2/29/88 Merrick Co, I c. 4, 000 . 00 Financial support for
2• 1779 2/29/88 Merri'ck Co. I c. 1,500. 00 Merrick Co, Inc. a
3. . 1786 3/11/88 Merrick Co, Ir�c. 1, 500 . 00 vocational training _
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4. 1788 3/16/88 Merrick Co. Ir�c. 1,500 . 00 center for mentally
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5. 1792 3/31/88 Merrick Co. Ir�c. 2 , 000 . 00 handicapped adults.
(, 1808 5/20/88 Merrick Co. I c. 500 . 00
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11. :
12. . �
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TOTAL CHE K UNT �11, 0 0 0 .0 0
NOTE: These expendit�res will be p � id d to Council hlembers at your Cauncil hearing.
� Be sure that your financial r�por is complete and accurate.
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Application for renewal of a a s A Gamb1ing ticense (all forms). j
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Notification Date: 2-10-89 Hearing Date: 2-28-89 ;
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.. . p�q.� .. .. Gy�gEqy�.� DATE N' DATE��T. � � � ANALVST . . PHOIE Fp.�� . . .
.. . �OIMq OOMA�SION 180!26 BCHOq.BoAiro . . . . . . � � . . . . ... . . . E .
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016�NIC�COUWCtl. . * TION . . � .. . . . � . . .. � .. .. . .j .
.. � &1PPOAf8 Y1iNt�1 C70UNCIL�OyJECTIVE? � � � . . . .. � . . � . . . . � . ' � . � .. ��.
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N1tAlrN/w01t�M,MSUE.OrPORTWRfY iWlw.VMUF.Nllrn.V1R1�n.rMhY). . �
Mr. Kevin Martineau, on behal o the Merrick Booster Club, requests Council
approval. of hi s appl i cati on f newa]� of a State Cl ass R Garr�a�i ng Li cense at � --
1Q60 University. Avenue. The m ling :sessions are he1d Su.r�days, 6etween the
hours- of 1:00 PM�and �:00 PM. P ceed� are used for equipmen�, events and :
pragrams for me�tally retarde a lts.
.�6fwCAflOK�ht.Ad�Drs.i1�11a): ; _ .. -
All fees and app}i�tions hav b n submitted. Contribution to tF�e City,W�de �
Yauth Fund are c�rrrent. ,
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If Cauncil approval is given, er ick Boaster Club wi11 continue to sponsor �
a bingo session at, 1060 Unive it Ave. � ¢ ,
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