89-440 WMITE - C�TV CLERK
PINK - FINANCE COIl/1C11
CANARV - OEPARTMENT G I TY O F A I NT PA U L
BLUE - MAVOR File NO.
� Co nci esolution ;����
.� �, 3
Presented By ,' �
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID 22 12) for renewal of a Class A
Gambling License by t e oly Childhood Women's Club at
408 Main Street, be a id he same is hereby approved/
de�
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
��
�� _�,�� in Favor
Goswitz
Rettman B
scheibel _ A gai n s t Y
Sonnen
�
1 4 ,�9 Form App ved by 'ty orney
Adopted by Council: Date 2/l�/�
Certified Ha: d by Council Secre ry BY
gy, �_
A►pproved by Yfavor: Da ` _� Approved by Mayor for Submission to Conncil
_ By
Pli�llSilED ►VtAR 2 � 198
o�r�aann , a►a I 4/— " f ` '- i
, G#��f�t ��t�E�' No.O 0 2�4 4 9
J. Carchedi
cot�rmcr . b�v,��rr os�ECroA ►�►vow wn�run,
� C�ristine Rozek � _ �a��� 3�«�
� �.
�� �a� 2 Counci1 Research
oan�n. � --
. _ ' #xn"rrowrev
Application F+�r renewal of a Sta lass 'A Gambling Lieense.
Notification Date: 2-23-89 t�earing Date: .3�3-�'9 3-t�� �S�l
�DATwMS:(APProve W o►Fleiect(p)) COIlN�
. � PUNNM�10 OOA�NN89pN CMI,SERVN:E COMMISSWN DATE IN � DATE . � ANALVST � PNOME-N0. ' � . .
ZONNIO CONM�SION 190 826 SCHOOL.90ARD . � . � . . . � � � � ..
� BTAFF . . . � � CMARTEH OOMMISBION � IS . . ', � ADDL MIFQ.ADDED* .. RETD TO CON�A�T . . � .. .
' � - � � _FOR ADDt MFO. . __F�lOBA�IC ADDED� .
DIQTRK."f COUIJCIL - � #ExPLANA �� . . � - .
BUPPONTB�WHIp1 WlM1CiL OB�CTM1+E4 . � . . , . � � . . . . - , . .
� . . � . . � . ... - - . � .. . . �.. - . . . � .
� - . . _ . . . . . � . . � i . � . . � . . � � �. . � .
M11A7r10 i110lLEY,I�l1Er OiP01171M1FY{VWp.NM19t.W11on.�Mhi►e.Whyf: '
Mr. Jerome Krzmarzick, on behalf f he Hply Chi1dhood Churc,h Wamens Club,
requ�sts City C�uncil approval o hi app1ication �for;renewal flf-� Class A
_ GambTi�ng License at 408 Main Str t. Gam ]ing sessions are:h�ld Sunday ;
� .
nigt�ts bstwe�n the h�urs �f 6:30' M nd�1�:30 PM. Proeeeds are donat�d tc� .
Holy Childhood Church and Schoo1 . � -
�
�
.�m.�►noN�,�,;�r,�....fl..w�y: . � : .: . -
All fees and applications have b n ubmitted. A11 10� contributions
� . - to t�ie City.. Y�uth: Fund are curre . ,
� �iMiM6;Wh«+�.�nd io vr►am):: , . , , . . ' ;.
� . . . � . .. � . � � . . - � � � � � . . i�- . . . . .. . � . . . . . - . .. .
If City Council approval is given ly Ghildhood Church Womer�s Club wii1
continue ta sponsor a bingo sess� n t 40$ Main Street.- �
_ _ . _ . . . ,
�t�+,►n�: � . c:aas :
_ C���c�i ��:^e��c9� C�nter.
�.
. '. j F � 2 '7 ���3
; � � �
FMBTORI►,PREC�EIITS: �
_ �
LEOAL 16611E8: I
. _
. . ��'j--�D
DiVISION OF LICENSE AND PERMIT ADMINIST T ON DATE � (0 b � / °2 I�Q O �
INT�,RDFPARTMEI�TAL REVIEW CHECKLIST A.ppn ro essed/Receiv d by
Lic Enf Aud
Applicant �OI� Ch� I�{�d�n� (��(��n� cf �tome Address ���� �C��,-, �P y��
Rusiness Name Home Phone �Oyy-1�C'S
Fu:,iness Address �� �al✓1 �� Type of License(s) �.e�'l.Pll�� L�Cc.SS �'1
Business Phone _��_ � �� ; �1GlV►'�blir�� �iC�.v�S �%
I
Public Hearing Date � I U License I.D. �� ��«
at 9:00 a.m. in the Council hambers,
3rd floor City Hall and Courthouse State Tax I.D. �� � �A'
llate Notice Sent; 23 �� / ��`, Dealer 4� � IA^
to Applicant �•
Federal I'i.rearms �� �
Pub.lic He�.�ring
DATE TNSPE �I
REVtEW VEKFIED (CO U ER) CUMMENTS
A proved No A roved
�
Bldg I & D �
�
�J Q'
Health Divn. '
_
' ��� :
�
Fire Dept. �
I � � �
I
Yolice Dept. �y�-�" Z11�
6+�
�
License Divn. � '
a � � et�-
City Attorney �
�L�J Ql� � � �
���-� v �
i
Date Received:
Site Plan N �/�" �(�j
� To Council Research � oZ� u 1
Lease �r Letter Date
from Landlord Z � � �
�,;: . ���o
. ..
�
, Charitable Gambling Control Board
Rm N-475 Griggs-Midway Bldg. For Board Use Ony
.� '1821 University Ave. Paid Amt:
- - St. Paul, MN 551043383 Check No.
:•••�:'� (612) 642-0555
� Date:
GAMBLING LICE SE RENEWAL APPLICATION
y LICENSENUMBER: ,_. ,l _ � /EFF. DAT : ;pp /AMOUNTOFFEE: IA.�A
1.Applicant-Legal Name of Organization 2. Street Address
� F �1 i v r�t o il! !!� 9' o �
3.Ciry, State,Zip 4.County 5. Business Phone
�� ''�� - R �a b12 6�1-1�95
6. Name of Chief Executive Officer 7.Business Phone
�
" � � $`i�n fli 54+1-74a5
8. Name of Treasurer or Person Who Accounts for Revenues '^ri� 9. Business Ph�y�;
��� '��„�•^: � bl: 544-44?5
10. Name of Gambling Manager 11. Bond Number . 12. Business Phone
4 • �y . 561°i`.23 .
13. Name of Establishment Where Gambling Will Take Place 14. County 15. No.of Active Members
� �r. ,; .� �•�;�� ;r �-��! Ra�s�v 291
16. Lessor Name 17. Monthly Rent:
t �t.; �i. c,i Sq�9
� . 18. If Bingo will be conducted with this license, please specify days nd mes of Bingo.
�
,��'
% Da�rs , .i Times � _ . Da � . .Times_ . .. . _ .. .Days • Times
R .x ✓�� �.1�.'fl�� �� �
� y
��" . " -", '� .%� % � � �
"' 19. Has license ever been: � ❑ Re�ioked Date: '❑ uspended Date: O Denied Date:
�` 20. Have intemal confrols been submitted previously? �'XYes ❑ No pf"No,"attach copy) �
�� -�21. Has current lease been filed with the board? II �Yes ❑ No(If'No,"attach copy)
� ' .T
.'."�.22. Has current sketch been filed with the board? _ �Yes ❑ No(If'No,"attach oopy): -�
i"'"�:i�t' y GAMBLIN SIT AUTHORIZATION ,.
�:� By my signature below, local law`enforcement officers or agents of t B rd are hereby authorized to enter upon the site,at any time,gambling is
being conduci�d,to observe the gambling and to enforce the law fo 'any nauthorized game or practice. '
• BANK REC RD AUTHORIZATION
� By my signatyre below,the Board is hereby authorized to inspect th ba records of the General Gambling Bank Account whenever necessary to
� fulfill requiremerrts of current gambling rules and law. ,
TH -
I hereby declare that:
1. I have read this application and all information submitted to the ard; _
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 of the organization;
5. I assume full responsibility for the fair and lawful operation of all ivit es to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota re cti g gambling and rules of the board and agree,if licensed,to abide by those
laws and rules, including amendments thereto.
�3.Official Legal Name of Organization ,, ig,,..ture(Chi xe utive Officer) te Title �
x , �" - r
,, / � �. � 7 ` ,l
L�G � .J:/���- :�l�C.. �.1� `L`�rGr •. �U. �f'���. 1 l�� ��/�/ �r'
,/ ACKNOWLEDGEMENT OTI E BY LOCAL GO RNING BODI� �""'
I hereby acknowledge receipt of a copy of this application. By ackno ed ng receipt,I admit having been served with notice that this application will
Lie reviewed by the Charitable Gambling Control Board and if approv b the Board,will become effective�80 days from the date of receipt(noted
below), unless a resolution of the local gove� 'ng body is passed whi s ifically disalbws such activity and a copy of that resolution is received by
`lthe Charitable Gambling Control Board within�3Q days of the below n ted ate.
� ' 24.Ciry/Counry Name(Local Governing Body) Township: If site is loc�ted within a township,please complete items 24
��t,, .} �;,���.i,�.�� and 25:
{ Signature of�Eerson Receiving Application: 25. Signature of Person Receiving Application
-• ; '
, �j . . _��,:� i -, ,.�
r
Title Date Received(this date begins 3Q day perio,d Title:
_.�._ ,,� { � , ;;r c�
_ , Name of Person Delivering Application to Local Governing Botly: Township Name
CG-00022-01 (5/87) Whi Copy-Board Canary-Applicant Pink-Lxal Govemi�g Body
vlol/L�
. • ity f Saint Paul �� � `
Depa�tment of Fi nc and Management Services i Q
Licens an Permlt Division
� City Hall
• St. Paul, Inn ta 55/02•298-5�6
APPLIC I N FOR LICENSE
CASH CHECK CLASS NO. Ne Ranew
a `'�''� . � _ G
Date ;�, � 19�
Code No. Title of License �.•- ��_�o�C�To, ,.,?—/_� 19,�
.
� From -��r-
� � •
100 �G�iL�1,� �
� �� A kanUCompany Name
. . 100 .
100 BuslMSS Nam� 64{�,
' �a �'�9S
,00 �Ll�
nqs Addnss i "PhaN Na
_ 100 8��� 08
i
100 Mail to ross /� P�wn�No.
�oo �2-�-Z`�' �• G� �.�
MaMqKlOwnsr•N •
_ �oo /� a �� .L���L',Lv�� �.l'.f '
100 Atanap�►IGwnN•Nom�Addross . Pha+�No.
�Ops Applieatfon FN� 50 � �
t Sum of 100 �GZ;�!.l-� J!J{/D�
JL.r/.�� �u�-�C �"� Manap�Own�•Ci�Y�Slat�3 Zip Cod�
. ���� 100 TOt I 1 �
' � �
/'"�,ry �
LIC�t1sf tftBp�CtO� �-----By: � Slqnstun ol ApplieaM
�/ �/ �/
� Bond•
Comp�ny Nart� Poliey No. Expiratbn OaN
Insura�ce•
Comp�nr Nanw Pdtey No. ExP�ntbn at•
)
Min�esota State Identification No Social Secu�ity No.
Vshfcls Information•
SNlal Nump�r at� umb�r
Other
THIS IS A RE IP FOR APPLICATION
TNIS IS NOT A LICENSE TO OPERATE.Your appUcation tor Iic nae ill either be granted or rejected subject to ths provisbns of tht zonln�
Ordinane�and eompl�tion of th�insp�ctions by the Health. Fi ,Z inq andJor Lics�s�Inspectors.
.
$15.00 CHARGE FO AL RETURNED CHECKS
. ,
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' - ',�--�' ��'��c�r� 13�7 /�J�' 4'�-
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City �of Saint Paul
Finance and Management e ices/License & Permit Division
INFORMATION RE UIRED WITH APPLICATION FO ' P RMIT TO CONDUCT CHARITABLE GAMBLI�IG GAME 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 bs.)
1. Full and comple e ame of organizat on which is appl i g for license
� , i
2. Ad ress where games will be held .p � . �'`�/Ox
N ber reet ity Zip �
3. Name of manager si ing this applic ti who will conduct, operate and manage
�
Gambling Games � Date of Birth �� ���3�
r-
(a) Length of time manage has been me er of applicant organization 3� ..
4. Address of Manager �i / �� J�.�/O g.
Number Street City Zip
5. Day, dates, and hours this applicat'pn is for ' `:�O
6. Is the applicant or organization or �n ed under the laws of the State of MN?
�
7. Date of incorporation �� � ,
8. Date when registered with th State f innesota � � � (� �
9. How Iong has organization been in e �Cst nce? �
10. How long has organization been in e st nce in St. Paul? ,
11. What is the purpose of the organizat on. .�
♦
.
12. icers of applicant organization:
Name /��� ' Name �
Address � .Z , •����c�dress
. ��
Title DOB �o�,�i � Titl DOB ,��/��S �
Name � Name
Address (� D d, Address
Title `� DOB ��� Title DOB
13. Give names of officers, or any other pe sons who paid for services to the
organization.
Name Name
Address _ Address
Title Title
(Attach separat s eet for additional names.)
� � .
� �� � ������4
�14. Attached hereto is a Iist of names addresses of 1 members of the organization.
� �
15. In wh e custody will ganizatioD,' cords be kept? / � • '
! /�,
Na � Address � /00 •
16. t all persons with the authority o sign checks for dispersal of gambling proceeds:
N Name
dress �� � � s
/��/� Membe of J'� Member of
DOB � V � /Organ ati ? DOB Organization?
�
Name Na�.e�,��
/� <l
Ad�'re s ` O dress
Member f a�� Member of
��OB Organization? DOB Organization?
17. a) Does your organization pay or in to pay accounting fees out of gambling funds?
yes no
b) If you do pay accounting fees, t �', om wi11 such fees be paid?
Name Address
DOB Member of rg nization?
c) How are the accounting fees cha ge out? (flat fee, hourly, etc.)
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?
19. Attached hereto on the form furnish d y the city of Saint Paul is a Fin ia1 Report
which it .emizes all receipts, expen es, and disbursements of the applicant organiza-
tion, as well as all organizations ho ave received funds for the preceding calendar
year w i h has been signed, prepare , d verified by
-' 3� ' �Q/
Addr ss � f.t' �'�
��
o is the of the applicant organization.
Nam
20. Oper r of premises where games wi 1 b held:
N f� �
/
Business Address � a, � ���•
Home Address Q /�1'�'�'. �/�/D or
�d 7�d
21. Amount of rent paid by applicant o ga ization for rent o the hall:
� �� ' � �
.
22. The proceeds of the games will be �is ursed after deducting prize 1 yout co ts and
opera ing expenses for the llowi g rposes and uses:
.
. •
.�/ ��� a-�-�
23. Has the premises where the games a e t be held been certified for occupancy by the
City of Saint Paul?
24. Has your organization f ed federal fo 990-T? If answer is yes, please attach
a copy with this application. If a sw r is no, exp ain why:
. � . ,�✓
.
�� .��---
Any c n e des �ed by the applicant ass ci tion may be e'onl wi h the✓cdns�t'�o� the
City Council.
.
Or a�iz ti n e
; �
Date �; �
Manag r in c �rge of game
y � �
Organization President or CEO
� b = 9 e � ' (� 1' � � n .. : ^.
� � 3 = �
n .r t0 -* /v,. S 's o r► �t
A A �t ^f 3f v� A !�r r r0 7 3
ti '0 : t t ,� 7 O � :0 ^
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, O �it of Saint Yaul Page 1
� � � 4 Departmaat o !FI nce attd Management Sarvicea /�,._,r�^����
�� � Division of ce e and Yermit Admiaistration C�d 7 T`l`�
� �'� � �O O �i llNIFORli AB GAl�LING FINANCIAL REPORT �
� � `'Y` � Date R�"c7/�6 `
,� �� of Organizat
� � �����.
. Address vhere Charitabl� Gubl g conducted
� ,
� � 3. Raport for period coveriag � 19 through ��i� 19 �
� � `v�. 2otal number of daqs play�d
` � ��'
5. Grosa r�ceipts for above p�rio �
6. Gross priz• payouta for above sri (iaclud� eaih short) : �/ • �O
7. Nat receipts - lias S �i.nus li 6 ; � C!
8. Expanaes iacurred in conductia a operating gase: � 2_ 2 ,
A. Gross vages paid. Attac6 rk r list vith "
• � . names. addressas, grosa va Rs� wber of hours : � 9 o a• ��
vorked, and a nt paid pa 'ho
B. Rent for`J V weeks ��✓V • �
r
C. Licenae fee � • ' ; �
D. Inaurance v��; �
E. Bond i �L o-�
" F. Dishonorad checks not zec ere i �/ ��
� .
G. Accounting Fa�pense � �
� ` H. Employers F.I.C.A. ��
I. Pulltsb Tax Paid to Depar knt of R�vanus = � ��
J. Minn. U.C. Tax � O
iC. Fedsral Exciae Taa 6 Stasp ; ���
\ L. Stat� Cabliag Taa �
�.33 � o
H. lSiscsllaneous Expenaaa. I ent y th� mount .
a��� aid., �
. COo. i V,. �
/
2. i
3. _
4. � ; G
9. ?otal B:penses ?0?AL = � �4
� 10. N�t Ineos� - lins 7 sinas lins � = O `�� �/
11. CAeckbook balance bagim�ing of per od = �/
12. Total of line 10 and 11 = �
° . 13. Total contributions (froi atta �►sd rb6�st) _ � � �
14. Checkbook balanca end of repor 1Lag period -
' lina 12 less lina 13 �
. ��� /�� � �
' �..,..� . :- ---
. �' � ,�t�'�e��
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� �.a� V 1 J 1 • �I'1 V V
UNIFORM CNARIT �BL GAMBLING FINANCIAL REPORT
� � LAWFUL PURPOSE CO TRIBUTIONS - WORKSHEET C��--��
Line �13 - Total Lawful Purpose Co ributions. S 3 0��
-. List below all checks writ en rom gambling funds which are
charitable lawful purpose ont ibutions. The total dollar
� amounts of these checks mu t tch the amount claimed in
line �13. Use additional ee s as necessary.
CHECK # DATE � PAYEE CHECK AMOUN PURPOS
�
�. 3 /8'0, .t.9. �' � � �. f 000'd� �f.c• �
2. `3 � � � ' ��d �' � �,!.� i� �'� , ° '
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5. 3 3 �� 9 3..�
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6. 3 7 � ! ,► �oo ,� �
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8. �� �V ��7 , '' � � ' �
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9. � 3 , �- /�. P' � � Q.
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12. p . a �, ii � �-��
a�o� /�O . i ,' �/ �� `�
�s.,� . .t3 /.2.�• 8 . ., �. � � /. �� ,
� . .�-
TOTAL CHEC I �
NOTE: These expend�tures will be pro �de to Council Members at your Council hearing.
� Be sure that your fina�cial re rt is canplete and accurate.
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