89-439 � � I
wHiTE — ciTr CLERK COLLf1C11 ///��j
PINK - FINANCE C I T� O F � I NT PA LT L /J7 �.
CANARV - OEPARTMEN7 � �
BI.UE - MAVOR File NO• V , -
Counci � esolution ���������
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Presented By
Referred To Committee: Date �.1��'y/�
Out of Committee By Date
RESOLVED: That application (ID �8 d43) for renewal of a Class A
Gamb1ing License by ;.I .V.E. Inc. DBA Custom Contracts &
Services Inc. at 132 � E Rose, be and the same is hereby
approved/�ed.
i
COUNCIL MEMBERS Requested by Department of:
Yeas Nays i
—�i�se�
[.ong In Fav 'r
Goswitz
Retlman f� B
�ne1be� V _ Agains , Y
Sonnen
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�R � 4 � Form Approved by City Attorney
Adopted by Council: Date -
Certified P•s• b Council Secretar By � ����
Y � '�/�j �/�
B � A// i�'�-CYiL'�/�e��
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Approved y 'Navor Date Appr e by Mayor for Sub ' si to�ouncil
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PU8ltS1�ED MAR 2 5 ,'98
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J. Carcheda
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' Christine: Ro ek '►ss+°" =��a��� 3�,«�
. _ � RO�' _I��*� 2 Council Research
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Fi nance_ .& t. = 456 1 ��„�� ; . . _
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Application for renewal of a St te Clas� A Gambling License �a�l forms}. �
Notiff,cation Date: 2-23-89 � Hearir�g Date: 3-14-89 _
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�w�N:t�y+vro»cN«R.iec+{�)> cou�c� ; .
- . . RJ1MiRiQ OOMN9810N � CNLL BERVICE COt�tl�A�SB�ON DATE IN � DATE , ./{NALYST . .. . . � Plid1E MO. . � ... �
.. ZONN�O COMMt138�ON . 18D 826 8(�OI.BOARD � _ . . � . .. � . . �
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. . OWiRICT COUNCIL � - � #�. � . . . . .. . . .
. SUPrGRTB W1wCFi COUNCIL OBJECfWE?�� � � . � . � . . . . . . �.. . � . - � .
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Mr. Michael J. Sarafo1ean, on ha f.of�G I V E Inc. DBA Custan :Cartracts &
Services, .Inc. requests Council ap rova of his applic�tion for renewal of
a S�a�e �Class .A Gambling L7cens a 13�, �...Rose. Gatnbling_ sessi�ns a�re
held an. Thursday afte.rn�on� be e the hours o� 1:00 PM and :5:�O: PM. Proceeds
are used to provide services t a lts �rith mental retardation.
,
..�M1sflICA'i1DN�tJDer�eNls,Adi�ahLp�e.RMUqsy. I _ _
: All fees and applications have e subthitted. All 10% contributions to the
Ci ty Ycwth Attil eti c Fur�d are c r t-
I
" �(NTat:Mpiwi.r+d�To Nlhom). 1 ; ., '
if Gouncil approval is given, V Inc.� will continue to spt�sor a week�y
� bingo session at the Phaten Pa 11 . �
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� UiVYSION OF LICENSE ANI) PERMIT ADMINIS RA ION DATE � a'J � y / I Z�o �
INTP,RDF.PARTMFNTAL REVIEW C:HECKLIST I Appn Processed/Received y
/� �Gh�l�� J' Sz�iSc��nfleardj
Applicant � �V e- �Y1L _ Home Address �'4 1(� �n �r�j��l�/�� �Y"
, �1 c
Rusiness Name Home Phone �l �� ' � 7 0 Z
Business Address ��J o��' �. OS� Type of License(s) �Q y�g�J�,1' C�l1S5
Business Phone _ �' �-�C(,yy� �(v�� LI C.pi►'iS�
Public Hearing Date '� � License I.D. 4F � Cf� %3
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �t �JI/�-
llate Notice Sent; Q q(�j� Dealer �� ��
to Applicant ��1 U� �� t `v I
rederal I'irearms �� � �'
Public Her.iring
DATE II�SP 'T UN
REVIEW VERFIED (C TER) COMMENTS
A roved N roved
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Bldg I & D � I
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Health Divn. �
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Fire Dept. I� � �
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Police Dept. I
��3� ���j D 1�
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License Divn. � ' �I
/lo�$� ' 0 K
City Attorney �
�/�1�� � o�
Date Received:
Site Plan � a /�/a
To Council P.esearch � �
Lease or Letter Date
from Landlord l o`�Lj �
� , C�/_`��Y"�f
; ,
Charitable Gambling Control Board
• Rm N-475 Griggs-Midway Bldg. For Board Use Only
1821 University Ave. Paid Amt:
- - St. Paul, MN 55104-3383 Check No.
:•°•:'� (612)642-0555
Date:
GAMBLING LICE SE ENEWAL APPLICATION
UCENSE NUMBER: a���di 1-111 /EFF. DAT : !�f 18�88 /AMOUNT OF FEE: j19l.li
1.Applicant-Legal Name of Organization 2.Street Address
i C l411 �nerQ Park Dr Sui!e 12
3.City,State,Zip 4.County 5. Business Phone
�t P u! ��li! '.,:A2 Qanser o12 b41-U82
6. Name of Chief Executive Officer � 7. Busine,4s Phone
6eor e ?uth 612 b41-1�82
8. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phone
Polt ";.�n;�, � �2: 5�1-1�81
10. Name of Gambling Manager 11.Bond Number 12. Business Phone _
Ni�hees �ara•`��:�r. 4l/6�35Aa � � , �
13. Name of Establishment Where Gambling Will Take Place 14.County 15. No.of Active Members
� Phalen ?a;k +�alls ''! �jul Ra�sey 11
16. Lessor Name _ 17. Monthly Rent:
Phalen aark �ai�; •� ;i58
18. If Bingo will be conducted with this license,please specify days d t' es of Bingo.
Days Times Days Times Days Times
, -
19. Has license ever been: ❑ Revoked Date: � spended 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 ❑ No(If"No,"attach copy)
22. Has current sketch been filed with the board? kE7 Yes O No(If"No,"attach copy)
���,; ,
GAMBLIN 'SI AUTHORIZATION
By my signature below, local law enforcement officers or agents of t e rd are hereby authorized to enter upon the site,at arry time,gamb�ng is
being conducted,to observe the gambling and to enforce the law fo any nauthorized game or practice.
BANK REC R AUTHORIZATION
By my signature below,the Board is hereby authorized to inspect th ban records of the General Gambling Bank Account whenever necessary to ,
fulfill requirements of current gambling rules and law.
O TH �
I hereby declare that:
1. I have read this application and all information submitted to the 8 ard;
2. All information submitted is true,accurate and complete;
3. All other required intormation has been fully disclosed;
4. I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and Iawful operation of all tivit s to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota re ecti g 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(Chief�x tive Officer) Date Title
;' T �� '„r :` r��r c': � ��, ti �'1 ��, - � 'r-_�.i;?ent
ACKNOWLEDGEMENT OF OTI E BY LOCAL GOVERNING BODY�G �-'
I hereby acknowledge receipt of a copy of this application. By ackno edg ng receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if approv the Board,will become effectivA`30 days from the date of receipt(noted
_below), unless a resolution of the local govecning body is passed whi h s ifically disallows such activiry antta copy of that resolution is received by
the Charitable Gambling Control Board within�9�days.of the below n 'ted ate.
24.Ciry/County Name(Local Governing Body)l;;��; Township: If site is located within a township,please complete items 24
�` ��t '�, !�s . � ; and 25:
Signature of persoh Receiving Application: 25.Signature of Person Receiving Application
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Title �, Date Received(this date in day period Title:
� / .. � ,' � � j' '�
Name of Person Delivering Application to Local Governing fBody: / Township Name
CG-00022-01 (5/8� Whi Copy-Board Canary-Applicant Pink-Local Goveming Body
, S90�3
, . ity of Saint Paul
� Department of Fi n e and Management Services ��--��9
Licen a d Permit Division
I 2 3 City Hall
St. Paul, , in esota 55102•29&5056
APPUC 'TI N FOR UCENSE
CASH CHECK CLASS NO. 'Ne Renew
� �' � 0 , � —
oa�e � �s�
Code No. Title of License From � �� 1$�To � G S 19��-
�'Lt5'j A — �1L. �-r.�Ii,, �( 7 ,5� /'
,00 �.1 V�, J.VI C�
�( t�.,y,<-• I�.F ;t.w�``, APPIIcanUCompany Name
' 100
I 3 � y � �v>e�
100 Busirrosa Name
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,00 S� � I�G c.� i -� rl
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Business Address PhoeN Na
100
100 Mail to Address PhoM No.
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�� �-� . C_ G�i�� f ,S, �'� �% �rl�iiit
ManapeHOwner•Name ���r�_ �i���L
. 100 -
Iyf l� C�i�J� � �G �fC- T�f— ,..'�.� � ��
100 AlanapedGwner-Home Adbreas Phon�No.
4098 AppifCetton Fee � ��
1
Rece+ved tns Sum or . �O �� ' �'C���I, C'� r� 5$/�;��
ManapeNOw�er•City,Stale 8 Zip Code
100 T tal 100
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LiCense Inspector �� By: ��' 2— ` Sig��f Applicant
Bond•
Company Name Policy No. Expiration�ate
Insurance:
Company Name Policy No. Expiration Oatt
Minnesota State Identification No. Social Security No.
Vehicle Information:
Serial Number Plate Numb�r
Other:
THIS IS A RE EI T FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Yow appiication for li �ens wilt either be granted or rejected subject to the provisions o(the zonfn�
ordinanCe and completion of the inspections by the Health, ire, oning and/or License Inspectora.
$15.00 CHARGE F L RETURNED CHECKS
1u�.� b� d
C�rb ss �c�
.
���9'(�.,/ 7 � ',
� Cicy f aint Paul �j���/
Finance and :fanagement S r 'cesiLicease & Perniit Division ����
' INFORI�IATION REQUIRED WITH APPLICaTION FO ' P IT TO CONDUCT CHARITABLE G?,MBLIVG Ga:�1E IN
SAINT PAUL (To be used with the followi g: New A & C application, renew A & C
Licenses, and new and renew B in Private C1 s.)
1. Full and complete name of organizat on hich is applying for license
G.I.V.E. , Inc. dba Custom Contracts rvices, Inc.
2. Address where games will be held 13 4 . Rose St. Paul 55106
N mber Street City Zip
3. Name of manager signing this applic Iti n who will conduct, operate and manage
Gambling Games Michael J. Saraf �le n Date of Birth 9/13/56
(a) Length of time manager has been me ber of applicant organization seven vears
4. Address of Manager 973 , L nwood Avenue St. Paul 55105
Number Street City Zip
S. Day, dates, and hours this applicatlon is for Thursday, 1 — 5 p.m.
6. Is the applicant or organization or an zed under the laws of the State of MN? yes
7. Date of incorporation Mav 27 196
8. Date when registered with the Stat lof Minnesota May, 1966
9. How Iong has organization been in li tence? 22 Years
10. How long has organization been in �Ci tence in St. Paul? 22 years
11. What is the purpose of the organiz Iti n? to provide services to adults with
Mental Retardation
12. Officers of applicant organization i
Name George Ruth Name David Aune
Address 23221 Woodland Rd. , Lakev 111 Address 4869 Churchill, Shoreuiew
Title President DOB 9/14/ 8 Title Secty/Treasurer DOB 4/25/56
Name Jane Wells Name
Address 4209 Oakmede, WBL Address
Title Vice President DOB 7/27/ 'l Title DOB
13. Give names of officers, or any ot r ersons whorpaid for services to the
organization.
Name N/A Name
Address Address
Title Title
(Attach sepa �at sheet for additional names.)
' . l.�0 % ��
14. A�ttached hereto is a I.ist of names nd addresses of all members of the organization.
15. In whose custody will organization' ' r cords be kept?
Name Michael J. Sarafolean Address 1410 Energy Park Dr. , #12, St. Pau:
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name Michael J. Sarafolean Name George Ruth
Address 973 Linwood Avenue, St. P 1 Address 23221 Woodland Rd. , Lakeville
Member of Member of
DOB 9/13/56 Organization? yes DOB 9/14/48 Organization? yes
Name Michael Michlitsch Name
Address 3870 Effress, White Bear k Address
Member of Member of
DOB 12/18/56 Organization? e DOB Organization?
17. a) Does your organization pay or in en to pay accounting fees out of gambling funds?
yes X no
b If ou do a accountin fees tl w om will such fees be aid?
) Y P Y S • P
� Name Stan Babel Address 4618 Parkridge Drive, Eagan
DOB Member of rg nization? no
c) How are the accounting fees cha ge out? (flat fee, hourly, etc.)
flat fee
18. Have you read and do you thoroughly �'un erstand the provisions of all laws, ordinances,
and regulations governing the opera io of Charitable Gambling games? yes
19. Attached hereto on the form furnish d y the city of Saint Paul is a Financial Report
which it .emizes all receipts, expen es and disbursements of the applicant organiza-
tion, as well as all organizations ho have received funds for the .preceding calendar
year which has been signed, prepare , nd verified by Michael J. Sarafolean
973 Linwood Avenue St. Paul 55105
" Address
who is the Gambling Manager of the applicant organization.
N
20. Operator of premises where games w 1 e held:
Name Richard Mangin
Business Address 1324 E. Rose S re t, St. Paul
Hame Address 1900 East Shoi� D ive Ma lewood
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21. Amount of rent paid by applicant or n zation for rent of the hall:
$175/session
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:
All lawful purposes
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? n� If answer is yes, please attach
a copy with this application. If a 'sw r is no, explain why:
Not required
Any changes desired by the applicant ass ici tion may be made 'only with the consent of the
City Council.
G.I.V.E. , Inc.
Organization Name
/ �% �
Date /—��� O y By: �l. ,� L��
Mana in ch rge of game
0� ��U�.-
�rgani� ation President or CEO
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C ty f Saint Paul Page 1 /��—�j�-�-�3/
. Department of ina ee and Management Servicea � �� v
Division of Li ene and Penit Administration
UNIFORH CHARIT LE GANBLINC FINANCIAL REPORT
Dac• 1/13/89
1. Name of Otganization G.I. .E. Inc.
2. Aildress vhere Charitabl� Ca�bl L condueted 1324 E. ROSe St.� $t. Paul, 55106
3. Report for period covsring 19 88 ehrough NoV mb �n 19$8
4. Total number of daqa played 4
5. Cross recsipcs for abov p�riod ; 22�,4��.43
6. Gross prize payouts for above p iod (iaeluda caah short) ; 16�'�62.43
. 7. Net r�c�ipta - liae 5 minua lin 6 ; 53,338.��
8. Expenses ineurred in conductiag nd persting gaa: _
A. Gross wagea paid. Attach ke list vith 19,916.45
names. addresa�s. gro�s vag , er of hours ;
vorked. and. amount paid per. ou .
• B. Rent for weeks � 8�600•��
C. Licenae fee ; 600•��
D. Insurance s
E. Bond ;
P. Dishonored checks not recov 1r�d ; 6�3.38
G. Aecounting Expensa � 35�.��
H. Employers F.I.C.A. ; in A
. I. Pulltab Taa Paid to Depart� nt t R�ve� = 1�2�9.8�
J. liinn. U.C. Tax = in A
R. Fsderal Excise Tax 6 Stasp ; 17�.47
L. Stat• Gmbliag Ta�c = 5'42�.25
H. Hiscellaneous Expeases. Id nt � ths aaint
. and to vho� paid.
Bingo Lingo . 1. Advertising 75.00
MN Tipboard Z. Equipment Lease 1�239.84
MN >`Tipboard 3. Cost of Goods Use '', 2.168.06
4.
9. Toeal Expenses � TO'tAL ; 40,500.25
10. p�t Ineose - line 7 dws lins ; `�12,837.75
11. Checkbook balance beginaing of ari d ; 1�'�23.26
. 12. Total of line 10 and 11 ; 22'861.�1
' 13. Total contzibutions (froi attac ed rlu6sst) = 16,304.46
16. Checkbook balance end of raport g eriod - 6�556.55
� line 12 less lins 13 . �
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UNIFORM CHARITAB E AMBLING FINANCIAL REPOR7 C��0��°�"/
� " ` LAWFUL PURPOSE C NT IBUTIONS - WORKSHEET
Line �13 - Tatal Lawful Purpose C nt ibutions. S 16,304.46
•. List below all checfcs writte f m qambling funds which are
charitable lawful purpose co tr butions. The total dollar
amounts of these checks must ma ch the amou�t claimed in
line #13. Use additional sh et as necessary.
CHECK # DATE ' PAYEE CHECK AMOUN PURPOSE
1. 1491 03/24/88 Custom Contracts ! $3,750.00 -�p aSS�S+ W�i-C� `�- ��'�''�
2. 1645 06/27/88 Custom Contracts 4,750.00 �� ��'� w�� ��'�
r2{�,tr�k.�l u�n bti1 VOCi�%�una..�
3. 1760 09/15/88 Custom Contracts 7,500.00 K'`��'
4. 1698 07/31/88 City of St. Paul !I 27.67
5. 1760 09/15/88 City of St. Paul 131.72
�(�.c-l� GL� �.-'�c S
6. 1794 10/O1/88 City of St. Paul 77.72
7. 1845 10/31/88 City of St. Paul ' 67.35
8.
9. � �
10.
11.
12. �
13. �
TOTAL CHEC 'A UNT � 16,304.46
NOTE: These expenditures will be pro de to Council Members at your Council hearing.
� Be sure that your financial re rt is complete and accurate.
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