89-656 WHITE - CITV CLERK COU[1C11 /
PINK - FINANCE GITY OF AINT PAUL (/�
BLUERV - MAVORTMENT File NO. � � �V -
� � Cou cil es ution _ 1�
sa ;�
Presented By
Refer d To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID 34 78) for a State Class B Gambling
License by St. Bernar 's Grade School at Rudy's Tin Cup,
1220 Rice Street, be nd the same is hereby approved/.�ed.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�� In Fa or
coswitz
Rettman {� B
s�ne�ne� __ A gai n t Y
Sonnen
�ison .
Ap� � � � 9 Form App ved by Cit Attorney
Adopted by Council: Date _ - n��e 3 Zg/py
Certified Pas e Coun .il tar BY
1/GU[. d
By "
Appro by Mavor: Da e 4 Approved by Mayor for Submission to Council
B By
PUB��� �IPR `' 98�
_
: °t.��`�yb
_ �„�.�„� �,�� GRE �H�ET No. 0 0 2 4 8 9 .
J. Carchedi
CONT*'T PER�ON . .�' . . DEPAR'iME4R DIRECTOR � � MAVQR(OR�ABBIBTAIET) � � � .
Christine Roz�k �F _ ������ �«n«�
. ^���°. aour„� �o�� � � �Counci� Resea rch
Finance & t. 2,9 -505.6 ` °"�': � ��„� -`, . �
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Application f�r a State Class B m ling License. ;
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Notification �ate: 3-29--89 Hearing Date: i 4-13-89 .
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710NS:(APD►4w 1Al or Rejsct(R)1 COUNdL REPORT:
PUINNNIO�ION GVIL 3ERYIICE COMM18SION DATE MI . �DA7E OUT � AtiALY87� � . AqNE.N0.. � . . .
. � . � . . . . � � � � � � . . � � . � .. . �.
. . 2�QtiIWO CQA�M18SION � ISD 825 8¢li00L Bt7ViRD . � � � ) � . - ,
� . STAFF � �. - � CkiARTERiCOMMtl8910N � � . i8 ADD1 MIFO.ADDED*.. � RE�'D7p CaNiA�T QQNST[TUENT� .
� � � �. � � �_ . � _ . � PDR At3Di�IIdFO. _lEEDB1IGC ADDED• � .
OIBTRIC'f COIA�CIL � ' * � . � � � � � . . . .
. � BUPPdRfS VN�IICFI OOUNCN.-OBJBCi1VE�: . �� � : .. � . - � � � � . � . .. � . -� - . -
.. . .. . . . . - I - - . ��
' . , . �� . . . .. - � . � � . �} . . � . .� � . . . � . . . . � :I . �. � . � . .. � .. . . . . .
lRI1A7N1O rRO�l�r 1981IEr Oh40lITIN�f77Y 1M1at.W11eI1.WhBrB.NfhY): .
St. Bet�nard'S Grade School requ st Council approva] f its app1ication for
a State Class B Gambling Licens a Rudy's Tin Cup, 1�20 Rice Street.
Proceeds from the pulltab sa1es:wo ]d be used �o suppQrt �he e1ementa.ry
. school at St',. Bernard's. i �
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• xrem�cn,�ow tco�ve.�.�. �: r
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All fees and applications have h n su�tittQd. � �
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_�MN+iM.Wpen..ne,b vYlqm}:, ,� .: : ;
If Coancil dpproval is given, t. 8ernard's Grade Sci�oo1 Will be licensed
, for pulltab' sales at Rudy's Ti C p. �
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a.�inres: , � � � -. .
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nsronr�s: �
�his is th� first application fo. St. Bernard's Gra e School
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��sromr oF s�pe��wvona�zw5�roxrr��u.s:
srnKEHOtDEns(ust> . vosrtan(+,-,o� -i r wn.�.�srnrt�rnr> w�����rn a�enml
FlNAIYCIAL IMPACT �T,��s�o� . sfc�u r�►n NorES:
o�rtATxao euoc;er:
REVENUES OEI�RATED
EXPENSES:
SalerieslFringe Benefits.....................: -
EQWP�tt.....................................................................:........
�PP�g........................:..................:.....:... ...:...::........... . .. ._..
Cadracffi for Service
Other
PROF7T(LOSS) .................................:.............................:................
FUNDINQ S�1RCE FOR ANY LOSS(Name and Amount)
CAP�TAL HNPROVEMEM BUDGET:
DESKiNCOSTS.........................................................................:......
ACQtNSIT10N CO3T� _
CONS7AUCTfON COSTS
TOTAL ,
...........................................:...:..........:.........................................
SOURCE OF FUNDINO(Name erM AmouM)
�ACT ON BUOGET:
AMOUNT CURR2MTLY BUDOETED:.................
, . .,
AMOUNT M!EXCESS OF CURAENT BUO(iET . ,
SOURCE OF AMOUNT OVER BUDOET '
PR�iPERTY TAXES GENERATED (EOST) .........
II�LEMENTATION RESPODISIBIL.ITY:
.� DEPT/OFFICE � DIVISIOPI . � FUND TITLE � �
BUDOET ACTNIT/NUMBER-6�TITLE �� � � ACTIVITY MANl1OER . .... .... .. . , , . . �
HOW PERFORMANCE WII.L BE MEASURED?:
PROORAMF OOJECTIVES: PROGRAM INOICATORS 13T YR. 2ND YR.
EYALUATWN RESPOlISIBILITY:
PER80N DEPT. aHONE rio. REPORT TO COUNdL OF �
FlRST QIIARTERLY
_ T@Y_.
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DIVISION OF LICENSE AND P�:RMIT ADMINIST TI N llATE � vZ� �� / � �� U I
INT�,RDF.PARTMFNTAL REVIEW CHECKLIST Appn Proc ssed/Received by
Lic Enf Aud
Applicant �,JT• ,UQ.r/1(,�rdS �((� 0 Ilome Address _
, r
Rusiness Name �n Home Phone
Business Address ���� ��Lp, 5'�.,�. Type of License(s) J'�� �t�l�
Business Phone g �(Ai� �j l��G� L� �"'`S-��
Public Hearing Date � 13 o License I.D. �{ � �`7_] �
at 9:00 a.m. in the Council Chambers, Q' C. �/��
3rd floor City Hall and Courthouse State Tax I.D. �1 0 � 1
llate Notice Sent;� Z� n � Z2 Dealer 4� �' �
to Applicant r � �
Pederal I'irearms �� � ��
Public Ne�.iring
DATE II�SP ' TI N
REVIEW VERFIED (C U ER) 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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r �i c
Police Dept. S�n I � o �
3 �, ��
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License Divn. '
3 ��i � ��.
City Attorney �
�z���,
Date Received:
Site Plan
To Council P.e.search � (� �
Lease or Letter D te
from Landlord �
CURRENT INFORMATION NEW INFORMATION
Ciirrent Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
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Charitable Gambling Control Board FOR BOARD USE ONLY
� Room N-475 Griggs-Midway Buildi g �N,,iiiei — �
; . 1821 University Avenue
St.Paul,Minnesota 551043383 PAID
(612F64-2-96�Fr AMT
CHECK#
DATF
GAMBLING LICENSE APPLICAT O
INSTRUCTIONS:
A. Type or print in ink. ' � '
B. Take completed application to locai governing body,obt n si nature and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends original to the above address with a che k. . :'
C. Incomplete applications may be retumed.
D. Enclose license fee with application.
� Type of Applicetion:
�, ❑Ctess A— Fee 9100.00(Bingo,Raffles,Paddiewheels, pb rds,Pull-tabs)
(�lass B'— Fee 8 50.00(Raffles.Paddiewheels,Tipboar s. II-tabs) M'k'e�"d'•pw'a't°:
❑Class C— Fee$ 50.00(Bingo only) r` MN""'°"�n�c'a'°""°x�°�°°"°i eo�a
❑Class D— Fee S 25.00 IRaffles only)
Check one: ,�'1 A. Organization has never been licensed.
�1 B. New site—Give base license number. �
❑1 C. Renewal of existing license—Give co let license number. � - �� - �
❑1 D. Change in class of an existing license— ive ompiete license number. 0 - � - �
❑Yes�SI.No 2. Has organization ever received a Lawful am ing Exemption Permit from the Board? If yes,give complete
permit number
DYes No 3. Have Internal Controls been submitted pr vio sly on a form provided by the Boardl If no,please attach copy.
4. A plica�t(Official,legal name of orga�ization) 5. Bu in�ss Addre�s of Organization
`'�• l4' � 1� 4~ 'NUL� II�� i"/L�
6. C'��tat�,ZiP �� � /j 7. oun� 8. B�siness Phone N mber
� f� �r 1 . a 1 , 1 :?;�f� - d
9. Type of organization: ❑Fratemal ❑Veterans ligi us ❑Other nonprofit• '�` �'`
•If organization is an"other nonprofit"organization,answe que ' s 10 through 12.If not,go to question 13."Other nonprofit"organizations
must documeM its tax-exempt status.
�Yi�s O No 10. Is organization incor orated as a nonp fit rgenization?If yes,give number assigned to Articles or page and
, :.<, . , _ ; ,:, . , . . �:- . : ,..
book number.' copY of cerdficate. . . < ' � � �
O1fbs O No t t. Are articles filed with the Sec�etary of ta 1 : : a: .
�. �lhs ONo ..12., is organization exempt f�om Minnesot or deral income taxT(f yes,pleasefatta�3�lsttx from DepartmeM of� ;��
Revenue declaring exempiion. • � . . '� , , ,��v.. ��� .��;''� r,.{� �. n:�i�
❑Yes�No 13. Hes license ever been denied,suspen ed revoked�If yes,check all that a ly:
❑Denied ❑Suspended �Rev k Give date: -
14. Number of active members 15. Number of ars n existe�ce � Note: Attach svMe�cs of
� (j tluse years existsnce.
16. Name of Chief Executive Officer(Cannot be 17. Name of treasurer or person who accounts for other revenues
' � ` Gambli�g Menager =� .; . ;. ' _ of the organiz ion(Cag�ot be Gembling Managerr ��
�n�r�r 5: �o�n�o c��nf � _ . : �� ;,. ��::�rs
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Title Title
; y o
' i'f��i�!�f �'n 1� r:: �p ��� E�
Business Phone Number Business Phone Number .
( _ , _ V 1 i'`r�(� _ (� k� � . � �` � :.<��: _ ��� - t.
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18. Name of establishment where gambling will be 19. Street address(not P.O.Bo�Number)
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conducted �,,.� . ; . , �� • � 'f"
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20. City,State,Zip 1 21. County(where gambling premises is Iocated)
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CG-0001-03(81881 White Copy-Board Canary-Applicant � Pink-Lxal Goveming BodY
Page 1 of 2
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Gambling License Application
_ Type of Application: ❑Class A �Class B ❑Cla C ❑Class D
es ONo 22. Is gambling premises located within city lim' �
�Yes❑No 23. Are all gambling activities conducted at the re ises listed in#18 of this application7 If not,complete a separate
application for each premises(except raffles as separate license is required for each premises.
DYes No 24. Does organization own the gambling premis sT I no,attach copy of the Is�s with terms of at least one year,and
attach a skstch of the premises indicating h portion is being leased. A lease and aketch are not required for
Class D applications. �
25. Amount of Rent Per 26. Do you plan on conducting ngo ith this license?If yes,give days a�timea of bingo xcasions.
Month or Bin o Occasion Day Tim Day Time Day Time
S t� �
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Yes ONo 27. Has the 810,000 fidelity bond required by Min so Statutes 349.20 been obtained?
28. Ins rance Company Name(not agency namel D , �_ 29. Bo�d N�qer
� Y-, ,; " i t'� ;v'�: . 7',_;�.� /", .�- � �� ;-- ' 'S' / �o`�
30. Lessor Name 31. A res 32. City;State,Zip _ ,
'!�i � ;�' li�� � I � - f��t�" 7.*' -�','' _-'� %'�N�.`�- /%� ._-�..i ,/,
33. Gambling Manager NarBe 34. A dre 35; City,State,Zip , '/
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36. Gambling Manager Business Phone 37. Date gamb ng anager became
( � member of rga ization: Month;,;y, Year .�
❑Yes�No 38. Has the license termination form been compl ted Attach copy.
❑Yes ONo 39. Has the compensation schedule been appro d b the organization?Attach copy.
40. List the day and time of the regular meeting of the organiz ion.Day � � �� `'��Time ' � �
41. Bank Name ' 42. Bank ddr s 43. Bank Account Number
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GAMBLIN S E AUTHORIZATION
By my signature below,local law enfo�cement officers o ag ts of the Board are hereby authorized to enter upon the site at any
time gambling is being conducted to observe the gambli g a d to enforce the law for any unauthorized game or practice.
BANK RE OR AUTHORITATION � %�
By my signature below, the Board is hereby authorize to i spect the bank records of the gambling bank account whenever
necessary to fulfill requirements of current gambling rul s a d law.
" Ffiereby declare that: OATH _ , � . '
� 1. I have read this application and all information sub itt to the Board; ,
2. All information submitted is true,accurate and co ple ; '
3.. Atl other required information has been fully disclo , ,
�' �` �4. ;Pam thechief executive officer of the organization �,. b�=`�„',:�;;_� -. ;��`�-;' A �.' �F-�' *s :�' *; � �� �p '� ; �i
' 5.. 1 assume full responsibilityfor the fair and lawful ra ion of all activities to be conducted. � � . ' �' -� �� � ��
6. I will familiarize myself with the laws of the Stat of innesota respecting gambling and rules of the Board and agree, ff
licensed,to abide by those.laws and rules, includi g a endments thereto;
7. Membershi list of the or anization will be availa e w hin seven da s after it is re uested b the board.
44. Official,Legal Name of Organization _ 45. Signature(must be signed b Chief Exec�utive Officer)
t '_h �.:`=- �'"!.. ' �-�" .:�L.Fr!'G X ''
Title of Sjgner , Date ,� , . u ,
� �v , � �� . '.--i ;� /
ACKNOWLEDGEMENT F OTICE BY LOCAL GOVERNING BODY : . , - �;�
I hereby acknowledge receipt of a copy of this applica on. y acknowledging receipt,l admit having been served with notice that� .
this application will be reviewed by the Charitable Ga bli g Control Board end if approved by the board,will become effective
60 days from the date of receipt (noted below) unl ss resolution of the local governing body i�passed which specifically
disallows such activity and a copy of that resolution i re ived by the Charitable Gambling Control Board within 60 days of the
below noted date. '
46. Name of City or County(Local Governing Body) If site is located within a township,item 47 must be completed,in
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addition to the county signature. If township is not or�anized,
t, �'� 1 �` j'''C ,U - ' county must sign.
Signature of bers n receiving application 47. Name of Township
X '•�! � �-, _ ( �� �
Title Date received(60 day p rio Signature of person�eceiving application
-'� ' begins from this te)
�;� .�C °�` ,, f� ..�-� `� x /
48. Name of person delivering application to Loca Gove ing Title
CG-0001-03 (8/881 White Copy-Boa Canary-Applicant Pink-Loeal Governing Body
Page 2 of 2
- � ' City o S int Paul
Department of Finan e nd Management Services
Division of Licens a d Permit Registration
INFORMATION RE UIRED WITH APPLICATION FOR E IT TO CONDUCT POLLTAB/TIPBOARD SAI.ES I�
SAINT PAUL (Class B Gambling License in L qu r Establishments - New Application)
1. Full and complete name of organizatio w ich is applying for license
,
2. Does your organization meet the defi it on of a "large" organization as outlined in
the November, 1988 revision of Secti n 09.21 of the Legislative Code?
Attach to this application pertinent fi ancial and/or organizational information to
support your answer to this question OTE: Only 5 large organizations will be allow-
ed to open pulltab operations under he revised city ordinance. If more than 5 organi-
zations apply, qualified applicants il be selected randomly by the City Council.
a �
3. Address where games will be held p� , �����.
N ber Street City Zip
4. Name of manager signing this applic ti who will conduct, operate and manage
Gambling Games , Date of Birth `7��7 �lG�
(a) Length of time manager has been me ber of applicant organization � ��C � ,
�" h � n :�� � �' I r Wi/1.i� ///�VI
S. Address of Manager �,>�,3 C, � � �^ ���� � '�7���
Number Street City Zip
P �
6. Day, dates, and hours this applicat on is for � ' - "�" � ���� 'w �T C�
7. Is the applicant or organization o ga 'zed under the laws of the State of MN? _�1��
J
8. Date of incorporation
9. Date when registered with the Stat o Minnesota '�j1-�������
10. How long has organization been in xi tence? �c3
11. How long has a rganization been in xi tence in St. Paul? , ` ,
12. What is the purpose of the organi t n? , �/ �� �/ �t�(,<-L��l
13. Officers of applicant organizatio :
.
Name '(�t� Name �
Address � , Address ��� /�,
Title , OB �' - �"� Title � DOB :;.�-y' �'?f
1"�uQ:V N��1 v ,
Name '� � Name ����.(�� ' �f (.6G�����(.J
,
/� , ,� 1� < <? 7,-,�%- � /�, ��/, �.
Address �(, ��(�c�� Address `,� ;' d'LLtY-�."�- (.Lf,"� � .
�y�� C� +1� /� .
Title � � �' W�OB /C " �� 5� Title ` DOB ���- �7 G'�
. . � al�
� 14. Give names of officers, or any other er ons who�rpaid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separat s et for additional names.)
�
15. Attached hereto is a list of names a d ddresses of all members of the organization.
16. In whose custody will organization's re ords be kept?
. O
Name ��NN/S �cNoUAN Address l�� � ��.e���
17. List all persons with the authority o ign checks for dispersal of gambling proceeds:
, 5��� �
Name Name
Address �3 . � � Address /1�� �, �,�'�c'�
Member of � Member of '
DOB �" �y- �y� Organization? DOB ��� — i✓3 Organization? C�l�
Name ^° � '' Name ,U�c�-N/Uf�'/�%� /�f�l E��.5 �JS�
Address ���r1 � �L�y�-�-�- � Address %q7 a�/�J-/U %Gl./��l/� �
Member of Member of
DOB .3- 30-5�7 Organization? DOB �{�"]—�j�p Organization? ��.Q,Q
v
18. Have you read and do you thoroughly un erstand the provisions of all laws, ordin nces,
and regulations governing the oper io of Charitable Gambling games?
v
19. Will your organization's pulltab o ion be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or d es it intend to sign, a consulting agreement or a
managerial agreement with any pers n r campany to assist your organizati�ith the
pulltab sales and/or recording kee in ? yes no
If answer is yes, give the name an a dress of the person and/or company contracted.
Name Address
Name Address
If answer is yes, how will such a o ultant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Atta copy of said contract to this application.
21. Operator of premises where games il be held:
Name �.U`r� � �' °� lV��
Business Address � � �L' ��� � Ru-� " f,�'` �-����
Home Address (1 � � / � ��� JS�� /
?2. a) Does your organization pay or int d o pay accounting fees out of gambling funds'
yes no
b) If you do pay accounting fees, to ho will such fees be paid?
Name ddress
DOB Member of Or an'zation?
c) How are the accounting fees char ed ut? (flat fee, hourly, etc.)
d) What do you anticipate will be y ur average monthly deduction for accounting fees?
23. Amount of rent paid by�pplicant org ni ation for rent of the hall:
,
��Q,��
24. The proceeds of the ames wil be d sb sed after deducting -prize layout costs and
operating expenses for the followin p poses and uses:
� - d ,,/�,
4'���L% �
25. Has the premises where the games ar t be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization filed edera f 990-T? �(� If answer is yes, please attach
a copy with this application. If ns er is no, explain why:
� t" / �� �
Any changes desired by the applicant as oc ation may be made only with the consent of the
City Council.
�l, `��'��SC��-�9�'""
Organization Name
.
Date �-�� - BY� � C
Manag in arge of ga�e
pr�....-, L���"
Organization President or CEO
' 3�4�? �
ty o Saint Paul
Department of Fin �c and Management Services
License an Pennit Division
203 Cfty Halt
, St. Paul, inne ta 55102•298-5058
APPLICA 10 FOR LICENSE
CASH CHECK CU►SS NO, ew Renew
� � � � Date �� t9 �
�
i Code No. Titte of Licenae From Z �� 19��To �� 19 ��
' �, 3 �Q�� � i nc 9 ' � /� �.'
_ , i ,o0 5'� r i1�rC�5 �`�/�c�L �Ch;.�v 1
1 r;' .� �pa� �5 r,.�+.
. ,00 kdH
� �`� ��u �S
100 Bualn�ss Nam�
�� laao ��cz s-�
i Busir»ss Addross Phar►ro•
� 100
_ S�� ����.i� �1 n 5.�il�
� 100 Mail to Addnss P�on�No.
� 1 '
� �� C� ✓� P /1 � i'1 u 1�
Manaper/OwMr•Nam�
100
t �3 �. L� rl 1� C�� ,���lw��
100 AlanapsNGwnN•HotM Addrtss PIqiN No.
ION Appli�atlon F�t 2. 50 "�" �j0 c.�-
„�«.S�m o� ,� c., � ��, C'a �,ti�.G , M ;� s�i t�
� � Ma�a�ow�.�•cuy,s�u.a z�a coa.
; �oo �si �oo
�
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;
Licenss Inapeetor � By: Siynaturo of AppNeant
� Bond•
Company Name Policy No. Expiratbn Oat�
Inaurance•
' Compam Nsm� Pouey No. Expiratlan ae•
� Minnesota State Identification No Social Security No
� Vehicle Information•
' SNfal NumbM at� um
i Other
TH1S IS A EC IPT FOR APPLICATiON
` THtS IS NOT A LICENSE TO OPERATE.Your application fo lice se will either be granted or rsjected sub(eCt to the provisions of the zoninp
ordlnanes and completton oi th�inspectiona by the Healt , Fir ,Zoni�fl andlor licsnse Insp�ctors.
$15.00 CHARGE OR ALL RETURNED CHECKS
' , rt_.r_���z--''
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� ,`�'( G i � `� , /{'�t�►'' �C� �� � L;,�i z ��� 1 C�' ���u.,%" �t,.i,��"
�(c� � �_ ! !�(� , �� r /ti�
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TO BE OM LETED BY
ORGANIZATION PRESID NT AND GAMBLING MANAGER
I understand and will uphold Sain P ul Ordinance 409, Sections 409.21
and 409.22 relating to pulltabs a d ipboards in bars.
Further, I understand that my jar ar must meet city standards; that 10%
of the net profit from pulltab sa es must be returned to the City-Wide
Youth Fund on a monthly basis; th t onthly financial statements must be
filed with the City; and that 51% of net proceeds must remain in St. Paul
or be used to support St. Paul re id nts.
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ignature - M ager
ignature - Organization Presiden
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Gambling Locat on
Date
Please retain the tt ched ordinance for your records.