89-344 WNITE - UTV CLERK I� COIII�CII
PINK - FINANCE G I TY O A I NT PA U L
CANARY - DEPARTMENT
BLUE - MAVOR File NO•
� .0 unc l Resolution ;�;,
Presented By
.����' � �.�`J.%
Referred To Committee: Date
Out of Committee By Date . --—
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RESOLVED: That application (I # 7333) for renewal of a State Class C
Gambling License b St. George Church at 408 Main Street,
be and the same is he by approved.
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COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Lo� � [n Fa or
Goswitz
Rettman O B
�hQ1�� Again t Y
Sonnen
Wilson
FEB 2 81 9 Form App oved by City Attorney
Adopted by Councii: Date ' �j�
2 '(/ '?S�
Certified Yas C ncil r r I By
gy,
Approve �Navo . q�1_. , Approved by Mayor for Submission to Council
B v V.. By
PUBtIS�D ��,4� 1 1 19 9
c� �- 3 �y
. DiVISION OF LICENSE ANI) P�RMIT AI)MINI T TION DATE � ��Ja 0 / � � 7 � l
; DF.PARTMENTAL RE , A. n ProCessed Re eived b
INT�R VIEW (T�ECKLIST pp / y
Lic Enf Aud
Applicant pr� . A(,C�AD Home Address j 7 3 Cl L-!v%nC�S-�a� �v
Rusiness Name �• r Q,, � L� Home Phone
Eusiness Address � d Type of License(s) �py�p�) -�(�l l[55
Business Phone � ��A✓Y1 1,✓1 �) 4/
Public Hearing Date � � License I.D. 4� �� ��3
at 9:OQ a.m. in the Counci Cham ers,
3rd floor City Hall and Courthouse State Tax I.D. �� IV ��
llate Notice Sent; � �� / .���� Dealer �� �(�
to Applicant L
I�'ederal F�_rearms >� IU �'
Public Ne�.iring -�
DATE TNSP 'CT ON
REVIEW VERFIED (C MP TER) CUMMENTS
Approved t roved
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Bldg I & D �
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Health Divn. '
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Fire Dept. II ��� �
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Yolice Dept.
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License Divn. '
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City Attorney � �
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Date Received:
Site Plan �
To Council P.esearch �
Lease or Letter J Da e
from Landlord a� g�
I� C ty of Saint Paul � � ��� /�J�
. � . ' DepaKment of �'in ce and Management Services
Lice�se and Permit Division
: 203 City Hali
St. Pa I, M nnesota 55102-298-5056
' APPLI�A ION FOR LICENSE
CASH CHECK CLASS NO. ew Renew
i a � � ' a ' Date ' Z3 tg��
• Code No. Title of License � 1 / ct
From `� 19 0/To � °�� 19 ��
q � �
� 3 / Q � � C ' � in� 3 •��
• 100 S I • C1 PJr!� Q, � � U yC..�
�� e � I� ApplleanUCompany Name
� • 100
: � �� ;� Q � ✓1 :�—�- rP r—f
100 Businsaa N�me
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• �oo S ( • �a �� � �"��� ==� '��.
,
Businass Addrsss Phon�Na
i 100
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' 100 Mail to Addmss Phon�No.
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I �� � Irl C'1 r C7�-'! � • 7`� �<i C� C�/
Manap�dOwner•Nams ,c.��'�_
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1 � �; 1 �..� �� ��,�—�o., ��..a.eJ
100 AlanayedGwner•Home Addreaa Phon�No.
4098 Application Fee 2, 50 �� —�-
� Received the Sum of 1 S I • �''C/ :-� � , �� >> � � �� �
3 Z,� Manaqer/Ownet•Gty,Slate 3 Zip Code
, 100 Ot81 100 �
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License Inspector ��— By: `� � � Signature ol Applicant �
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' Bond•
Company Name Policy No. Expiratlon Oa1e
Insurance•
Company Name Policy No. Expiratfon Oate
Minnesota State Identification No. Social Security No
' Vehicle Information: '
• Ssrial Numbsr lat�Number
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� Other
; THIS IS A R CEI T FOR APPIICATION
. THIS IS NOT A LICENSE TO OPERATE.Your application for I cen a will either be granted or rejected subject to the provisions ot the zoMng
i ordinanca and completiOn 01 the inspections by tha Health, ire, oning and/or Licenss Inspectoro.
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, $15.00 CHARGE F�R LL RETURNED CHECKS
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Cit o Saint Paul � �
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Finance and Management Se vices%License & Permit Division
INFORMATION REQUIRED WITH APPLICATION F R ERMIT TO CONDUCT CHARITABLE GAMBLING Gt1.�E I�
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 ubs.)
1. Full and complete name of organiza io which is applying for license
�7• ��.�(Z�',E C v.�'.. i►v G O
2. Address where games will be held �U g �`�� � � N �r. o�T• �A��--- 551 b�-
umber Street City Zip
3. Name of manager signing .this appli�at on who will conduct, operate and manage
Gambling Games �1�}-A(=-O� T't ��'�!� Date of Birth JO -���7 -�j �
(a) Length of time manager has bee� m mber of applicant organization c� I 12.5 �
4. Address of Manager �� 3y �-i J)I�S �3'"p iJ ,fi-t��. , �T' I �-�-�- �`_ �
Number I Street City Zip
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5. Day, dates, and hours this applica io is for �J1�1;D. - �� �O -- � � : 30 ,p�1� .
,6. Is the applicant or organization o ga ized under the laws of the State of MN? (� �5 ,
7. Date of incorporation �0 12 .- �v�r C� Ci�N�-� �-• �
8. Date when registered with the Stat o Minnesota � � � �'J'� ( ��-TiC,��S ���.Ed•�
9. How Iong has organization been in xi tence? �� 5 .
10. How long has organization been in xi tence in St. Paul? �� )25 .
lI. What is the purpose of the organiz ti n? R-k�.�Gjp-�.l�.s ,
12. Officers of applicant organization ,
� ` �� �e r ��c-�,�,�i �
Name � ` c� � W O C-r Name �-
Add:ess Addr�ss �'J J� �A i� C�E j2 �i{ZC�.E,
Title 1 ��S � DOB � " Title ��C� - ��.5, DOB Ca-�"��
Name ��E 1-�N 1`1 1�[TH ` Name 1 V 012(vl A N f�v �Ivt k S
Address �p% '7"(-�f'i Address �����2�GC.�Q.1����•
Title c��C. , DOB - Title ��1�� , DOB �'-7-"0��
13. Give names of officers, or any oth�er ersons who paid for services to the
organizat�on. �
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Name _ , , . _ _� Name y
Address Address
Title Title
. (Attach separ te sheet for additional names.)
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14. Attached hereto is a Iist of name a d addresses of all members of the organization.
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15. In whose custody will organizatio�'s records be kept?
Name Address ���-�'�, ���i.t,MET- �v� .
16. List all persons with the authorit�y sign checks for dispersal of gambling proceeds:
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Name ��}A R-0 N � � �U�►� I� � Name �b d{� I v ) ��'ri��_
Address �7�� i 11 i fS��`SOtJ � Address ��+�a l._.� �u-1'riQ-T � � �
Member of Member of
DOB )� "0l1 -�$ Organization? •Q � DOB Organization? l.��S •
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Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
17. a) Does your organization pay or te d to pay accounting fees out of gambling funds?
yes no
b) If you do pay accounting fees, !to om will such fees be paid?
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Name Address
DOB Member ofl Or anization?
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c) How are the accounting fees ch�rg d out? (flat fee, hourly, etc.)
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? �
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
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year which has been signed, prepar�d, and verif ied by � � ��'�� � ' ����
` o�-�a 1�`,,� �.
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Address
who is the � ' Ip-, (�n Oc�� ` ti (� of the applicant organization.
Na e
20. Operator of premises where games w ll be held:
Name � � , +� ( 4� 5-�u� Ic�. �}SS!1
Business Address � $ � �n ���
Home Address �1
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21.. Amount of rent paid by applicaat org ni ation for rent of the hall:
� 105.�_° . S�.Ssi oN
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22. The proceeds of the games will be di bu sed after deducting prize layout costs and
operating expenses for the following�pu oses and uses:
���i G;cN.I.S /�ro� � rri�a.v�1' A- � }�. o ' �%�t�Z.'c..�-� .
23. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul? 1. � •
24. Has qour organization file federal c 990—T? �1d if answer is yes, please attach
a copy with this application. If an we is no, explain why:
Any changes desired by the applicant asso ia ion may be made only with the consent of the
� City Council.
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' Organization Name
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Date By;
Manager in charge of e
Organization President or CEO
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UNIFORM CHARI SL GAMBLING FINANCIAL REPORT �� $Cj-�y c�
LAWFUL PURPOS CO TRIBUTIONS - WORKSHEET
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Li ne �13 - Total Lawful Purpose, Co tri buti ons. S a(,� ,D b U
-. List below all checks writ� en from gambling funds which are
charitable lawful purpose on ributions. The totai dollar
amounts of these checks mu t tch the amount claimed in
line �13. Use additional he ts as necessary.
CNECK # OATE � PAYEE I CHECK AI�UN " PURPOSE
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�. �a7i ���8-�� s',-. ��e�E �r! �000. o0
j7 , ao� ad
2. �D�.S i-.��?. �� , ,� � � .s
- �` �� �? ooa. od
3. /D 80 3 - y-8�' "� �� ,
4. /D �� �- tr-8�
„ �� '' � �op, 00
5. /��� 5-�o �'g �� �� �� � ao a• ao
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9. //D l 9- 7- �'l i� . �, " � Doa - v0
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11. // �� //- i�-�' �� �, „ � oao, oo _
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TOTAL CH CK UNT �O C>G�� .
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NOTE: These expenditures will be p vi ed to Council Member� at your CouRCil hearing.
� Be sure that your f�nancial epo t is complete and �ccurate.
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' ' J. Carchedi
: °"�: °"�`� C��EN �#��T No:0 0 3 5 2 0 ;
c�r�cr aen�oN _ o��wr�,r o�c� w�s�on ca��Mm '
, Christine Rozek . F = �:���, �«r�
: : ���.. ��, 2 Cfluncil Re�earch : f
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Application for renewal of a S t C1ass C �Gambling License (Bingo On1y). �
Notification Date: 2-3-89 Hearing Qate: 2-Z$�89 '
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:(APpove N)a Rafect(R)) COtllICR, REPOlf1': '
�PLAMAN6 OOMA18810N.�. CML 9ERVICE COMMIBSION DA7E IN DA7E OUT ANN.YST . . .. . . ..PiIONE NO.. ' � 'i
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. DOlMIO OOUM8810N �� � . ISD 826 8CFi00L BOARD . � . . � . . f
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. . STAFF .. . . . . .. tYUURiERCOMNSSIIXd . . . . AS IS � � AOOL IWFO.ADOFDi� -.�RET9��A�T . -.F��• -i
- - iM6fNICT CQUdCIL . � � . . � . . . � . '.
� � SUPP'ORTB MIINCX OOINiCIL OBJECTNE? . . . � � . . .. . . .... - .� . . . -
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�Mi�l�N�tlr.1l91lE,0l�OR71MRY MR+o.VYlrf.NIHsn.1MMfA�WhY): i`
Sharon A. Awada, on behalf of t. George Church,. requests Counci� approval �
of her application for renewal of a St�te C1ass C_Gamb1ing License at �_
. - 4U8 Main: Street. Gambling ses io s.are held on Wednesdays between the ' 4
� I�aurs of .7:30 PM and 11:30 PM. P oceeds are: donated to �St. George Church. ;
��.aeve�o...ae�sl: :: � . , : ; �.
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All fees and applications have be n su�nitted. No 10� contributions are ;
:co11 ected f rom bi r�go anl y l i ce se. . � . ;
: _ �,�Mw4 whtrR�nd To 1lNwmk -.. ,
If Council approva1 is given, t. George CMurch will contit�ue to sponsar i
.a bingo session at 408 Main S . �
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C� �t�;1 �esearch C�nter
FEB 3 i�89 ,
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