89-651 WHITE - C�TV CLERK COUflCIl �( � /_ �/
PINK - FINANCE G I TY O SA I NT PA U L
CANARV - OEPARTMENT /] `V
BLUE - MAVOR File NO. V
, . �Co n 'l Resolution ,� , ----�
, � ��,
Presented By �
Refe Commictee: Date
Out of Committee By Date
RESOLVED: That application (TD # 2 ) for renewal of a Class A Gambling
Cicense by St. Peter Clav r Social Club Inc. at 1060 University Avenue,
be and the same is her by pproved/de�-i�e�k
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�� in Fav r
Goswitz
Rettman a B
s�ne�be� Agains Y
Sonnen
�lson
�PR � � �.7t7 Form Appr ed by City orn
Adopted by Council: Date . �
Certified Pass uncil Se tary By 3 a
gy, D
A�pprov by lVlavor: Dat �R 1 � Approved by Mayor for Submission to Council
By
'pg�{�}� A P R 2 2 19 9
.. . . . . i. . . � ..
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CA�car�u►,+oR wns ,eo o�se car.u�en., ,
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- � �. r���r�a; � � -�i�ET �wQ. 0 Q2 5�1 �
�� �� : ����� :
Chrfistine Razek —` �8►���� ���
"�'. . � � —'�� I� ' � Council Res�arch
FinanCe & �.. 2 $-5056 �. � T ��,� '
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Application for! renewal of a Stat C1 ss A GambTing License.
= _ i
Natification Da�e: 3-30-89 earing Date:.: 4-13�89 -
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. MJViN��i Cas�1o+�" Cnn��Efnr�Ce cowpn�ss�a+ oAT�� o,�TE Caur : �wu.rsr PFpNE Np:
. . - DOlMA OOMMq9&ON .. . .18D 626 9CMOOl 8d>HD . � � . . . . . . . . . .
� �STA1F� . . - .. .� �� :C}VWI�R t�IMdIS310N�� � . � . A8 IS � � �� � AD47.INfG.�ADD�*I . .. R!?!�TO COtRA�T . CCN�1fRlBlf ..�.
' . .. � . � . _� . .�,_ -. � _�FORADDLMFQ ' _P�ObNdC�ADDED'�'... .
O1mRICf QplI1�C< � - � i . � * . .. - � . _ _ .. , .
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Ip1ifA71pti N10lLEY.1!ltlE.OPPOlr!'u1�tY .wf�.VVhsn,wMre:wh�: ' � .
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Council�appe^oval�af herbahal�catio ef t�renewa1CofVarStatlia1 C7ub Inc. , requests
• � pp ` �e C1�ss p Gambiinq �.icense
' . at 1fl6U,Universi;�ty. Avenue.. B:��go s ions are, held on: Sal�urdays be�ween the haurs
` of 7:30 PM and 1�.;30 PM. Proceeds fr, the gambiing sess�fions are used to assist
the operation of .St. Peter Ciaver u h and School. ,
;
,�c�taK coowa«,ear,�: r. _ .
i _ -
All fees and app�ications have bee su mitted. ip� payme�hts are being held
i_n escrow pendin�_set.tlement of,,a i ws i.t. ,� ,
, _ _
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cowec�u�c�s-p�;�+.n.�,�e Tc wno„��: . _ _ .; . -'. . _
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If Council ap�proval is given, St. P te Social Club wi�l dontinue to spo�sor
a bir�go session aIt 1060 University ve ue. �i
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OF�GI�N�O Ti0N/PFI�ICIPALS: T
_ STAI�Ii0LDE143(Ueh P08I11011(+.-.O) � r;-l1fM.l TES�Y7(V!N) RATIOt1AlE(Sirmr�iss IdYn ArgunerNS)
- � � . ��.c:.�. . . . . . . . � . . . . . .
�INA911CIAt IMPACT wusr v�w�n o+ua s�,�w . NorEs
�rnra euoG�:
NEVENUES GENERATED ....................._.:...................................... . '
EXPEIISEB: ` :
. _.,
Saledes/Fringe Benefits........................................................ ,
�...............................:........................................:.....
S�+PP�g................................... .:....:....:............:....:........ ":.
ConVacts for Service.............................................................
Odte►
PROFIT(LOSS) ................................:............._................................
RINDIN6 SOUi�E F'dR ANY L�S(Name and Maunt)
CAPfTAL N�APROVEIi1ENT BUDGET:
DESIGNCOSTS................................................................................
_ A�CQUISI'TION COSTS..:.... _ ..
_ _
�iipfiSTRUCTION COSTS ................................................................
roTa�....................................................................................................
sou�oF�o�c�r�e�,a ar�o�m�)
p��aa suoGer: ,
AMOUNT.GURRENTLY.BUQOE7ED_...:.......................................... _ _ _
, _.,_
.
AMOUNr IN EXCESS OF CURRENT BUDCiET :...........................
SOURCE OF AAAOUNT OVER BUDOET........................................
PRQPERTY TAXES 6E111ERA'TED (LOSTI ......... ,
�tEN'fAT10N RESPONSINLITY:
OEPTlOFFlCE . � DIVISION � . . FUND TIILE - � �
� BUDCiET ACTIVITY NlHd9ER 8 TITLE� � -- ACTIVITV MANAOER . .. . .. . .
H01N PERFGRMANCE WIL6 8E 1�:
PROQRAM OBJECTIVE8: PROCiRAM INDICATORS 1ST Yli. 2ND YR.
EVALUA710N WESPK)!�LlTY:
pEq�ON DEP7. PFpNE NO. Tb COGMCIL OF DATE
fMIST QUARTERLY
Y..
. ��-GSi
UiVISION OF LICENSE AND P�RMIT ADMINI T TION llATE � � / � O �
INTERDFPARTMFNTAL REVIEW CHECKLIST Appn Pr e ssed/Rece v d by
Lic Enf Aud
Applicaut �UQIU Y� M��Y lS�. � Home Address �y� �J �,. t_Ct /'���P�tr"
Rusiness Name �, e Q Home Phone
Business Address � Y1l y Type of License(s) �Q.YI,Q..W �
Business Phone �—�, ��� � �Cc vr� b��n� �I(11n S-e
Public Hearing Date � License I.D. �F q �a �{(�
at 9:00 a.m, in the Council Ch uibers, r1
3rd floor City Hall and Courthouse State Tax I.D. 41 N'l4
llate l�otice Sent; Dealer 4� � �/�
to Applicant �
rederal I'ixearms 4� ti l�
Public Hearing
DATE IA'SPE 'TI N
REVIEW VEKFIED (CO U ER) CUMMENTS
A proved No A roved
�
Bldg I & D +
N
Health Divn. 1
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Fire Dept. �
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Police Dept.
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License Divn. '
3 3� �`I� o l�
City Attorney �� �
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Date Received:
Site Plan � �
To Council Research � �� �
Lease or Letter Date
from Landlord �, l �
� � �-�-�s�
• � Charitable Gambling Control Board
� Rm N-475 Griggs-Midway Bldg. For BoaM lJse Only
�„'. '
, 1821 University Ave. Paid Amt:
�`, St. Paul, MN 551043363 Check No.
:....:'� (612) 642-0555
Date:
;;, �° GAMBLING L E E RENEWAL APPLICATION
�.
� •-.. LICENSE NUMBER: /EFF. ATE /AMOUNT OF FEE:,,'
= 1.Applicant—Legal Name of Organization 2.Street Address
a Tc t1F c,
•. 3.City,State,Zip 4.County 5. BOSiness Phone
, r � c��
0
'�6. Name of Chief Executive Officer 7. Business Phone
-1 �� o
B;.Name of Treasurer or Person Who Accounts for Revenues 9. Business Phone
z• �
10. Name of Gambling Manager 11. Bond Number 12. Business Phone X
i
13. Name of Establishment Where Gambiing Will Take Place 14.County 15. No.of Active bers
a �- G� � o p p
16. Lessor Name 17. Monthiy Rent:
r, .�. •c
18. If Bingo will be conducted with this license,please specify da s an times ot Bingo.
Days Times D s Times D� Times
.-.
�?.' l._ y ;
; i
19. Has license ever been: � Revoked�ate: Suspended 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? .�Yes 0 No(If"No,"attach copy)
GAMBLI SI E AUTHORIZATION
By my signature below, local law enforcement officers or agents of he oard are hereby authorized to enter upon the site,at any time,gambling is
being conducted,to observe the gambling and to enforce the law f r an unauthorized game o�practice.
' BANK RE OR S AUTHORIZATION
By my signature below,the Board is hereby authorized to inspect t e b k records of the General Gambling Bank Account whenever necessary to
` fulfill requirements of current gambling rules and law.
ATH -
I hereby declare that:
� 1. I have read this application and all information submitted to the r '
���` 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 ctivi ies to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota re pec ng 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(Chie Ex utive O�cer) Date Title , ��:.
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'�N/ECKNOW DGEMENT O . O E BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application. By ackno led ng receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if approv b the Board,will become effective�days from the date of receipt(noted
below),unless a resolution of the local governing body is passed whi h s ifically disatlows such activity ar�bpy of that resdution is received by
the Charitable Gambling Control Board within 3�days of the below n ted ate.
24.City/County Name(Local Governing Body) Township: If site is located within a township,please complete items 24
-'� : �-�, . and 25: '
-�
Signature'of Person Receiving Application: 25. Signature of Person Receiving Application
1 � !��� r�
Titfe. Date Received,(this date begins�YBay period) itle:
... � ,� .,i i'r`
, Name of Person Delivering Application to Local Governing Body: ownship Name
°•.r ,J` ._._.
' C 22-0t (5/8� hit Copy—Board Canary—Applicant Pink—Local Goveming Body
C ty of Saint Psul ��°L'�
. . � apshm.nt or i� snd M p�nNnt s.�vi�.s ��j
Lic� s� nd P�nMt�Dtvision ���'
zaa cuy�
.. , s�.Pa i. �soa ss�a¢•zse�sosa
APPLI ON FOR LICENSE
CASN CMECK CU►SS �vr R�new
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CoO�No. rn1�01 Cic�na� " / �}
Fron1 ��C%�- t��e �_ / 1' %i
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100 MaU fo Addr�ss MoM Na
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100 / �7 ��:�G;i
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IOie AOplfutlon FN 2 � at��►b�Addaas' / � /Aa�tNa
�tM of � � � ��1 t00 �L-�G!x� �'�--9�
`��!_i4E%�yClac_.i�L•12s+(/�2!J4�'/ �D Mian�p�qOwn�r•Cih►.8Ub i 2�0 Cos�
100 ot 100
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uwns��esa�cta �'`'� er � ''7— T s�w.a�oa+�
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C0111p�11�1 NaTf POIiCp NO.
Insurs
Co�npinp Nanw PoNer Na E�01►Mton OaM
Minnesota Stste Identifiestlon No � Social Secu�ity No
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VMkI�IntormatiOn•
SNiM N1MnpM
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TNt� 18 A EC PT FOA APPLICATION
TNIS!8 NOT A LICENSE TO OPERATE.Your applieation f 1 � se witl eNMr b�Qanted a re�sct�d wbNc!fo th�prarisbns of th��ontnp
ordManq Md eomplNlon of tM in�p�ctbns b�►tM Hult .Fi► ,Zooi�q�ndfp Lic�n�Insp�Ctan.
#15.00 CHARGfi OR ALL RETIAtNED CHECKS
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Cit o Saint Paul ����°`��
`�• ,� �• , � ' � Finance and Management Se icesjLicense & Permit Division
INFORMATION RE UIRED WITH APPLICATION F R ERMIT TO CONDUCT CHARITABLE GAMBLING GAME IN
SAINT PAUL (To be used with the follow ng New A & C application, renew A 6 C
Licenses, and new and renew B in Privat C ubs.)
1. Full and complete name of organiza io which is applying for license
St. Peter Claver Social Club In .
2. Address where games will be held 1060 Universit Ave.
umber Street City Zip
3. Name of manager signing this appli at n who will conduct, operate and manage
Gambling Games Evelyn M. Morriss tte Date of Birth 9-�0_70
(a� Length of time manager has bee me ber of applicant organization �R Years
4. Address of Manager 2443 E. La e teur Av .
Number Street City Zip
5. Day, dates, and hours this applicat on is for Saturday. 7 :30-11:30 p.m. 5-1-89 - 4-30-9
6. Is the applicant or organization or an zed under the laws of the State of MN? Yes
7. Date of incorporation 6-3-8
8. Date when registered with the State of Minnesota 6-3-85
9. How long has organization been in e is ence? 18 Years
10. How long has organization been in e is ence in St. Paul? 18 Years
lI. What is the purpose of the organiza io ? To assist financiallv with the oneration
of St. Peter Claver Church aad ol.
12. Officers of applicant organization:
Name Laura Carlson Name Grace Kielbasa
Address 1343 Gentr Address 3889 Cranhreel� i�,-+.,e
Title President DOB 12-27� 7 Title sec._TreAQLrpr D�B �_21�_26
Name Name
Address Address
Title DOB Title DOB
13. Give names of officers, or any other pe sons who paid foz services to the
organization.
Name None Name
Address Address
Title Title
(Attach separat s eet for additional names.)
.. G,�����
, ; , .
, � i4. �� Attached hereto is a Iist of name a addresses of all members of the organization.
15. In whose custody will organizatio 's ecords be kept?
Name Evel n M. Morrissett Address 2443 E. Larpenteur Ave.
16. List all persons with the authorit t sign checks for dispersal of gambling proceeds:
Name y Name Frances J. Morrissette
Address Address 2443 E. Lar,penteur Ave.
Member of Member of
DOB 9.20_20 Organization? DOB 3-19-21 Organization? yeQ
Name Grace A. Kielba N�e HenrX L. Kielbasa
Address 3889 Cr n oo v Address 3889 Cranbrnnk Drive
Member of Member of
DOB 6-24-26 Organization? DOB g_lp_23 Organization? yeS
Gerald D. Jansen, 1949 Ebertz Co rt, 5-14-42 A Member
17. a) Does your organization pay or i te d to pay accounting fees out of gambling funds?
yes x no
b) If you do pay accounting fees, o hom will such fees be paid?
Name J. L. Jansen Address 1949 Ebertz Court
DOB 1-4-47 Member of Or anization? �
c) Sow are the accounting fees ch rg out? (flat fee, hourly, etc.)
Flat Fee
18. Have you read and do you thoroughl u erstand the provisions of all laws, ordinances,
and regulations governing the oper i of Charitable Gambling games? YeQ
19. Attached hereto on the form furnis d y the citq of Saint Paul is a Financial Report
which it .emizes all receipts, expe 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 Grace Kielhaca
38t3 Cranb ook
Address
who is the Actin M of the applicant organization.
Nam
20. Operator of premises where games wi 1 e held:
Name Richard Sal er Investments
Business Address 535 South
Home Address 535 0.
�� , � ������/
; L1. Amount of rent paid by applicant org ni ation for rent of the hall:
$585.00 per month
22. The proceeds of the games will be di bu sed after deducting prize layout costs and
operating expenses for the following pu oses and uses:
All roceeds e us fo D o
Ctrur h such 1
•
23. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
24. Has your organization filed federal 0 990-T? YeS If answer is yes, please attach
a copy with this application. If an we is no, explain why:
Any changes desired by the applicant asso ia ion may be made only with the consent of the
City Council.
St_ Pr+tPr C'lavar Cc�rinl,� ('lt�h� jpC
Organization Name �
Date �7 - „7�- .�J gy;
.
�+ Manager in charge of game
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Organiz ion President or CEO
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C y of Saint Paul Page 1 �" ' ���/
` �; ' � Department f nanee and Management Services
� Divisioo o Lic ase and Permit Administratioa •
�`
. UNIP'aRH LE GAl�LIIiG FINANCIAL REYORT
Date 2-15-t39
� 1. pame of Organization St. et r Claver Social Club, Inc.
2. Address vhere Charitabl� in� is condueted 1060 Uni versi ty Ave.
3. Rspost fo� period coveria` MS 1 1989 19 througb A�ri 1 30 19�,a
4. Total number of daqa pLyed 51
5. Cro�s reeeipts for abw• p�r �f 27 S,329
6. Gross prise payouta for abov per od (lnclnds caa6 short) = 201,55i3
. 7. N�t racaipts - line S �inus ne = � 7 3�71
8. Espense• ineurred in conduct g a oparatina ga�:
A. Cross vages paid. Attac vor er list vith
nsmes. addzesses, gross ges nusber of hour• � 15.680
vorked. and amount paid r 6 ur.
• B. Rent for 52 veeks ; 7,155
C. License fee ; 6�0
Ci ty and tat
D. Insuranee f 56�
E. Bond i 100
F. Dishonored cheeks not re sr d S �+6$
G. Accounting Facpen�e ; 700
H. Employers F.I.C.A. = 905
. I. Pulltab 'fa: Paid to D�pa of Ra�enue ; ��1�4
� J. liina. U.C. ia�c f �
1C. lederal Excise Tu i St � �T 1986�87 = 4,499
L. Stats Caablin� Tnc i 3.524
M. Miscellaneous Fapen�as. it� tha aaoune
and to vdo� paid.
1.3Diamond (Pulltab ) i 3�554
Z, St. Paul 10% Cont : 1,062
3,DeMar Printing ; 18
4.Misc. Office Supp ie = '��
9. ?otal Fspensas TOZAi. : 7�d x
10. ll�t Incose - lin� 7 ainu� 1 9 f ��_ %•�/
11. Cheekboqk b�ee bssianins p iod � �_3��
� �
� , 12. Total of line 10 and 11 i ��� =�r�d
' : 13. Total contributiona (fsoi at vorkshsat) ; 3-� �
14. Checkbook balanee end of rep t p�riod -
" line 12 less line 13 i _,,,�,����G
���'..4...
. � v� �i . rnu�
�. UNIFORM CHARIT Bl GAMBLING r"I��ANCiAL REPORT �G����l�
LAWFUL PURPdSE CO IBUTIONS - WORKSNEET (i+-
. , , � . . . . . .
)i
Line #13 - Total Lawful Purpose o ributions. S .�� �v
�. List below a11 checks writ n rom gambling funds which are
charitable lawful purpose nt 'butions. The totai dollar
� amounts of these checks mu tch the amount claimed in
line �13. Use additional s ee s as necessary.
CHECK � DATE ' PAYEE CHECK AMOU PURPOSE
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NOTE: These expend�tures will be pro id d to Council Members at your Council hearing.
� Be sure that your financial re o is complete and accurate.
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