89-649 WHITE - GTV CLERK COQflC1I 7C � / , / �
PINK - FINANCE G I TY F SA I NT PA LT L U �y�• �
CANARY - DEPARTMENT
BLUE - MAVOR File NO.
C n i Resolution �----�
� ;���� �
Presented By � __.
Referred o Committee: Date
Out of Committee By Date
RESOLVED: That application (TD # 70 ) for renewal of a State Class A
Gambling License by B1 ss d Sacrament Home and School Association
at 1494 No. Dale Stree , and the same is hereby approved/
�.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
��g � [n Fav r
Goswitz
Rettroan v� B
Sc6eibel A gai n s Y
Sonnen
Wilson
Form Appr ed by Cit7�ttor ey
Adopted by Council: Date '�J
Certified Yassed u il Secre y BY � ���� ��
sy
61ppro e y Mavor. Da s AP � Approved by Mayor for Submission to Council
B BY
p�gl��p AP R 2 2 19 9
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_ ornaru► , . . � � onn � � o�ooM.��o _:
��� J. �Ca � � di �'��� ��►���� r�. �42����� �����
cdrt�cr�oN o�rrr�r�r aaECroa ' w►va+ta+�sr�
Christine Rozek : — �.� � �«n�
. �°� -.�� _ �:Council Researcb
, -_ �., � �-5f15�b � � cm��.�w+Er �
.. Fir�anc!� &: :
�:
� . Application for rer�wal of a Sta ass A Gambling Lic nse. §
;
� N+�tification t�te: 3-29-84 Hearin� Date: 4-�:3-89 :
_ �u�oo�w.w a R.t�«cm f _. �vonr: > . � -
_ ri�wca cc�.nss�, av�.�co�srias�o� rwor�no.
o��M o��6ar u�vsr
` _ aD�NO oo�oN �eo eza sc►ao�eo�no
s�. cwwrEa oa,�wssww �a�s �oo�.ww. * p��p ro aonr�r ooMennierr
. � . � . _ � � � _ . � _�PoR MD't�M0. _.,_F$OMCK ADDED*
. . . DILTIiC�OOUNCIL . � ; . - . . �'� . . � - ... � . -�
. . . . . . . i. . . : . . . � . ..
� -�.�JMOpIa M�Mpi COUNCM.�OBdECTIMB? � . � - . . � . . � . . I . . .. �� . � . .- .
_ . . . I - � � � . ' . . . _ ...
i
. . - '.� . . . . .. �;�' .� : � . i . . - . , . �, ., . ; � . ... � . �:- . . . � . .
.' . � .� .� . . . �. � � . j . � � � - . . � - i � � . . . � , � - .
. ' . � � ' . . ... ' � I� . � � . . . _ � . � . , � . . . . .I . � . � . . . . ,
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.. . . . . � . -1 . . . .._ . , . .� . . . , . , . . . . ' _ . ..
.. . '��1*pr���Y(Y�IfD��1�.YN1W�.YNIY(9r.��: � - . . � � . � . . � . . . � . . . � .. . � . . .
Gerald D. Jans�n, on behalf of B1 ss d Sacrament Ho�e: ar�d Sc#�ool Association�
rec�uests .Caunc 1 approval of his pp ication for r�tewa� �of a State Ciass A 4
Gambling lic�n�e at 149�4 H. Qale tr et: Garttbling �s�:ss�ons are he1d on Wednesdays
� . . � : between the k�o�rs of 7:(�J PM and i: Q PM. `Pracee,ds ar� used ta. assist.��es�ed -
Sacrament �Grad� School . i
;
i
>JI�l�ti�oi�t�o.uaen.M�,i�awr.oea, c. „ _.; . '
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l�ll fees and applications have be n u�nitted. i0� payrrlents to the City Y�t�th' `
: . Fvnd have been �put in es�row pend ng resolutior�= of a la�Isuit. Proaf of eSCror� "
deposits have bleen submitted mont 1y �
i �
,
; ,
�iot�c�s cwa.t,wh.pr�.ea s'o w�,)c . . .
. ; , . i >
I�' Eounci l apprbval i s gi ve�, Bl e e Sacramerrt�Nome and� Sc�►�o1 Assoc��a�ia� K�'1�
�ontinue to sponsor a qambl_ing se i � at I�ea� ,Wa'F1 . , .
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MtlrlNl►l�RC�ENTS: i, �
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lEBAL 1wf11lL: '�•••
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8TAI�IIOLDERS(LIBt) POlefloN 1?.—.�.� s--wll.�Ei1�FYY�?//NT w►710M/►Le(Sun�ne�hMM�Arpu�erre) .:
, �
FINANCiAL IMPACT w�ar r�n cs�o.a� sc�o rwi r,orES:
cx+�w►�a euoa�:
REVENUES(iENERATED ...............:.........................................:..... �
EXPENSES:
Salaries/Fringe Benefits................................:....................... "
E���t ...........................................................................
�PP��......:........... _ _. _ _
ConVacis for Servioe . , : . . - . „. :
OTher '
PAOFfT(IOSS) .....................................:..........................................
FUNDINO SOURCE FOR ANY LOSS(Name and Amourd) ,
CAPFfAL IMPROYEAAENT�1DOET:
DESIGN COSTS................................................................................
I�TIOM COS75...:......:.............. _ --.
,
,
C,OMSTRUCTION COSTS
'i't3TAL .................................................................................................... �
' souAC�oF Fu��r��,a a�,o�n> _ ,.
xrrncr oN euoaer:
, AMOUNT CURR2NTLY BtIDLiE7EQ...............:.......:....:...... :...... _ _
, . : , , _.
AN10Ut�R MI EXCESS OF CtlRREd'f OUDLiET............................
SOIJACE OF AIAOUNT OVER 8llDQET........................................ .
PROPERTY TAXES GEN�KTED'(IAST1 .........
■APLEMENTATION RES!'+ON818fLRY:
.� DEPT/OFFICE � � �� � DIVISION � FUND TffLE .
BUDf3ET ACTNITY NUMBER 8 i1TLE. . .... . . . . . - .. . ACTIVITY MANAGER � - - - �
HOW PERFO�AANCE YYILL!lE�A81lA�?:
PROQRAIA t18dECTIVES: P�(i�11 MdCATONB 1ST YR. 2N0 YR.
_ _ : _ _
�
EYAW�TION RESPONSIBIUIY:
. �PERSON. . . . . . DEPT. . . � PMONE NO. - . �,Qp�... DAlE� .
A1R4T Ol/MilEA1.Y
� � --�T�- �nw-'s.�. .._- ,.,-o..��..
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UIVISION OF LICENSE AND PERMIT ADMIN ST TION llATE � /� g/ / 3 I � r
INTERDF.PARTMENTAL REVIEW CHECKLIST A.ppn Pr cessed/Received by
C7 I Lic Enf Aud
� �J Gl�S?�1
Applicant ���SSe d, � ,�yy�p yi,. F Home Address �y�� f�vT Z [` � _
Rusiness Name 5�k�v' Home Phone a'�-
? 3 g- ��i
Business Address �`1 �1� dV� �C��� Type of License(s) C�.(cSS /9 ' �7li�-•b��n�
Business Phone �� (�Q,�y,se, r�1�Gvti �
Public Hearing Date �3 ��j License I.D. 41 3 70a-L'�
at 9:00 a.m, in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� ��'�
llate Nutice Sent; G ./� Dealer 4f �� �'
to Applicant 3 oZ �-! t� �
rederal I'irearms 4� ���
Public Nearing
DATE INS 'C' UN
REVI�,W VERFIED ( MP TER) CUMMENTS
A proved t roved
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Bldg I & D +
N ,4- ,
Health Divn. '
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Fire Dept. �
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Yolice Dept. '
3�'�'�1 i o��
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License Divn. !
3I3i� �� ' 6 �L
City Attorney �
3I���� � 6��
Date Received:
Site Plan � � �� p�
To Council P.esearch � 0
Lease or Letter G D te
f rom Landlord � l � 1
_ � ._
�,-- — — -- - -
. � 3 70 a.o
" • fy ol Saint Paut
D�paMn�M of �. .nd Msns�n�n�s.nk.: ��7- ��I�/
s� snd P�nnit Dirision
203 citr Hs11
St. I. �nesota 5S10Z•2965058
APP�i A ON FOR �ICENSE
� CASM CMECK CUSS NG. Renew
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Cod�No. Titl�of LicMSe Fron� ��� 1�To � �� t��
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100 ��' 7 r� ;r. ��-C7�C2 `,� ' 1Be
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. �Y i�►' "' ,.�i�t:(�L/�,.E' '� AOW��YNMM (/�'�'C�.
100
100 ewin�ss Namt
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ewin�ss�aaMS wiaM M..
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t00 Msu eo�dd.as `--Mo��Na
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tao Afan.O.�K,wn..•Mon�.�ee�.=.� Niee.«a
' �OiA AppllCStbn FM 1 2. � �� �
tn. ot / � ,/� ����, :��-L,�s-u� ..'rS//9
��..1.�-ori�.�tJ�i��/ � ,j . a�U 1Manap�HOwn�r•Clt�►.SIaN i D�Codt
100 Ots 100
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Lkyna�Insp�etor �' 8y� � / Stqn�wr�obfl�anM
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COmpafy Nam� POliq No. ��
Instu
Camoany t1an� Pv1ky No. EaoMMbn oaN
: Mtnn�sota Stste Ide�titiwtlon No �����-� Sociat Secu�ity No
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V�Ificl�tnformation•
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Oth�
THIS IS A R CE PT FOR APPLICATtON
. TFIIS!S NOT A LICENSE TO OPERATE Your applicstbn fw ieen wlll eithe�bt p�snte0 a►e�SeNd st�e!M tM prorbiees of tM loNnp
adlnanW and eompl�tion of tM M�p�ctions by tM Nwlth,Fir� to�in�snd/or Liernp In�p�tton.
�15.00 CHARGE F R L RETURNEO CHECKS
����� 3-/ -�``�' � 7, / � - �
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� � .+11�.,;:?'1,�,.,4 Ns�^* .. • .. . . �. � t R >�! ����.. . S.r- '1:-,...., �+o �.'z.�t�` ,r,.: tsv,a*.�.:Rt'`,i• . , . .�:� .. � 'i..7`�� r� �t,L•�" r €::s.
Charitable Gambling Control Board For Boerd Uae On �
,. , Rm N-475 Griggs-Midway Bldg. � .,�
.,., 182i U�►iversity Ave. ,, Pa�d Amt �
� .;S��aul�MN,�5�'04�3383 "` .�, r: �
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„� . (612�642-0555 T f � w� ,Cfl � � �
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- •n.
GAMBLING LICE SE ENEWAL APPLICATION
LICENSE NUMBER: -.. _ _ z /EFF.DAT : �- • - �;� 7 AMOUNT OF FEE: ` �t+ ,�$
1.Applicant—Legal Name of Organization 2. Street Address
s c cr ni � snr
3.Ciry, State,Zip 4.Counry 5. Business Phone
�+�:^
, Name of Chief Executive OFficer ,:�x' . �' � ,f h ,'.4 a t� :, r � 4= ness Phone �
.ia. i'J�ab'_ '�':., ��y' -<rf�F:�> ;� ,e, ''yFT,k:�.�-��� !!Fr#F� �+ ,,•� F r.- '�'tr r �� �;. ; �,�� 8� ,.,�,;:::
`i.:
� .;�Wame of Treasurer ocPerson Who Aa�unts for Re�renues ,�,':, '� r,�:��'�;,„":;� ';� :9y,�i�ineas Phone
�,, , `'�' �4 r� �::a^ az ��y , «��:� a'��';.
��� � ����,�} :. �L`s ',�� ,., :.. ..-"r' .1�t f •:, ���.- � � �:
:. . . ... .. � ,r- � �., .
10.Name of Gambling Manager . w�, 4f':Bond Number ' �l. 12.Business P `nq* #;�
_ . , � 1�.�. -,�,'�, ''� "" •
13.Name of Establishment Where GamblinguWill Take Place 14.County � _ 15 No.of Active Membe ;,,,
, . �;�.�:;. �_.�»� . .,... .�.:._. ,. _-:-.. �_ : . �.: - ' r - a� . .. -�, .. .. ._ ,_ . . _ �. �' �_ .
-y�•� �` .'.� ��.� .i.. •._: ��, ...�.
, '....' � ' .F: .
�.. .- .. ..__ . . . . _,r . . �' � _ . . /�.'"...,- :' . . �'.._ �.
i.` � 16. Lesso�Name � .-' ' :,,� '. . �, 17.Monthly Rent: :
�. _ �- ,
#�.,
18. If Bingo will be conducted with this license, please specify days nd ti es of Bingo. ' �:
Days Times Days Times D� Times
r.�?':t9:Has license ever been: � Revoked Date: �"` D nded Date: `�' : �, �'Q Denied Date: `���£.;�"�� :'�;;•„, �
�.. ,. �
-j � , . �
20.Have�intemal coMrois been submitted PreWOUSy? �,`�ti'" $ , � .;;.�d Yes� �Q No(If9�o,�attact�copy �, �,�i�' ,���"w �
• ,:ec ) r a + �; ��`.,;:
`" 21.Has current lease been filed with the board? ' O Yes {xNo(If"No,"attach copy) - _
22.Has current sketch been filed with the board? - . es �lo pf'No,'attach copy)
s ,-.::,'r�'� . .. :; ,:.. � : , ,,,. ., �., ;,..,,., u,_,r,; P. F.,.,.��. s„� '*Y
. n � GAMBLING SIT AUTHORIZATION �} � °
` � B�!�.signatu� . * bcat�larr�enfa�cemen�ofGcecs -
. :' � .s
_ ,.,e�_ b,.
• !�' l :" l } 17. . ' { -w.,�x 4x1
���n� . � +
� NIflU/p/�uirements of current�p�bli ru 1w � ' �,'�$ "��' ++
�.� �..�7 �"• � �16W �� . F � '. I � ���i�t� Y� "�t�f^i �`r'�'3��cC '�"� .4Y !�!W' S+'+7.
,t`� .0 F 4 e G TFI C � ( � � a � ;'> { y
I hereby deciare that ' . �., " M ' '.��a ` ; •.
'�1: F have read this application end all information submitted to the__ r �;� � ;;-�a� j �`g« +.r�•y,;: +'�i'�� .��'� r, ���.> �.. � '��.�� A��N=
`�2. All information submitted is true,accurate and complete; '� A � ��1
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 aN ivit to be c�nducted; ��.:e�"
. 6. I will familiarize myself with the laws of the Stat�of Minnesota ' cti g mbli a�nd rules board and agree,if licenged to abide by those
�._> laws and rules,including amendments thereto. . ° : - -�; � -, �r._ . . .�-- �-- :�..__� . .t ,�t ,�! .. ..:: :. .::. _
� �... �_:..
23.Official Legal Name of Organization Signature(Chief x tive Officer) , Date " Title
�:; : �'; � `
� ,; �:•''' -
��RT�� F• F� �. �I� �::�' { �if h.'��` ��_4�4 '� "f� "{1, � ���
�k !�
v�i./1�e/ f�ss�• ACKNOWLEDGEMENT OF BY LOCAL GOVERNING BODY ` �
1 hereby acknowledge receipt of a copy of this appiication. By ackno ed g receipt,I adtnit having been served with notice that this applica�on wiN
be reviewed by the Charitable Gambling Control Board and if approv b the Board,wilCbecome effective L�y�from the date of receipt(noted <
below), unless a resolution of the local goveming body is passed whi h s ificaliy disaliows such activity`sv��eLEoPY of that resolution is received by
the Charitable Gambling Control Board within�9a s of the below n ted ate.
24.Ciry/Counry Name(Local Governing Body) Township:If site is bcated within a township, please complete items 24
� :v` "1 ���� and 25:
�.+
Signature of P�on Receiving Application: 25.Signature of Person Receiving Application
! l � Lt-.:C!�Le a:L � ���/� - _ _
�itle � Date Received(this date begins day period Title:
��C.li r -�h S J!-`+: :,-�-t�. lr""�
° Nart�e of Person �iverin�Application to Local Governing Body: Township Name
`7"
A / �
G-00022-01 (5/8� Whi Copy—Board Canary—Applicant Pink—Local Goveming Body
. • C'ty of Saint Paul ���`10�y
� " Finance and Manageme t rvices/License & Permit Division
INr�ORMATZON REQUIRED WITH APPLICATION 0 PERMIT TO CONDUCT CHARITABLE GAMBLI,IG G�,�iE IN
SAINT PAUL (To be used with the follo i New A & C application, renew A & C
Licenses, and new and renew B in Priv e lubs.)
1. Full and complete name of organiz ti n which is applying for license
�LESSED SACiZAME:VT ciOME AND S 0 A 'OCIA N
2. Address where games will be held 1494 N. DALE
Number Street City Zip
3. Name of mana er si nin this a 1 ca ion who will conduct o erate and mana e
8 8 S PP . P 8
Gambling Games GERALD D. JAN Ei�I Date of Birth 5-14..4�
(a) Length of time manager has be n ember of applicant organization 9 YEARC
4. Addre�s of ?Ka-ca�pr 1949 E;3E TZ COUK
Number Street City Zip
S. Day, dates, and hours this applic ti is for WEDNESDAY� 7 •�0-11•0o =_m_
6. Is the applicant or organization ga ized under the laws of the State of MN? iNQ _
7. Date of incorporation
8. Date when registered with the Stat o Minnesota
9. How Iong has organization been in xi tence? 34 Y�ARS
10. How long has organization been in xi tence in St. Paul? 3[� y�S
11. What is the purpose of the organizlti n? THIS ORGANIZATION WAS FORMED TO AS�I�T
BLESSED SACRAMENT GRADE SCHO L.
12. Officers of applicant organization
Name CHRISTINE MOREHEAD Name �������y
Address 2131 COTTAGE ST. PAUL t�durr.ss '/� t/d C- 7t/>- S''�
Title PRESIDENT DOB - - 0 Title VIG --PR _STDNRT DOB � �a—�/
Name ROXANNE EFFERTZ Name
Address 2091 E. MINNE'r1AHA Address
Title TREASUREtt DOB �- �.�' S� Title DOB
13. Give names of officers, or any othe p rsons who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separa e heet for additional names.)
. � � ����y�
14. At:ached hereto is a list of name d addresses of all members of the organization.
15. In whose custody wiil organizatio 's records be kept?
Name GERALD JANSEN Address 1949 EBERT7_ CoutzT
16. List all persons with the authori y o sign checks for dispersal of gambling proceeds:
Name GERALD JA�YSFrv Name JACQUELINE JANSEN
Address 1949 EBERTZ COURT Address 1949 EBERTZ CWRT
Member of Member of
DOB 5-14-42 Organization? YE' DOB 1-4-47 Organization? YES
Name Name
Address Address
Member of Member of
DOB Organization? �OB OrganizaCion?
17. a) Does your organization pay or nt nd to pay accounting fees out of gambling funds?
yes no X
b) If you do pay accounting fees, to hom will such fees be paid?
Name Address
DOB Member o 0 anization?
c) How are the accounting fees c 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 gonerning the oper ti n of Charitable Gambling games? YES
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
year which has been signed, prepar d, and verified by J. L. JANSEN
1949 `Ei3EKTZ COUdT S . AUL
Address
who is the LOOKKF,�PER of the applicant organization.
Na e
20. Operator of premises where games w 11 be held:
Name JOSEPH PERKOVICH
Business Address 1494 N. DALE
Home Address 297 MA►2IA
. � ���� ��
"L1. Asnunt of rent paid by applicant o ga 'zation for rent of the hall:
175.00 P 4
22. The proceeds of the games will be is rsed after deducting prize layout costs and
operating expenses for the followi g rposes and uses:
ALL PdOC E.�.D
A'SOC A U
23. Has the premises where the games a t be held been certified for occupancy by the
City of Saint Paul?
24. Has your organization filec� federa fo 990-T? �� If answer is yes, plaase attach
a copy with this application. If �� r is no, exptai.n why:
Any changes desired by the applicant ass ci tion may be made only with the consent of the
City Council.
BLESSED SACRAMENT H�fE & SC1i00L As�nc'_
Organization Name
Date o�- 07�� d f By; e"
Manager n charge of game
���� ���. ��'��..4 �,�.�.�,�-
Organization President or CEO
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. ty f Saiat Paul Page 1 �
, - Department of in cs aad Hanagement Services �r fi�..G /
Division of L en and Persit Adainiatration � �/t'��
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UNIFORH CHARI L CA!l�LltiG FINANCIAL REP�1� `
Date �
�sse� .
1. Rame of Organization '
2. Addrsss vh�re Chari[abls Canbl ; i eondueted /4�1��� /�• ����_ -�f ' �
3. Report for period cov�ring � 19�throug6 /�- 3� 19�
i. Total numb�r of days playsd
S. Cros� reeeipts for abova puiod = °��--�Sy�
6. Grosa psisa p+youts for abavs p si (inelud� eaah �6ost) : .?d� -3�_
7. N�t r�eeipts - Iine S oina� lin 6 ; �-3J �T�
9, Expenses iacurred in conductiag and operatin; �a�s:
A. Gtoss vages paid. Attaeh v tks list vith
names. addresses, grosa vag s. umber of hour� ; �� ,7���
vorked. and amooat paid per hou .
• H. Rent fot �� Wet� ; ���-
C. License fee -5�-��r � / ; G�
D. Insurance : � D�
E. Bond =
T. Dishonored checlu not reeo r� : ��'�
. G. Aceounting Expense =
e e �
: -�
H. l�ployeta P.I.C.A. ----7
i. Pulltab Ta�c Paid to Depar nt L Revenua = '�� �'
' J. liinn. U.C. 'fa�c ;
" x. Tederal F�ccsse ?az 6 stasp 'S -�87 T��s °'y : °?Jl L '�
y. �- ��
L. Stat� Casblin= Tax ; -----
. li. liiseellaasous Expensss. I �nt f� the mount
. and to vhoi paid.
�.sf��iQli/-�J7 Co t• : /�a3 "
2..3 D��,�o,✓S Aist : � �yy
3.Sdr'.q/ s�.o/%Eqk . f .�S�D
,cOE.t/�A�
�%yJi SG• E�C��'NS r S
s i_si.s
9. 'fotal F�tpenses !0?AL = �.� L D�i
10. 11�e Ineos� - Iins 7 aiau• Iin 9 = ,�_ D /G
11. Chsekbook balanee be;3m►inf o p� od S �'�j-��—
12. Total of ltne 10 and 11 = y7� ���
� . � _ �s o� �`
• 13. Total contributions (frod att he vorksheat)
14. Checkbook balance end of repo tin P�riod ' (���� ��
• . Iine 12 less Iiae 13 ;
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� it Ut �i . �AUL ' "- '
- UNIFORM CNARITA LE GAMBIING FINANCIAL REPORT
` LAWFUL PURPOSE ON IBUTIONS - WORKSHEET ���` �y�
Line #13 - Tctal Lawfui Purpose on ributions. $ �� r�
,
�. List below all checks writt n ran gamblinq funds which are
charitable lawful purpose c nt 'butions. The total dollar
amounts of these checks mus tch the amount claimed in
line �13. Use additional s ee s as necessary.
CHECK � DATE � PAYEE CHECK AMOUN PURPOSE
1. � � 7-� :t-.�G-�b� .�.�� � o� G.�� s����"-`G"
� '
2. .����'S ,�-.��- � �%,�, y � - � �..�..L..�
�
3. ,�8�G � �� � �, �"� �a���
G%�-� `
4. �,P� v d�"�`� � a;� ��� _ � -
5. 28y� �-�s F�' ,
;i �r�D '/ ,l�-��.,.le�
6. � y� � 7- � �� �s� . �y%
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8. .3�°`3 f� zl .�l' � �,�..�-�.
e-,t:�-�r�' �, v-�r'° .c_'3"'G"
9. �3 � �7 � . � " --
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10. 3 ° � � � ::.
il. .3°8' 7 ia-� �'� . �, �'''' Y .
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-�(��d�' °"� s�� e:���� p
�w��' � ��� TOTAI CHEC UNT $ � �'
� �- -
�YO`iE: These expenditures wii7 be pro id to Council Members at your Council hearing.
� Be sure that yaur financial re or is complete and accurate.
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