89-441 WHITE - C�TV CLERK
PINK - FINANCE G I TY O A I NT PAU L Council ///��(�/,'
CANARV - DEPARTMENT X `� ��
BLUE - MAYOR File NO. �� i
y�� c Resolution ��`
� �
� , �3
Presented By `"�Y
Referred T�6 Committee: Date
G
Out of Committee By Date
RESOLVED: That application (ID #2 636) for renewal of a Class A Gambling
License by the Rice aw on Booster Club at 1079 Rice Street,
be and the same is h re y approved/�d.
-
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
���
I.one .j [n Fav 'r
Gosw;tz
Rethnan
Sc6eibel �-- A gai n s ' BY
Sonnen
� MAR � � �9� I ved b Cit Attorne
Form App y y y
Adopted by Council: Date •
Certified Pa -ed by Cpu
ncil Secretar BY Z���
By
A►ppro by Mavor: Date Approved by Mayor for Submission to Council
By
PU�t►�ED i��� 2 " ��19 9
o�c�uron o�� �ea u� � � ��7 �,
�. �archedi GR�EN ���Efi` rro.0�2444 :
EONTAt."T PER90N . .DEPAHTY�H!DIRfeCTOR . � - MNMOR(OR.AS$IBTNI��.
Chl^1 St11t@ ROZ@k N� � �a ir�eaoars�v�s o�croR 3 cm c'�
"'�°�. � � �*� 2 `Counci l Research .
FinancE &` I�Igmt:. 298-505� °r+� —1r- �ma��, - _
Applicat�on far renewal of a G s A Gamblir�g License.
Not�fication Date: 2-23-89 i Nearing Date: 3-14-89
�:UPpor+(A)or Rs�«(R).)
r�NSUrxi� crva s�wcE c�issiorr o��� o� our nwursT ritor�No.
mwx+o�aN i�en scrbo�eoe,�o
sr,� . �c�wnssroN ns�s �oot x�o.nooEO* nErv To caH►n�r ,.. �anru�r
— — _Fon�x�o. _�oa�ac�ooEO*
o�srr�cr couwa. *
aurranrs vaa��caxrca.oarECrne� '
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ItftM'llNd M10��M.��P�l11ftINIf1F M�ho.VYAat,when.wf+ae.WhYY
Kathy Crea, on behalf of the Ri e awsoM Booster Club, requests Council
approval ��f her application for re �wal ;of a Class A Gamblin�..license at
1.079: Rice Stree.t. Gambling ses ia s .ar� hetd Fridays between the hours
of 7:30 PM and 11:30 PM. Proce ds are ysed to support and promote the
youth activities and programs o R ce L�wson Recreation �Center.
.�,s��qca��awe.,e�rs naar�aq.6.�a,nsT•
All fees and applications have ee submitted. Al] 10�. contributions to
the Eity Youth Fund are current
i
,
oowEau��r,w�,a�a a�o wnomf: - li .
I
If Council approval is given, t ice L�wso� Booster Club will continue
to sponsor a gambling session a 1 79 Ri�ce Street.
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�u:�nw►,�:. cor�s .
. , . Gou�a� ! Res��rch Center
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� DIVISION OF LICENSE AND P�;RMIT ADMINI T TION DATE � � � / � C0
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn ro essed/Rec iv d by
Lic Enf Aud
Applicaiit I CG �5.� l � I��y cr,r���
� �.q,�,�py� tc Home Address (Of S ��Q lQ✓ S�
Rusiness Name Home Phone �'�/ '87`�v
Business Address I C�7 q J�tc:� �� Type of License(s) �!ClSS 19'
Business Phone n � � � �,,
Public Hearing Date J � � / License I.D. 4i Z �t�3�p
at 9:00 a.m, in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �1 ��+�+
llate Nutice Sent; 2� �� ��� Dealer �l ���
to Applicant
rederal F3xearms 4� N �.
Public Hearing
�
DATE INSP CT UN
REVIEW VERFIED (C TER) COMMENTS
A roved N t roved
Bldg I & D � ��I
nl 'q'
,
Health Divn. �
�
►�1�- �
�
Fire Dept. I �
! NI� �
�
Police Dept.
� �� I � �^
License Divn. �
� �f �y� (� t�-
City Attorney �
�la���`1 i O�L
Date Received:
Site Plan �
To Council Research �—o��—� �
Lease or Letter � Date
from Landlord Z
, _ > , y !
� . �
' Charitable Gambling Control iard " ' FOR BOARD USE ONLY
. Room N-475 Griggs-Midway B ildi g ; �N�� �
� 1821 University Avenue ` �
' St. Paul,Minnesota 55104-33 3 PAID
: 1612)642-0555 AMT
; � CHECK#
` DATE �
;
GAMBLING LICENSE APPLIC TI N'
' INSTRUCTIONS: �"k
A. Type or print in ink. '
j B. Take completed application to local goveming body,o tai signature and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with a c ck
C. Incomplete applications may be retumed.
D. Enclose license fee with application.
Type of Application: '
�Class A— Fee S 100.00(Bingo,Raffles,Paddlewheels ,Tip ards,P�dl-tabs)
❑Class B— Fee S 50.00(Raffles,Paddlewheels,Tipbo �ds,Pull-tabs) M.k.d►«�cs p.yabi.to:
❑Class C— Fee S 50.00 IBingo only) Mw""'°t`ch�t'a'c3a�b�trq�°"tr°�Bw�d
❑Ciass D— Fee S 25.00(Raffles only)
Check one: �1 A. Organization has never been licensed.
❑1 B. New site—Give bese license number. , 0
; �1 C. Renewal of existing license—Give co ple e license number. a� - � - 0
O 1 D. Change in class of an existing license— ive omplete license number. � - � - 0
❑Yes�hlo 2. Has organization ever received a Lawful am ling Exemption Permit from the Board7 If yes,give complete
: permit number "}
Yss 0 No 3. Have Internal Controls been submitted pr vio sly on a form provided by the Board?If no,please attach copy.
' 4. Ap licant(Official,legal name of organization) 5. Business Address of Or anization` /j—�y,LT��c,e,.�
� � � L!J Od� �.SJ� /A o�/ �/�'If�/f.�� �O ,,5� L . ..:.�//
6. City,State,Zip 7. Coun y 8. Business Phone Number
%f � ( � � a �S
9. Type of organization: ❑Fraternal OVeterans ❑R ligi s �Other nonprofit• _
' •If organizaUOn is an"other nonprofit"orga�ization,answer s 10 through 12.If not,go to question 13."Other nonprofiY'organizations �
� must document its tax-exempt status. -
'�i lfes�No 10. Is organixation incor o�ated as a nonp�o o anizationT If yes,give number assigned to Articles or page and �
book number. � 1 A h y of csrtifkata.
ONo 11. Are articles filed with the Secretary of S te
QYes o 12. Is organization exempt from Minnesota F erel income tax�If yes,please attach Istter from IRS or Department of
Revenue declaring exemption.
OYss o 13. Has license ever been denied,suspende I or r vokedT If yes,check all that a ly:
❑Denied OSuspended ORevok � Givedate: -
14. Number of active members 15. Number of yea in xistence Note: Attach evidsncs of
, il� throe years exbtence.
i 3�
16. Name of Chief Executive Officer(Cannot be 17. Name of treasurer o�person who accounts for other revenues
� Gambling Manager) of the organization�Cannot be Gambling Ma�ager)
i-� v
. .
� Title Tttle
` /�/ I �/`�i ��G�V U���
Business Phone Number Business Phone Number
� � ► �1'— �/7�C, � � �/Q?� .��P�''—e���
� 18. Name of establishme�t where gambling will be ; 19. Street address(not P.O.Box Number)
conducted
�/ , lr�Dl� 1� .0 �D.7 �.�' ,
20. City,State,Zip 21. County(where gambling premises is located)
..ST l.�L �.'.0 �.�'"//7 rE�,�/,if.�� '
CG-0001-0318/88) White Copy-Boerd Canary-Applicant Pink-Local Goveming Body
1 of 2
;: . . . .. ,. , , _ ,� r _
� . � . �-��/
Gambling Ltcense App ication '
,�Type of Application: Class A ❑Class B Cla s C ❑Class D
es ONo 22. Is gambling premises located within cit lim' 7
, es�No 23. Are all gambling activities conducted a the remises listed in#18 of this application7 If not,complete a separete
application for each premises(except ra les as a sepa�ate license is required for each premises.
�Yes o 24. Does organization own the gambling pr mis s?If no,attach c�y of ths lease with terms of at least one year,and _
attach a sketch of the premises indica 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 IicenseT If yes,give days and times of bingo oe�asions.
Month or Bin o Occasion Day . ime Day Time Day =Time
$ f a�a:r G� .+�I"��f. t�"f/�'
+ ,,� � n
ea�No 27. Has the$10,000 fidelity bond required by inn sota Statutes 349.20 been obtained7
28. Insurance Company Name(not agency name) 29. Bond Number
1�,��"1/'r:: .- �f � � �'.!.%� T ... 7�-�7�. �
<7+
30. Lessor Name 31. ddr ss 32. City,State,Zp �
;%�' _ _ '�" ,"� � ��L' 7' ::�L., i�..' '���i :i
33. Gambling Manager Name 34. ddr ss 35. City,State,Zip
J i� 1 /7 ;: ./ .G- j �� i�;L /l :..1r.�,1/,�
36. Gambiing Manager Business Phone 37. Date gam ling manager became
� /, . � � r��'._� � member org nization: Month Year � ��
�Yes o 38. Has the license termination form been com lete 1 Attach copy.
❑Yes No 39. Has the compensation schedule been appr ed y the organization?Attach copy. -
40. List the day and time of the regular meeting of the organiz ion Day .�'Q" 7.�'-+�°� �='�.il�'�"�-�Time �'�'�'�- f=���•
41. Bank Name 42. Bank ddr ss 43. Bank Account Number
/�� ' �� ti%�
�.�/!".�'L-. ,�'.��� � ,� -f- / �..5� ��D�,�-'
,
GAMBLIN S E AUTHORIZATION
By my signature below,local law enforcement officers o age ts of the Board are hereby authorized to enter upon the site at any
time gambling is being conducted to observe the gambli a d to enforce the law for any unauthorized game or practice.
BANK RE R S AUTHORIZATION
By my signature below, the Board is hereby authorized o i spect the bank records of the gambling bank account whenever
necessary to fulfill requirements of current gambling rul an law.
I hereby declare that: ATH
1. I have read this application and all information subm tte to the Board;
2. All information submitted is true,accurate and com lete '
3. All other required information has been fully disclos ; .
4. I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and lawful op rati n of all activities to be conducted;
6. I will familiarize myself with the laws of the State Mi nesota respecting gambling and rules of the Board and agree, if
licensed,to abide by those laws and rules,including m dments thereto;
7. Membershi list of the or enization will be available it n seven da s after it is re uested the board.
44. Official,Legal Name of Organization 45. Signature Imust be si "ed � ief Executive Officer)
a X �,
' Title of Si ner � � Dat
,� ^ , a _,� _
.
ACKNOWLEDGEMENT OF�10 ICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application By cknowledging receipt,I admit having been served with notice that
this application will be reviewed by the Charitable Gambl rg ontrol Board and if approved by the board,wiN become effective
60 days from the date of receipt (noted below) unless re lution of the local governing body is passed which specifically
disallows such activity and a copy of that resolution is re Isiv by the Charitable Gambling Control Board within 60 days of the
below noted date.
46. Name of City or County(Local Goveming Body) If site is located within a township,item 47 must be completed,in
'� -�- ; � '� , addition to the county signature. If township is not organized,
'i�" �;.-'�, 7�=���%�- county must sign.
...,_,.
Signature of per receiving application 47. Name of Township
' � ' j � �/
X \ �.1' !.I;
Title Date redeived(60 day period ' Signature of person receiving application
begins from this date)
� �. _r� ic; ! r' �� X
48. Name of person delivering application to Local Govetning , y Title
, t
i''r/a r �'� % ' _/
CG-0001-03 l8/881 : White Copy-Board I Canary-Applicant Pink-l.ocal Governing Body
ag 2 of 2
. . c�t of saint Psul °Z 9��,(o
Oepa�trn�nt of s • snd Ma ��n1 SNVk�s G
. Lictn • s P�rn�it O�ivision �G�
Cfty Halt
St.Paul Mf ssota 55102•296SOS6
APPLIC TI N FOR LICENSE
CASM CNECK CU►SS NO. N Renew
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' cod.No. rnw a��. F �" ���� T ^ ��
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J � 100 �1 C.,(.� �-!! G(�S011� �(i�S�lP✓ l.�G(..
l�•) � lr? Y�t W N�
; . 100
��7R �� c¢ 5��
' ,00 e�.+�...�.
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100 Msi1 fo AdM�ss M�OM Na
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' lot5 C�c� -�-r�,�, oy�z
� ,00 t►t�.�+on�.�. .�a�.Me.
� �ON Appllestlon FN Sp /�
2� �/ f r �7
� fM of 100 �( . U L�! G(,f � �y� s .� l� (
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; U•� Manapw/OirnK•GIy.Sf�N i�r.o0s
� 100 T tal 100
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, Lie�+s�IesD�tw ' gy; ��'I� eui�:a uoo�+�aM
� BOnd'
� NanN POlicy No.
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; Mi�nesota State tdentillcatlo�No Social Secu�fty Na
Vehicl�I�formatlon•
aMial NumbN �a
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THIS IS A R EI FOR APPLICATION
TNIS t8 NOT A LtCENSE TO OPERATE.Your appliWtion for I sn will eitha b�p�ante0 a ro�ected aub�ect to tM prorisfoes of!M toMnO
adleaeC�and Com0lNton O/tM Mspktbns by tM Htslth. ir�. inp andlq Liqns�Insp�Cton.
;
. a15.00 CHARGE F � LL RETURNED CHECKS
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Cit o Saint Paul (,�
Finance and Management Se ices/License & Permit Division
INFORMATION RE UIRED WITH APPLICATION F R ERMIT TO CONDUCT CHARITA.BLE GAMBLIVG GAI�IE IN
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 bs.)
1. Full and complete name of organiza io which is applying for license
2. Address where games will be held 7 w ��//�
N ber Street City Zip
3. Name of manager signing this applic ti n who will conduct, operate and manage
Gambling Games Date of Birth /� �—��p
:
(a) Length of time manager has been me ber of applicant organization //����2��Q/
�
4. Address of Manager �„�//j �7�, � .�s//�
Number Street City Zip
�/ P/h. /I9.9.c°_�9
5. Day, dates, and hours this applicat �on is for `�,�.L, ��,�,�, 7.:30�//,3� /yIA.P_ 9L�
6. Is the applicant or organization or an zed under the laws of the State of MN? G/�P�
��—
7. Date of incorporation 9 a�-
8. Date when registered with the State of Minnesota //— c�0 a �
� 9. How Iong has organization been in e is ence? ,�, � �7�
�T�
10. How long has organization been in e is ence in St. Paul? p����
11. What is the purpose of the organiza io ? �@�D1 �� i ��1 ����p�l.irr.�%�
12. Officers of applicant organization:
Name � Name
Address / Address /�9� �/����L/!� �
Title __��,�1J, DOB � —o�� Title y'. ��/L.p.Qf DOB / ��-7`�
Name , ' Name L� � �O����ni�
Address ��a Address 9/aj ��/��1?��3�r�
Title . DOB -o� Title �,,_Q�, DOB �Q�,3 �j o(
13. Give names of officers, or any other ',pe sons who paid for services to the
organization.
l Name Name
Address Address
Title Title
(Attach separat s eet for additional names.)
` ^ ���
�
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?
� Name Address /�/��j /�O�i'o�
16. List all persons with the authorit t sign checks for dispersal of gambling proceeds:
Name � Name ,� ii�D� i�",��
Address /��� �2�z�%�G� Address ��1�'..� '7�Z����
Member of p Member of ' �, - )
DOB %Q-o��-� Organization? DOB .S-c�d -Sc� Organization? '72�
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
17. a) Does your organization pay or i en to pay accounting fees out of gambling funds?
yes �C� no ��� �% ' �� .
b) If you do pay accounting fees, tl' w om will 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? GJ� D��
T
19. Attached hereto on the form furnish d y the citq of Saint Paul is a Financial Report
which it .emizes alI 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
—
Address
who is the of the applicant organization.
Nam
20. Operator of premises where games wi � e held:
Name
.
Business Address
Home Address
�,
� � ... - i I/' 0"����� �!
t
21. �mount of rent paid by applicant or an zation for rent of the hall:
.�ee.,� ,.�"/,�D.DO
� 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:
�G�-L��a"'�
23. Has the premises where the games ar t be held been certified for occupancy by the
City of Saint Paul?
24. Has your organization filed federal fo 990-T? 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.
l. �1/�t�� �ii�er�/„� � J
Organization Name �°��
Date o?—�—�9 By:
Mana r in charge of game
������. �� i�U�
Organization President or CEO
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` • • 1tq of Saint Paul Page 1 � y'
� ' �� Department of F1n nce and Management Servicea �� /
`� Division of L cen e and Pernit Administration ���
UNIFORM CHARI ABL GAl�LING FINANCIAL REPORT
Date � -���/
r. .
1. Name of Organization
2. Addresa where Charitable Ca�bli g i conducted �,c�j 7 7 � �
3. Report for period eovsring ! � 19�thsough ,�LY�. �� 1�9�
4. ?otal number of daqs played � -:,
5. Cross receipta for abova period f �G�� ��/_ ��
6. Crosa prize payouta for above p ri (includ� eash short) � / � �c�S�. A�/
7. Net receipts - Iiae 5 minus lin 6 f �Q� ���. �/
8. Expanae• incurred in conducting and operating gae:
A. Gross vsges paid. Attaeh rke liat with / ,/
namas, addresaes, gzoas vag s. �bsr of honra ; ✓� �lt��.��
worked. and amount paid par hou .
• H. Rent for �veeks i (O(b��-�
C. License fee � ([�QC�J.C/�
D. Insurance S �
E. Bond 3 ��Ct�. �_
F. Dlshonoted checka not recov red ; O ����J
G. Accounting Expense il i /�` C1. (.�CJ
N. Employere F.I.C.A. � ���CG.��
I. Pulltab Ta�c Paid to Departm �St f R�venw � �� '�` �. CDC.�%
J. Minn. U.C. Taz ; ����
R. Pederal Excise Tax 6 Stasp ; v
L. Stat� Gaobliag Ta�c � / o O L,J. � �
.
c
H. Hiaeellaaeous Expensu. Id hti tha amonnt
and to vhoe psid.
�. ..��. 3���, i 9
2.
3.
4.
9. 'fotal Eupensss ?OTAL : a��'�3� �T
10. N�t Incos� - line 7 tinu• lins � �� ��O /. ��
, /� �-7 �) C�
11. Checkbook balanee begianing of ri i /.� /(J� • / �
12. Total of line 10 and 11 ; ���� � ��
' � . 13. Total contributions (froi attac I'd rkshsat) i O T� �� �"
16. Checkbook balance end of report g riod - /;� '�
� line 12 less lina 13 . � ��v"� ' /�
a � � �� �i , rMU�
� ' " UNIFORM CHARIT BL GAMBLING FINANCIAI REPORT /f,..�.
, LAWFUL PURPOSE CO RIBUTIONS - WORKSHEET (iJ`��'y�
� . . . . .
, �
Li ne �13 - Total Lawful Pur�se on ri buti ons. S �-�a 9. ��
�: List below all cfiecks writ n rom qambling funds which are
charitable lawful purpose nt ibutions. The total dollar
amounts of these checks mus m tch the amount claimed in
line �13. Use additional s 'ee s as necessary.
CNECK # DATE � PAYEE CHECK AMOUN PURPOSE
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NOTE: These expenditures will be prov de to Council Members at your Council hearing.
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