89-681 WHITE - C�TV GLERK
PINK - FINANCE COUILCIl G
CANARV - DEPARTMENT G I TY O A I NT PAU L �{
BI.UE -MAVOR File NO. ` /
C unc 'l solution � }
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID # 13 ) for transfer of a gambling managers
license currently held by Kathryn Bondurant DBA Hayden Heights
Booster Club at The Ki k ff Bar, 1347 Burns Avenue, be and the
same is hereby approve f r transfer to Thomas K. Law DBA
Hayden Heights Booster C1 b at the same address.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Lo� [n Fa or
coswitz
Rettman
sche�net __ Again t BY
Sonnen
Wilson
APR 18 1 Form Approved by City Attorney
Adopted by CounciL• Date ,
Certified Yas ouncil Secretar BY � �
By
A►pprove by iVlavor: Date
�PRsL Q � � Approved by Mayor for Submission to Council
B BY
�11�11� �;Y�'� � 9 1989
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� J: Carchedi ����� ��� "�o. 0��`J 24
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Christine Rozek N —�,��� 3�,,,«� �
. — �� 2 C�ncil Research
F� n e t R ` �#3-�6: ` ,1 �^*,�
Application for. the transfer of a Ga bling Managers Lic�nse.
Notification Date: 3=37�-8'9 Hear-ing Date: !4-1$-89
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PLAlIM16 WMiM8810N CNN.'�BERVICE COF6N8&ON DA7E Mi -DATE�OUT- � ANALVBT ��, � . . . � PlIOIE M0.. . . �-. .
. . . .� _ . . . . . , . . . .
- aplfl0 CO�tA18&ION IBD 6R6�F1001 BOJ1A0 . . .. ��� .
.. . . . $fAFF � .- � � . G1�RTER COMMMBBfON � � . �AS 19 � ADDi MIF'O.ADDED . RET'D TO CONTA�T. � . Ci0l16flT1JBQf . .
. . . � . . . � �_ '. _FOR AGDi IWFO. _FE�BAdC/1DD�•
013TiYCi COUNf�L �' * . T� . . ��. . . . . . .
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Thanas K. Law �BA Hayden Heights oo ter Club requests Council approval of his
application ,for .the transfer of a Ga bling Managers Lic�nse currently held by
Kathr.yt� Bondura�nt. Hayden Hei ght i 1 i censed f4r the s�a1 e of pul l tabs and
: tipboards at the K�ck Off Bar, 13 7 urns .AvenuQ. _
ausii�e+rno�r 1cox�e«»+w.�.�e«�sr: . i ,. '
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All fees and applications have be n ubmitted. ',
: �M�•c+�.R,�a ra wno�:_ ;
, . .
If Counci l appr�oval i s gi verr-, Tho as K. Law wi 19 become th� gambl i ng .mat�agel�
for- Hayd�n Hef.ghts :Booster Club.
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Hsrc�mrr�rrrs: '
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t��o�t iepp�s:
` C�uneil;:Research Center
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APR 0 51�89
(�"6�-���
` DiVISION OF LICENSE AND P�:RMIT ADMIN T TION llATE 3 a� �qi 3 a� �
INTP,RPFPARTMENTAL REVIEW CHECKLIST Appn Proce sed/Re eive by
Lic Enf Aud
Applicant � ►�V►'Y� GS I.QC,t> _ Home Address p� (�0� �• ��Yl �C{r1QJ
Rusiness Iv'ame ��l `�{l �1f'S �` Home Phone �7 L�J �!7 U
b
Business Address �3 `i1 Type of License(s) � QYn b1/✓1G� ��
Business Phone
Public Hearing Date "i ► I� �� License I.D. 46 �1 3 3c�
a t 9:0 0 a.m. i n t h e C o u n c i lt C h a m b e r s,
3rd floor City Hall and Courthouse State Tax I.D. �t IV A'
llate Notice Sent; z 31 � � �Q2 Dealer 41 JU (A'
to Applicant �J g (, J )
rederal Pirearms ��
Pub.lic Hearing
DATE II�S EC IUN
REVIEW VERFIED ( Q TFR) CUMMENTS
A proved ot roved
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Bldg I & D �
N�q
Health Divn. '
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Fire Dept. �
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Police Dept. I
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License Divn. !
g�a���y � o «
City Attorney (
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Date Received:
Site Plan � �
To Council P.PSearch � 5 �
Lease or Letter te
from Landlord N
, - , � y of Saint Paul l/� �� "'��
Oeps�tment of ins ce a�d Msna�em�nt Servic�s
Lice se nd P�nnit Oivision
Z03 City Ha11
St. Pa 1, M nesota 55102•298�5056
APPLI A ON FOR LICENSE
a C� CLASS NO, Ren�e_w
Ost� _'� ��G tg�=�� .
Cod�No. Tft1e ol�icense From��_t�to �'�� � 19 �
( ,` � ; yy�
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a'7 i �!ryL.c�-�C� ,�J�a�'�.
��� 100 ������:z,•' �,.�7�GGC�,L- ���G-ti�
!:� %� � AppliesnHCanpanp Na�N
, � " �� . ,
� `,, ,�`,L, ,-� � / / ,�t�,�LE"�'(�f�L�
100 Bus1,e��sa Nsm� ;
� �� 1
), � /% ,
�oo �7 �'`-� '�� �"`�
Busln�Addrass '7� "' M�a»No��
100 / ��/?.v `/`�
:.� � 'o /�// �- 'ti �-"f.t'�'- .
G'G C U ��i� ti.�- ,
100 Maii to AdAr�as N�OM N0.
100 �.� _.�i� �,_. ;'�'� � 7 % �:L�,i
Msnaqa/OwnN•NsiM
100
��r4 4 �'. .' c`LiL ��-cJ �L'-:��.
100 AlanspeNGwnsr•MonN Addn�a N�en�Na
IOi! AppliCation Rk 2. 50 .
tM um ot � � ,2s00 �� ;�tL GG f� ��1'( • -��/l�
MansqK�Owner•Gq.stat�s Zio Cod�
100 T lai 00
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LicMSS Inspscta By: �,a.o�AppueaM
BOnd'
COmpany Name Pdicy No. ExpiraMon Mf
tnsursnee•
Compunr Name PWiey No. EspMalbn QiU
Minnqots Stste Identifiwtton No `� Social Security No.
V�hicl�Infonnation• �
SNfN NWnbN
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TMI8 IS A RE EI T FOR APPLICATION
TM1818 NOT A LICENSE TO OPERATE.Your application tor II �en wi11 either be pranted or►ejected supiset lo IM provisions Of 1M ZoM�
adininq�nd Compl�tion ol tM insp�etions by tA�Health, re. onin9 snd/or License Insp�etots.
�25.00 CHARGE FO A L RETURNED CHECKS
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�il l_ ,� �...E� �.�-X G�-' / � � �...
. - C ty of Saint Paul �O ' ��/
Department of in nce and Management Services
Division of L ce se and Permit Registration
INFORMATION RE UIRED WITH APPLICATION FO PERMIT TO SELL PULLTABS � TIPBOARDS IN SdItiT ?AUL
(Class B Gambling License in Liquor E ta lishments - Renew)
1. Full and complete name of organi at on which is applying for license
,�,9 �' o /4
2. address where games will be held S L s,j �
Number Street City Zip
3. Name of manager signing this app ic ion who will conduct, operate and manage
Gambling Games � � � �}L� Date of Birth �C���s�
�
(a) Length of time manager has b n ember of applicant organization s
4. Address of Manager �1Q �Q U L / �'
Number Street City Zip
5. Day, dates, and hours this applic ti n is for `�'C ,Qtf/�C'�/,Ej> � S�f�. �
6. Is the applicant or organization rg nized under the laws of the State of :Q1? ,j��
7. Date of incorpozation �
8. Date when registered with the Sta e f Minnesota 7°��� 7�
9. How long has organization been in ex stence? � S/�.s
10. How long has organization been in ex stence in St. Paul? �,q/�! /¢S �4,�✓t ,3Dv�
11. What is the purpose of the organi at on? J/DC[�� /i�GJ�/lJ/�/�S
T
12. Officers of applicant organizatio :
Name Name ��� f�j�;�,q/�
Address � Address �� � Ar/i�.s fa�
Title �`� _ DOB � �� Title�G DOB �so20 -.s�
Name � Name ���V sc/t M l�rl�
Address � Address L^�`/�N`i� �I/C S.S//�
Title ,r9t� _ �r�{ a',a��OB Title fl�/'�C��Gr DOB
13. Give names of officers, or any oth r ersons who a1^e paid for ServiCeS to the
organization.
Name a' j � � Name �.�d� /�5 �.6� �
Address � � � • Q/ Address ��� � ��/r }�/J /F �L�
Title� ,L� - �j Title �� �Z(.,�"� /� �G'�C s�`'
(Attach separ te sheet for additional names.)
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14. .�ttached 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 T Address �(,1(�� �/�/I ON �'�4�(/� /Q!/
16. List all persons with the authorit t sign checks for dispersal of gambling proceeds:
Name�+ /7 L�¢c.✓ Name ��A//U�- /��/�E/�
, Address GA/'��41� cJ Address �ly& �i /�,Qw/�j�/�,�✓�-
Member of Member of �s
DOB �d���,slp Organization? s DOB - �° Ll�o Organization'. y
Name Name -
�ddress �° fi p Address
Member of Member of
DOB Organization? DOB Organization2
17. 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? ��s
18. Attached hereto on the form furnish d y the city of Saint Paul is a Financial Report
which itiemizes all receipts, expen es and disbursements of the applicant organiza-
tion, as well as all organizations ho have received funds for the preceding cal.endar
year which has been signed, prepare , nd verified by _�/' �
Address
who is the of the applicant organization.
Name
19. Will your organization's pulltab op ra ion be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or do s t intend to sign, a consulting agreement or a
managerial agreement with any perso o company to assist your organization with the
pulltab sales and/or recording keep ng yes no
It answer is yes, give the name and ad ress of the person and/or company contracted.
Name ' -�� Address ����,/�fE &�� f�(� �i1�I�w�
:vame Address
If answer is yes, how will such a c ns ltant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a opy of said contract to this application.
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21. Operator of premises where games wi 1 held:
:��ame p(,�J j� - � F .�
Business Address � �4t /' S /�✓ f ��G . � ��✓
Home Address
, � . ��-���
�2. a) Does your organization pay or i te d to pay accounting fees out of gambling funds?
yes c�` no
b) If you do pay accounting fees, o hom will such fees be paid?
;�'ame � /i� ,G J�-S �v�� Address
DOB Member of Or anization?
c) How are the accounting fees ch rg d out? (flat fee, hourly, etc.)
S�`�.n�. � a
d) What do you anticipate will be yo r average monthly deduction for accounting fees?
�'Sf S"�' ��
23. �mount of rent paid by applicant o ga ization for rent of the hall:
� DQ `�°
24. The proceeds of the games will be is rsed after deducting prize layout costs and
operating expenses for the followi g rposes and uses:
� �
25. Has the premises where the games a t be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization filed federa fo 990—T? If answer is yes, please attach
a copy with this application. If s r is no, explain why:
99�
Any changes desired by the applicant ass ci tion may be made only with the consent of the
City Council.
/`/ �'N fil�S �os`/` �/`�
Organi ion Name
.�/.�o/� B / ,� --
ilate y: ��--
Mana in charge of game
0 nization Presid n or CEO