89-650 WHITE - CITV CLERK �� � � �
PINK - FINANCE G I Y O A I NT PA U L Council
CANARV - DEPARTMENT
BLUE - MAVOR File NO•
� ry Resolution � -°�
����
Presented By �
Referred o Committee: Date
� Out of C ittee By Date
RESOLVED: That application (ID #23 66 for renewal of a State Class A
Gambling License by Pros er ty Booster Club at 1494 No. Dale
Street, be and the same s ereby approved/��.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�� [n Favor
Goswitz
Rettman �J
�6e1�� __ Against BY
Sonnen
Wilson
�►pR 1 3 1989 Form Appr ed by City A torne
Adopted by Councit: Date •
Certified Pass d' ouncil S tar BY ��
By,
A►ppro by �4lavor: e APR 14 � APProved by Mayor for Submission to Council
By
PUBttS�ED ��'R 2 2 1989
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Christine�Rozek ; . "s�c" . � �a�,�+*�� ��„�
°�. ' - ,�*� ; �` 2 Counci i Research
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App3icati�n forja renewal of a Sta e ass flMGam�l'ing License.
,
Notification Dat�e: 3-30-89 Hearin� Date: 4-1� -89
�o�►,aNe:cMp�t�)«�(�) caw�a� n�roar:
a�waNO oP�on' , cw���or+ o��a w��our �vsr ; Ra��. .
�oNeoca�eeaw aDazai�raaBO�wo
ss�. qwadn caa��on as ia �ooL�o.�ooeu* wEro iv oavr,�r ca�etm�r
_ _Pon anot�o: _�oe�at�no�*
dBTRIC►OEM1t1Gl ; j
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NlM7M0�.lM.NOi1F O�l011fU1�Y ..What�Whxe.VYhyY
Jacqueline Janse�n, on behalf :of th P asperity 600ster Glaub, requests Conncil
approval of her. �application for re ew 1 of a S�ate C1ass �A Gambling Licens�
at 1�94 N. Dale �Street. Bingo s:es io s are held Thursda�s be�ween �hQ hc��irs ' _
, of 1:00 PM and :OO PM.. Proceeds re used to prot�te youlth activitfes and-,
coqmunit� invol ement at Prosperit R creation Cen�r. I
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.waswcAnoN�ca�►�ew�.«.;�.,n.o..; }: . . , -: _ ; - . ;
I .
All fees �r�d applications ha�e bee s bmitted. 1D� co�t�ibutions to �he City
Yauth Fund.are:qeing he1d i� escro nd�ng settlernent i� , a lawsuit.
;
oo�eor�cwnn:wn.�,.�a To wi,om>: � : , . _ - . _
If .Council apprqval is given, Pros r ty $aoster C�ub wi�l contit�ue to s�qnsor
a bingo .sess3on:at Ideal .Hall . i .
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'�'•"'� _ c�w ,c�i Re��a;ch Center '
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I ��1A� 3 ? i�89
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sTAKEttOL,DERB(ust) , , vosnmw c+.-.rn � i-'wai.s€s�ri tvir� -; nnnow►�cs�mn.i1..wr��xn«rs1
�MANCIAL IMPAG'T �r r�►n tsc�o�► sECa+o renn nores:
OPEAATiNEi 8UD(iET:
REYENUES(iENERATED .................................................:............. .
EXPENS�S:
Selaries/Fringe Beneflts........................................................
E4wP�......................................................................._.....
�PP�...........................:....:................... ........�........... ,
Contrads for Setvice.......................... ................................
Olher
PROFIT(IOSS) ................................................................................
RlNDING SOURCE FOR ANY LOSS(Name and Amount)
CAPlTAL IMPROVEk1ENT BUDGET:
DESIGNCOSTS.......................................:......_................................
ACQINSITION COS7'S.......................
COt+ISTAUCTION COSTS ................................................................ .•
TOTAL .....................................................................................,..:...........
SOURCE OF FUNdllO(Name and AmouM)
MRACT ON BUD(iET:
AMQUNT CURRENTLY BUDOETED..............................................
AAAOUNT IN EXCE8S OF CURRENT 81�T ............................ _ :
SOURCE OF AMOIIIiT OVER BUDGET........................................
PROPERTY TAXES GENLRA7'ED tLOSYI .........
IIAPIEMENTATION AiE8P0�:
.. DEPT/OFFICE � � . .. DIYISION � � � FUND TITLE
. ..�1DGET ACTIVITY NUMBER B�TITIE���- � . . � � � ACTIVfTV MANAdER . � . . .
�v n�o�ce wiu se�e�►sur�a�:
PROORAM 08JEC7'IVE8: PNQORAM INOIGATORS 1ST YR. 2ND YR.
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EVAlUAT10N RESPONSIBILRY: / .
PERSON oEPT. . PHONE NO. �EpORT FO CO(INCIL OF DATE
�' �ar ouA��Y
_. . rer ..
".i.?.�`-'r•. -_ . . . -,a. ..
C�,,c �'- ��
T�iVISION OF LICENSE AND PERMIT ADMI IS TION llATE � ! o � / � l v �
INT�,RPF.PARTMENTAL REVIEW CHECKLIST A.ppn Processed/Recei ed by
Lic Enf Aud
Applicant �yOS •� o. a.P✓ Home Address J - Jf,�V�S-en
Rusiness Ivame � ��?� N•���2 � Home Phone 1�� �� �b-�r�Z !lt✓1�
Business Address Type of License(s) �.Q.,Y1�W �
Business Phone I��CCSS �t l-�Cc.vn p l�� �—( C.l1irL S-��
Public Hearing Date � �3 O� License I.D. �F a����X�
at 9:00 a.m. in the Counc 1 Chauibers
3rd floor City Hall and Courthouse State Tax I.D. �� N �/}
llate I�utice Sent; Dealer �l (� ��
to Applicant 3 �U �
� rederal I'irearms a� IU
Public Hc��.iring
DATE TNSP 'CT UN
RE`JIEW VERFIED (C MP TER) CUMMENTS
A proved N t roved
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Bldg I & D �
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Health Divn. '
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Fire Dept. �
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Police Dept. I
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License Divn. '
33c� �S ' 4 �
City Attorney �
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Date Received:
Site Plan 3 �
To Council P.PSearch � � �j
Lease or Letter 2 p Da
from Landlord J � �
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it�r Ssint PaW
� . � oeput�n.ne a Fi snd M���N`lo�n�M s�ic.s �,%�--�j,SD
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S�Psul. 53102•29d306b
APPLI N FOR �.ICENSE
� aCHECK CU1S8 NO. � -
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,00 ��,'i�9 ,c'�.c�;,--�" ;? ,�/�9`�
100 Mall to Adekqs U � �M�OM Nw
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100 �_.��rf.��.=!_•�..l.G-�(-�' �.Q1��'-�t�C�
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100 �,% / ._.�=-
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10o A1.�.O.nGwn..•i+o�n.�►aaiw.,� 11�es.«a
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100 Otal, t00
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Company Nsnw Po��cp No.
Insu
Co�na•�r w� va�r�w. Eao+r+aoe .
� Min�qota Sbte Id�ntifkstlon � `^ �� Social Secu�ity No
VMIeN tMormat
BMIM NumOM
an.r
THis 18 A EC PT FOA APP�ICATION
TH13 IS NOT A LtCENSE TO OPEMTE Your applieation f I � wlll Nt1+K b��rsnt�d a rtleet�d subNet lo tM prowsloe�M 1M�a�MO
Ordin�nq M�d eanplNbn ol tM intp�etbM b�►tM NMR . ZoMep sndlo�Lk�nN Msp�Ctots.
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s15.00 CHAR6E F ALL RETURriEO CHECKS
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.;�r�''�.�� 3-1"�'9 � �,/ �i
� . Ci y f Saint Paul ��v���
• Finance and Managemen S rvices/License & Permit Division
r I1�FORMATION RE UIRED WITH APPLICATION OR PERMIT TO CONDUCT CHARITABLE GAMBLING GAME IN
SAINT PAUL (To be used with the follo in : New A & C application, renew A � C
Licenses, and new and renew B in Priva e lubs.)
1. Full and complete name of organiz ti which is applying for license
S z'�
2. Address where games will be held �
umber Street City Zip
3. Name of manager signing this appli at on who will conduct, operate aad manage
Gambling Games G Date of Birth /-�y�'J
r
(a) Length of time manager has bee m ber of applicant organization /T�/�,��s
4. Address of Manager � �• /
Number Street City Zip
5. Day, dates, and hours this applica io is for��,rs��,i /- ,�,r ��,
6. Is the applicant or organization o ga ized under the laws of the State of MN? �
7. Date of incorporation �
8. Date when registered with the Stat o Minnesota �_S'F�}}. Ly,s�
9. How Iong has organization been in i tence? 3S ,��� S
10. How long has organization been in is ence in St. Paul? _�D ✓F�eCs
11. What is the purpose of the organiz io ?'ie s/.,�ss��.� riss�it .��i��i�s s.ri�
CQ�/� .✓i �v F �E.�E.�
12. Officers of applicant organization:
Name ,�5 Name /J7.���/ ��i.r��r.tz�
Address /�'8 �.v� E Address i.�LG t• C/�.s�.�s
Title,��ES,��-,✓� DOB �- - Titl�j��s�,�.��� DOB �-�y/�
Name Name
Address Address
Tit1e DOB Title DOB '
13. Give names of officers, or any othe p sons who paid for services to the
organization.
Name d G Name
Address Address
Title Title
(Attach separat s eet for additional names.)
� ������
� 14. Attac:�ed heretcu is a list of names an addresses of all members of the organization.
.
r
15. In whose custody will organization's cords be kept?
Name � . �� Address /�l�� iyF �z
16. List all persons with the authorit t sign checks for dispersal of gambling proceeds:
Name _J "�^ Name /J��G�+E� �-/�i.�...E�o
.-
Address Address /�f"'G G E• �'�E.t�!
Member of Member of
DOB /- S/- S!j Organization? DOB a/y� S/� Organization? �/�
Name � �- Name
Address i9� � � • Address
Member of Member of
DOB .�-/;� �.� Organization? c DOB Organization?
17. a) Does your organization pay or i te d to pay accounting fees out of gambling funds?
yes no
b) If you do pay accounting fees, o hom will such fees be paid?
Name Address
DOB Member o Or anization?
c) How are the accounting fees c r d out? (flat fee, hourly, etc.)
18. Save you read and do you thorough y derstand the provisions of all laws, ordinances,
and regulations governing the ope at on of Charitable Gambling games? �_S
19. Attached hereto on the form furni he by the city of Saint Paul is a Finaacial Report
which it .emizes all receipts, exp ns s, and disbursements of the applicant organiza-
tion, as well as ail organization w o have received funds for the preceding calendar
year which has been signed, prepa ed and verified by T,�G��/.�/E L• _/�}.f/SF�/
L �
Address
wEio is the ,U of the applicant organization.
N e
20. Operator of premises where games il be held:
Name -�✓a c Q �
Business Address �f� � � •
Home Address 1� ,,�
, �� �5�
;� 21. Amou�t of •ren��paid, by applicant g ization for rent of the hall:
�
a � �•v.r.s
22. The proceeds of the games will be is ursed after deducting prize layout costs and
operating expenses for the follow g urposes and uses:
.� d � .�
s� v o
23. Has the premises where the games a e o be held been certified for occupancy by the
City of Saint Paul? �s
24. Has your organization filed federa f rm 990-T?��S If answer is yes, please attach
a copy with this application. If ns er is no, explain why:
Any changes desired by the applicant as oc ation may be made only with the consent of the
City Council.
Orga zation. Name��
„_..c� •�'� �.
Date o? -a7��Ql�' By:
Manager in c rge of game
✓� ` ,
Organization President or CEO
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' � it of Saint Paul Yage 1
' � Departaent o F nce and Mana�ement Ser�iees
� � ' � � ' ^ Diriaion of ce e and Perait IWsiniseration •
, � � �
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' � . tTNIP'ORH GAl�LING MNANCIAL RLYOB2
Dats �.T '
� 1. Nms of Organisation �u
2. Addrsss vh�re C6aritabl� Ga�bl g s eondueted /�� � Uf��c � •
3. Rsport for period eov�rin� - 19� throuf6 �,��l 19�d
�. Total number of days pLysd
S. Crosa reeeipts for abovs psrio i ��� �.�Z
6. Gro�a prize payouts fos abave eri (laclud� caa6 �6ort) = a 1�� 7 7/
� 7. Net recsipts - line S �im+s li � 6 i � 7� .+7 l
8. Expenses iaeurssd in conduetin a opesatin; aoa:
A. Gsoss va`ss paid. Attach rk s list vieh
aames. address�s, 6ross v es. n�ber of hons� i �� .3,_7�
vorked� and amount paid p� ho r.
• B. Rent for rS/ veeks = D 7-�S
� �
C. Licenae fee � �
D. Insurance ; ���-'
E. Bond = �4
i
T. Dishonorsd c6ecb not rec are ; �� �
G. Aecounting Expensa ; �
. H. mploysr� l.I.C.A. � f�`j
I. Pulltab ?ax Paid to Depar sn of R��enue i ��1�7
' J. liinn. U.C. ?az ; �7
x. lederal f�ceisa iax i SC i 8s-��9 y� i = ��i G
L. stat� Ga�blin` Ta: i � L,,_ Z�
M. lii�esllaasous E�cpeaaas. den if� tAe a�wat
• and to vho� paid.
i.�1�is�.��ud t7ist • t �� L
/�u//-Tit�S
2Sd�.4 f�.a//- E�... • i .��U
3.5�•fAa/-/o%E � i /. .7z//
�./l�i 5 G• �tC� ' = S/�/
. 9. ?otal la�p�n�es �� i ��,L_
10. tl�t Inco�a - lins 7 sim� 9 : �„�y•��
11. Cl�eckbook balanee b�;iaaia� o p� iod ; /y /.S�
• 12. Total of lins 10 and 11 ; ��7�_ �
' : 13. Tatal contributiona (fsoi at he wrbh�et) ; yL ��d
14. Chectbook balance and oi re tin period - �
' Iine 12 less lin� 13 = _G-9'z3
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� UNIFORM CNARIT 6L GAMBLING FINANCIAL REPORT �c�Cj-(p:�
' - LAWFUL PURPOSE CO TRIBUTIONS - WORKSHEET
- • . . . . . .
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� Line #13 - Total Lawfui Purpose Co tributions. 3 �l �/� ��
�. List below all checks writ en fran gambling funds which are
charitable iawful purpose on ributions. The total dollar
amounts of these checks mu t tch the amount claimed in
line #13. Use additional he ts as necessary.
CHECK # DATE ' PAYEE CNECK AMOUN PURPOSE
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i2. � y �� ia -�i- . � 3 �.��s =
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13. � ' �
TOTAL CHE K UNY b f�� . ,�
NOTE: These expenditures will be p vi to Council M�nbers at your Council hearing.
� 9e sure that your financial po is complete and accurate.
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