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89-413 WHITE - C�TY CLERK PINK - FINANCE G I TY O A I NT PA U L Council r�� If CANARY - DEPARTMENT ��L,J� BI.UE - MAVOR File NO. �� `� Counc 'l Resolution �� Presented By Referred To Committee: Date Out of Committee By Date RESOLVED: That application (I # 0551) for a State C1ass B Gambling License by People I c. at the Palomino Club, 2181 Suburban Ave. , be and the same i s er by approved/�e�a•i�„ COUNCIL MEMBERS Yeas Nays Requested by Department of: Dimond �� [n Favor Goswitz � Rethnan B Scheibel A gai n s t Y ��eea� Wilson MA� _ � �7�n � �� 7 Form Appr ved by City Att ney Adopted by Council: Date _ 2'�- '�y Certified Vass y ' S tar BY �/ By n 1 Approve Mavor: \at —�— , u f � Approved by Mayoc for Submission to Council � gy �'�_�r--- By PUBLISI�ED N�AR 1 � 1 89 � � � � �� DIVISION OF LICENSE ANI) P�RMIT ADMI �S TION DATE I � p l / 1 aa g� INT�;RDF.PARTMF.NTAL REVIEW CHECKLIST A.ppn Processed/Received by Lic Enf Aud Yl� �2�1 �2.�h� � Applicant �e�P` � -L _ Home Acldress �-��(/y��Up_ys�±y SS D3 Rusiness Name Q'� "'I�a, � Home Phone aa�-��3 / Business Address `�� -�(, � '� Type of Lic.ense(s) C1�(� � - 1..1Qh'l(�InG� Business Phone � 3� '" 3�� `-� CRiY�S�. l Public Hearing Date � � License I.D. 4{ J��S�� at 9:00 a.m, in the Council Ch mbers 3rd floor City Hall and Courthoiise State Tax I.D. �� (�}' llate Notice Sent; Dealer 4f � I/�- to Applicant �- aJ, g N�� rederal I'i.rearms �� Public Hearing DATE II�SP 'CT UN REVtEW VERFIED (C MP TER) CUMMENTS A roved N t roved � Bldg I & D � ��Q � Health Divn. ' , �U�q. , -- i , Fire Dept. �� i u � f Police Dept. � Se nt ��o � � I�a �p� orc � License Divn. ' 1 �� i � � City Attorney � �� , DlL Date Received: Site Plan N�A" �'f To Council P.PSearch °� ��' " ' Lease or Letter Date f rom Landlord �� 5�557' � " Ci of Saint Paul Depa�tment of F na ce and Management Services /}�,...ti,n_y� Licen e nd Permit Division �"0 `� 03 City Hall St. Pau, Mi nesota 55102-298-5056 APPLI T ON FOR LICENSE CASH CHECK CLASS NO. N w Renew a c� � � , a ., , l 9 �: � Date , 19 Code No. Tttle of License From i 1�`To , l 19 �� C--� � ; � ' �-�C� ` 3 �'I� 75 ,oo �-P v p�� c�C.. . !� ,�r (�{ �(�i� Applicanf/CompaMr Name 100 ��,/^ .�' f�- ` � �{J?� 1!.\ ,I�y �i�� '? :� C'Ll�J 100 Bualness Name 100 �' j ' �t,l e.)�i i" .��/'1 �L��', Business Address Phon�Na /� � ' ' 100 r--� + — � � � �c ::t. �, . i �� -��, 100 Mai�to Addreas " �jr ��Phon�No. .:i f ,� �c ►-r� e. la J�7 u ��« �� ManapeHOwnsr•Name � 100 � �� -f �, � �� ,�,�� .�� 100 AlanayenGwner•Hom�Address Pho�e No. . 4098 Applicatlon Fae `� � Recetved the Sum of 2�� `'�s��,�j � ��,3�` � �• ManaqeqOwner•Gty,State 3 Iip Cods 100 T tal 100 �• , , � �/ ucense�ns ector � g : � t 1'K�:'��l,-' / �� .�. ��,-(��'�_% P �`"J Y �� (� Sf9naturs of Applicant Bond• i Company Name Policy No. Expiration Dab Insurance• Company Name Policy No. ExpiraUo��att Minnesota State Identiftcation Na Social Security No. Vehicie Information: - S�rlal Number ale Number Other: - - THIS IS A RE EI T FOR APPLICATION , THIS IS NOT A LICENSE TO OPERATE.Your application for li �ens wifl either be granted or rejected subjeCt to the provisions oi the zoning ordinanCe and completion of the inspections by the Mealth, ire, oning andlor License Inspectora. $15.00 CHARGE F A L RETURNEO CHECKS � /��O �� r / � l:� . • �� ` -�r-� Charitable Gambling Control Boar FOR BOARD USE ONLY ' � Room N-475 Griggs-Midway Buil ing ��N� 1821 University Avenue St. Paul, Minnesota 55104-3383 PAID (612)642-0555 AMT , CHECK# DATE GAMBLING LICENSE APPLICA I� INSTRUCTIONS: A. Type or print in ink. B. Take completed application to local goveming body,ob in gnature and date on all copies,and leave 1 copy.Applicant keeps 1 copy and sends original to the above address with a ch k. C. Incomplete applications may be returned. D. Enclose license fee with application. Type of Application: QClass A — Fee$100.00(Bingo,Raffles,Paddlewheels, pb rds,Pull-tabs) C}Class B— Fee S 50.00(Raffles,Paddlewheels,Tipboar s, II-tabs) ►�°k`�h'ct'�.y°a°t°: ❑ClassC — FeeB 50.00(Bingoonly) M�+""°b�'a'"��"a�O"�B°°`d ❑Class D — Fee S 25.00 IRaffles only) Check one: ❑1 A. Organization has never been licensed. C�1 B. New site— Give base license number. re �nu�� '3�sit r�d � ❑1 C. Renewal of existing license—Give co let license number. 0 - � - 0 ❑1 D. Change in class of an existing license— ive omplete license number. � - �� - 0 ❑Yes ONo 2. Has organization ever received a Lawful mb ing Exemption Permit from the Boardl If yes,give complete permit number � " �'� Yes ONo 3. Have Internal Controls been submitted pr vio ly on a form provided by the Board7 If no.please attach copy. 4. �pplic�nt(0#ficial,legal name of organization) 5. Business Address of Organization eop�e, _r.corP��ra_•�d ';'`� ',nz��rsitn �ve� "204 6. C�ty,S�ate,Zip 7. County 8. Business Phone Number �t. auZ, "�`7 �51��? ?amsey � 61? ) ^2�-7"�� 9. Type of organization: ❑Fraternal OVeterans ❑R ligio s �Other nonprofit" "If organization is an"other nonprofiY'organization,answer uest ons 10 through 12.If not,go to question 13."Other nonprofit"organizations must document its tax-exempt status. �Yes�No 10. Is organization incor orated as a nonpr it o anizationl If yes,give number assigned to Articles or page and book number: `' � A h copy of cenificate. Yea�No 11. Are articles filed with the Secretary of S te C�Yes�No 12. Is organization exempt from Minnesota r Fe eral income tax7 If yes,please attach lettsr from IRS or Department of Revenue declaring exemption. OYes�No 13. Has license ever been denied,suspend or evoked?If yes,check all that a ly: �Denied �Suspended �Revo ed Give date: - - 14. Number of active members 15. Number of ye s in xistence Note: Attach evidence of throa yeara existence. �/�. �a 16. Name of Chief Executive Officer(Cannot be 17. Name of treasurer or person who accounts for other revenues Gambling Manager) of the organization(Cannot be Gambling Manager) �:,le�a :�:lcerscn �?ar�� ;.ea_er Title Title ;:xecutive lirector "`irector �� R+.nance Business Phone Number Business Phone Number � 612 � 224—;E��9 1 01:' f '.'_'4—?63� 18. Name of establishment where gambling will be 19. Street address(not P.O.Box Number) ��ld�� :IL� - .?t;�, `;uhurh�n Ave. 20. City,State,2ip 21. County twhere gambling premises is located) �t. r3lll, u;T �5 j l� �21'SP4 CG-0001-0318/88) White Copy-Board Canary-Applicant Pink-Local Governing Body P ge 1 of 2 _ �=��-� ' Gamtiling License Application Type of Application: �Class A C'�Class B CI C ❑Class D ❑Yes❑No 22. Is gambling premises located within cit limi s? ❑Yes�No 23. Are all gambling activities conducted a the remises listed in�i18 of this application?If not,complete a separate application for each premises(except ra les as a separate license is required for each p�emises. �Yes 01Vo 24. Does organization own the gambling pr mis s?If no,attach copy of the lease with terms of at least one year,and attach a sketch of the premises indicat ng hat portion is being leased. A lease and sketch are not required for Class D applications. • 25. Amount of Rent Per 26. Do you plan on conducti g bi go with this license�If yes,give days and times of bingo occasions. �`� Month ot:6i� �rtTE�as3�o: Day ime Day Time Day Time g.00.�a/��,��K es❑No 27. Has the S 10,000 fidelity bond required by inn ota Statutes 349.20 been obtained� 28. Insurance Company Name(not agency name) 29. Bond Number �eyna ��a _ Casuai�•,� :C� F ��0531S7I ;C11 30. Lessor Name �rio Cltib 31. ddr ss 32. C'tt�State,Zip �iner & Baker Incorporated �'TET Suburban Ave. S't. gauT, MN 55119 33. Gambling Manager Name 34. ddr ss 35. City,State,Zip ?31BE.'la .:1i'_:.uSZri , �� OUY*:1 :;t. Ct. D�iu2., '`;\r ;r� iG 36. Gambling Manager Business Phone 37. Date gam ling anager became ( �;I;� � �_��_•;;_��3 member o org nization: Month � Year ?? ❑Yes�No 38. Has the license termination form been comp eted Attach copy. ❑Yes�No 39. Has the compensation schedule been appro ed b the organization7 Attach copy. 40. List the day and time of the regular meeting of the organiz ion.Day Time 41. Bank Name 42. g�n(c ddre s 43. Bank Account Number =,�: t :�t .,i,:4 C �.,..�' T3 y' .� ^� t. �'.,1 ��S �"'7 1 '� i- t _s "t�t�_ �.. "ecr. ,t . _ Qn _:�a GAMBLIN SIT AUTHORI2ATION By my signature below,local law enforcement officers or ge ts of the Board are hereby authorized to enter upon the site at any time gambling is being conducted to observe the gamblin an to enforce the law fo�any unauthorized game o�practice. BANK REC RD AUTHORIZATION By my signature below, the Board is hereby authorized in pect the bank records of the gambling bank account whenever necessary to fulfill requirements of current gambling rule an law. I hereby declare that: TH 1. I have read this application and all information submi ed o the Board; 2. All information submitted is true,accurate and comp te; 3. All other required information has been fully disclose ; 4. I am the chief executive officer of the organization; 5. I assume full responsibility for the fair and lawful ope tio of all activities to be conducted; 6. I will familiarize myself with the laws of the State of Min esota respecting gambling and rules of the Boerd and agree, if licensed,to abide by those laws and rules, including e ments thereto; 7. Membershi list of the or anization will be available ithi seven da s after it is re uested b the board. 44. Official,Legal Name of O�ganization 45. Signature(must be signed by Chief Executive Officer) 'ec--�.:, :ncar�±or.�tad X -- - Title of Signer Date ..,c:cut;�-e ��r�ctcr 1% �j �!? ACKNOWLEDGEMENT OF UTI E BY LOCAL GOVERNING BODY I hereby acknowledge receipt of a copy of this application. a knowledging receipt,I admit having been served with notice that this application will be reviewed by the Charitable Gambli g C ntrol Board and if approved by the board,will become effective 60 days from the date of receipt (noted below) unless a eso ution of the local governing body is passed which specifically disallows such activity and a copy of that resolution is rec ive by the Charitable Gambling Control Board within 60 days of the below noted date. 46. Name of City or County(Local Governing Body► If site is located within a township,item 47 must be completed,in , addition to the county signature. If township is not organized, � ` - county must sign. Signature of person�eceiving application 47. Name of Township X F ..� Title Date received(60 day period Signature of person receiving application .: begins from this date) _ � • _ X 48. Name of person delivering application to Local Goveming Title CG-0001-03 (8/881 White Copy-Board Canary-Applicant Pink-Local Goveming Body P ge of 2 . . . • ._' � � �a in t °aul ��y'-1'{j�.3 Department of Fi an e and ;tanagement Services � Division of Lic ns and Permit Registration I\FORrWTION REQUIRED WITH �PPLICATION F R ERMIT TO CONDUCT PULLTAB/TIPBOARD SALES Iti 5AINT PAUL (Class B Gambling License i L'quor Establishments - New Application) 1. Full ancl complete name of organiza io which is applying for license People, Incorporated 2. Does your organization meet the de in tion of a "large" organization as outlined in the November, 1988 revision of Sec io 409.21 of the Legislative Code? No Attach to this application pertine t inancial and/or organizational information to support your answer to this questi n. NOTE: Only S large organizations will be allow- ed to open pulltab operations unde t e revised city ordinance. If more than 5 organi- zations apply, qualified applicant w 11 be selected randomly by the City Council. 3. Address where games will be held 18 Suburban Ave. ; St. Paul 55119 umber Street City Zip 4. Name of manager signing Chis appli at on who will conduct, operate and manage �� Gambling Games pamela Markusen Date of Birth 1-6-5R (a) Length of time manager has bee m mber of applicant organization 7 vears° 5. Address of Manager 2121 E. Fourt ' S . St. paul 55119 Number Street City Zip 6. Day, dates, and hours this applica fo is for Sundav - Saturdav 7n.m. - la.m. 7. Is the applicant or organization o ga ized under the laws of the State of I�J? Yes � 8. Date of incorporation 7-1-69 9. Date when registered with the Stat o Minnesota 7-1-69 10. How Iong has organization been in xi tence? 19 years 11. How long has organization been in xi tence in St. Paul? 19 years 12. What is the purpose of the organiz ti n? Charitable non-profit Human Service Agency 13. Officers of applicant organizat�on Name Diane Follmer Name Frank Staff_enson Address 1003 Summit Ave. St. Paul S1 5 Address 762 So. Synd�cate St. Pau1 55116 Title President DOB 10-12- 3 Title Treasurer DOB 6-20-33 Name Marv Ida Thompson - Name Sidney Lanee Address 2185 Arcade Ma lewood 551 9 Address 12 Buff.alo Rd. St. paul 55110 Title Vice President DOB 3-19-22 Title Secretary DOB 6-29-30 • ��Y3-� 14. �ive names of officers, or any othe p rsons who paid for services to the organization. Nar.►e Diane Follmer Name Frank Staffenson Address 1003 Summit Ave. Address 762 S. Syndicate Title presidenr Title Treasurer (Attach separa e heet for additional names.) 15. Attached hereto is a list of names nd addresses of all members of the organization. 16. In whose custody will organization' r cords be kept? Name Peo le Inco orated Address 379 University Ave. St. Paul 55103 17. List all persons with the authority. to sign checks for dispersal of gambling proceeds: Name Glenn Anderson Name Diane Follmer . Address 3223 4th St. No. Mnls 5541 Address 1003 Summit Ave. St. ?aul 55105 Member of Member of DOB 12-17-47 Organization? ye DOB 10-12-43 Organization? ves Name Mar lda Thompson Name Frank Staffenson Address 2185 Arcade Maplewood 5510 Address 762 So. Syndicate St. Paul 55116 Member of Member of DOB 3-19-22 Organization? ye DOB 6-20-33 Organiaation? yes 18. Have you read and do you thoroughly un erstand the provisions of aIl laws, ordinances, � and regulations governing the oper io of Charitable Gambling games? yes 19. Will your organization's pulltab op ra ion be operated/managed solely by members of your organization? yes no X 20. Has your organization signed, or d s t intend to sign, a consulting agreement or a managerial agreement with any pers o company to assist your organization with the pulltab sales and/or recording kee in ? yes no X If answer is yes, give the name an a dress of the person and/or company contracted. Name Address Name Address If answer is yes, how will such a on ultant be paid? (percentage, flat fee, gambling funds, general funds, etc.) Attac a copy of said contract to this application. 21. Operator of premises where games w 11 be held: Name James Viner � Business Address 2181 Suburban Av . t. Paul 55119 Home Address 15 Farrell St. Mapl wo d 55109 . �� '?2. a) Does your organization pay or nt nd to pay accounting fees out of gambling funds'. yes X no b) If you do pay accounting fees, to hom will such fees be paid? Name Peo le Incor orated Address 379 Universitv Ave. St. Paul 55103 DOB Member of Or anization? c) How are the accounting fees ch rg d out? (flat fee, hourly, etc.) Flat fee � d) What do you anticipate will be yo r average monthly deduction for accounting iees? 200.00 er month 23. Amount of rent paid by applicant o ga ization for rent of the hall: $100.00 per week 24. The proceeds of the games will be sb rsed after deducting prize layout costs and operating expenses for the followi p rposes and uses: Program equipment � 25. Has the premises where the games ar t be held been certified for occupancy by the City of Saint Paul? Yes 26. Has your organization filed federal fo 990—T? Yes If answer is yes, please attach a copy with this application. If a sw is no, explain why: Any changes desired by the applicant asso ia ion may be made only with the consent of the City Council. . People, Incorporated Organization Name Date 1/6/89 BY� �Cl.l'YL.f.�(�, !�!�-1�(,�,d.�Gl� Manager in charge of ga:ne � Organization President or CEO � � G,G�-�i3 State of �finnesota ) ) ss County of Ramsey ) being duly sworn, say tha he is (are) the petitioner _in t e bove appli- cation; that _he_has_r ad the forego- ing petition and know the co te ts thereof; that the same is true of _h wn knowledge. Subscribed and sworn to befo e e this �_ day of 19 � L i; ca�c� - -�-:��nc �� r.oTa;«;;:�;:-,;:;t;�ESOt� � � F�MS:v cour.mr 6:y Cx:�.E:,r.�L::r.13,1 � -:�tinntiti^nnlv�Mnnr�wv�, o Notary Public, Ram Couat M nnesota My commission expires � � E, c. ' � C��9��3 TO BE CO PLETEO BY ORGANIZATION PRESI EN ANO GAMBLING MANAGER I understand and will uphold Sai t aul Ordinance 409, Sections 409.21 and 409.22 relating to pulltabs nd tipboards in bars. Further, I understand that my ja ba must meet city standards; that 10� of the net profit from pulltab s le must be returned to the City-Wide Youth Fund on a monthl�r basis; t at monthly financial statements must be filed with the City; and that 51 o net proceeds must remain in St. Paul or be used to support St. Paul r si ents. � �til�cC�,� � 1 �L.% .. Signature - Manager • Signature - Organization Presid t Peo le Incor orated � rgan�zation ame ve. . P 5 1 Gamb ing Location 1/9/89 Date Please retain the at ached ordinance for your records. � �� c ` � N= �, c �° (j•`- � - �_� �uu -liri t O cC O N,� �'� t � �> y ��/� _ uM U ��U H � O i�� Q � O O� C = ry�J.�� . M�y�'mfn�t-� a c"o acCa-� � r ;� ;� w O j E � � N � � N p C O U 0 � . m � m� 3� a > � yw --� � ��s � � v> > � v� �:c - - � � c 1� � o � a� �n � � � � �o a� o> �T. 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N•� •� p c ca �npa -� a� � a�i rn`� �r n� � � � a� �, a_ � o ��rn � � ta•- �t � � c°� c°n- � mtiv = > Eco j «+' o 'o a� co c � fU = O >+ U N •y � Oa� L Q N � � � ��, � V •d� (OA O.� m � � a m_ L� O � p +-' 07 � �a �,� �� N V � �_�.-0'� p,� C � >.��C C N O � j � «� � p, p�� y�..r > �.0 � N � G.'� O � C �� X �L-' `O N � E.? E E O.�. � � = � C N � cC U cC Q� L h ... � �-�� 7 � �a� O C C L C 0 �•— C 0« ... C �'d A >+� � — N� 2 .� •� �,�'3 � � �'> = � � � .a c...o a o ea 3 ° � ° E o-�'c� °�y a�°i a�i .� a�i � c ;+ N L � �+� ,..� p . C L .� RS Q. cd C o c"o�•�' o.�.>�c=i o ' � � aa� v cz � dr� > nc�av•� m a ` 2¢.� nxi c`c c�v ° o e�; �� '�� U N � � d • �... ��f� . w . C _ ` ' .o�:�. . N � � p, V � ,,`.; � � � � r � 0 � � � � N a ` � � .c � c aNi a � � `��` ° °` � � � � � 0 �� o iii - � � \ �. � � � 3 m ca � .� e0 V C 4 �' (� "' � N 'r cC C y 'C N d m � 'p Za�iC V°�io N3o CZ.s � _ � � . V co � o �. � « aCiO� _ �, � �, c 'N= aai= Q� N eo E J �s cn � a� �LL y d >,a� a� p c � E = c�aOca '3EYy � � £ - a _ � ' z a� o o � >. O � « aac�vi�.�aa� � `° aa �o � � d d t � _. �0 7� �„� _ �,�.d,,,, �„��. G��7' �o. Q 0 3 51 S J. Carchedi �� Christine Ro�ek � _'� �.�� 3�«� � . Aou�n�wi —�� 2 Counci`t Research . Finance & t:. . Zg8-5Q56 0�: 1 ��,� APP�icatjon for a State .Class B a bling License. Notification Date: �faa�$�f Mea�ing Date: 3-9-�9 c�oa�a.�N«.r�+t��) c�. H�r=.,,. ° aur�c�ora�seaw, cnn�s�oasnssia+ onre w o,►re bur �w�.rsT a►anE Ho. m�r�q c�eeia+ mD azs edio0�eO�uw sr�s c�+urr�caYa�xssro� �s �ou+.rwo:�ooEO* _�A o+.�".�t R�ac�* -�_ oietwcr oou+c� �� — — auPrama wr«ac�eounc�.oa�cnve� _ M�t�►nw Mo�:wea�,a�o�rn�rr M�+o.wna�.wne�.wn.re.vKM: Pamela Markusen, on behalf of P op e inc. , requests Council appr.ova1 of her appli.cation for. a C1ass �B Gar�l, ng License (pul:ltatis ahd�or tipboards) at the _ . . Pa1Qmi�o C1u�, 2I81 Suburban AM nu . Peop1e 'Inc. -i� a charit�ab]� nor�-p.rafit , < Hu�. �er^�iee Agency (see� a�ta ed . Proceeds wi�11. be used fdr -p.rogram equipment. �.mACn��n�.�a+�w..;,�: _ _ , ... _ . :: A11 fe�s and applications have ' ee submitted:=� Pe�le, ` Inc. qualifies as a , "small" organization and is `aw ` e ha't 51� of the r�et proceeds fr�n ttie Palanino .site must be �used. to � ne i� St., Pau] resictents. . . <: :,: cc�°Ma�a.�a.�;ua To va,or�: - . ... . , _ _ < . . ;, �f Councii approval is given, p e Inc. �till conduct pul1tab sales at the Palomino Club. . :. . w�aw�nv�• . , ca+s "�'n"'►�"'�°d"': . '�� e��rch� Ce�ter FEB 22 i�� :