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89-739 WHITE - CITV CLERK COIlIICIl
PINK - FINANCE G I TY SA I NT PA U L ��—� 7��
CANARV - OEPARTMENT
BIUE - MAYOR File NO.
- u c l Resolution y 1��
Presented By
Refer d To Committee: Date
Out o ommittee By Date
RESOLVED: That application (I # 5939) for the transfer of a State
Class B Gambling Li en e currently held by �the Rice Stree�
�$'�'3 ost at 11 8 ice Street, be and the same is hereby
approved for transf r o 1134 Rice Street.
COUNCIL MEMBERS �
Yeas Nays Requested by Department of:
Dimond
�� [n av
Goswitz
Rettman
Scheibel A ga n s t BY
Sonn�
Wilson y�
ry•1Y 2 � Form Appr ed by Cit tt ney
Adopted by Council: Date -
Certified P- �sed by Counc.it Secretary BY ��/� ��
By
A►pprc�v y 1r1a Dat � � Approved by Mayor for Submission to Council
�...-� � BY
. !�� 3.^.,7r�� . -:
,� �t3�:..v,�:� _ �:'�y :; 1989
._. �___ __ _
, o��e � ia�rte oa�►sT� ��`�'� ,
- � � �E�����r:�: aoz52s
J. Ca�rchedT
catx�c* o��rr.v+►ox�c,oa M++r��+,a�rM+n
Christine Ro k _ —�.��� 3«r�
���. ! . �—
� �*� 2 Counc3l Re�earct�
, . — . _. _ —
, � .. _ . , ±__ . - ' �, cm nTma�v ,
Rpplication for the transfer of a lass B 6�ling License.
Notification Date: 4-6--89 Hearing Ddte: 4-27-89
. �as: -- uw..��.«�� �: ` . -
. .. �.PIJIMIMIO C�ION :�. � � GVIL 9ERVICE OOYMSBION , DAIE M � DATE OUT . NIALYBT . . - . . . � RIpE M0. . . ,.
. � DOIpN@,OdiMN8610N b0 d25�SCF1001 BOMP . .. � .. . . � ... � .
� , g�� . .. .�qy{�p�� - A318�. . � ADDL N�FO.AOD�*. . . RET��p COMTA�T�: �. CCI�JBiT . .
. . . . . . . . . _POH-.AODL KO. _FEEDBtiif7F ADDED• .
. �DIB7AR.T 001lNCIL . � * . � . . . . . � . . . .
- � �.84lPPDHR YMNCN DOIMlCL i1L1ECTIVE4 . . . � . - � .. _ . . ., .� . . . � ... . ' . . .. . . .
MTIA7NQ P�O�L�R MMit�a/lORRN�MTY(YNw.NIINt MIIM�,W�n��MM:
Harry 0. Koplin, .on behal;f :of t e ice Street VF�I Post #3�17, currently ic�cated :
at 1138:Rice �Street, requests C �y 'Counci� appro�al of his app1ication fo�^ the�
trartsfe.r af.a Class B Gaa�ling ic nse to 113a-Rice ::Street. �' Gambli�g proceeds . j �
are used: to help veterans and t ei fami1ies,� as we11 as yvuth ar�d cot�nity �
projects.
��c�.�e«+.�r��•..�r. . ._, : . : ,
All fees and applications have ee submitted.
.. ,�n�wn.�,.�e fo v�r. , • , : . _ .
If Council approvai is given, e ice Street VFW wi11 be able to s+�ll tipbt�ards
and pulltabs..at its neat locati� .
_w,�p.wr�es:. _ ooNS .. .
. wsran►�rs: ,
. �ecuu�s: . , w .. .,.>^:, �i�'`''�i.:�Cil �.�7 i�'r
AP� �3 'i::��� �
. : . C���7�y
DtVISION OF LICENSE AND P�:RMIT ADM NI RATION llATE 3 a� �j� 3 �d U �
INTERDF.PARTI�tENTAL REVIEW (:HECKLZST Appn P oce sed/Recei ed by
Lic Enf Aud
Applicant eh✓ �• /� �n _ Home Address b� � Sc./ �UQ r) a l
Rusiness Name (� -E, V�W � S� g��Home Phone
Business Address I I�� Type of License(s) �✓��n S 'K ''-�
Business Phone �� G S—I���2. C ��tSS 1' CCcm�[�n� �i�v.rs-u
Public Hearing Date y a� / License I.D. 4� 0 5 �3�
at 9:OQ a.m. in the Council Chambe s, '
3rd floor City Ha11 and Courthouse State Tax I.D. 4� N �
llate Notice Sent; Dealer 4� � '!4`
to Applicant '# d
Pederal Pirearms 4�
Public Hearing
DATE I SP 'TIUN
REVIEW VERFIED (C UTER) CUMMENTS
A prov�d No A roved
�
Bldg I & D +
n���'
Health Divn.
v�,� '
Fire Dept. � � �
�i
j � �
Police Dept.
� SC nt � �1� �
��� � �� o��
License Divn. '
� � ��� O /�
City Attorney �
yc� . � �_
Date Received:
Site Plan �(,��,.t�. ' I �
To Council P.esearch �C
Lease or Letter Dat
from Landlord � I�
. •
. . � (����r�
State of �finnesota )
) ss
County of Ramsey )
�� . / r
� �
being duly sworn, say _th t he_is
(are) the petitioner _in he above appli-
cation; that he_has ea the forego-
•ing petition and know the nt nts thereof;
that the same is true of own knowledge.
Subscribed and sworn to be or me this
�
. �� day of /Cit ��- � 19 �
tary Public, • Co n y, Minnesota
' y commission
. ....: :'.'��a,�.��►�.0 a.+_aa...:. �
,• ,;EANE E IFE
-', NOTARY PUBI •PA NNE�OTA
;,i�� HENNEPI C UNTY
, � —� My Comm.Ex .Oct 11, 1990
_ ""��. i
-�. , / .1 /
ity ot Saint Pau{
� • ' � Department of Fi �ee snd Mans ement Senrk�s �-1��
Lic ns snd P��nit Div�sion
203 City Hall
St. P ul, innesota 55/02•29&5056
APPL ION FOR LICENSE
CASH CHECK CUSS NO. New Renew
c� o a � � , ��
osee =� � ,9 =-
9 �i^�� G
Cods No. Title ot License From � �� 1�!To � 19=.
i. -� /_ � �
G S " �. CL�T`.bl�,� —
,00 J2► c,¢,5-4-►�e.e7� u F c.J �a,5� 3� 1 �
1 ��S� "� AppliwnUComp�ny Nan�
100
�r�, I I 3� �2►�.5-�-,�--r
100 8usln�ss Nan�
100 S l • �C{l��l.,` .� � .
Busin�ss AdOns� � /�OiN 1�10.
100
100 Mail to Add��si P�OMNO•
100 �-J�'V��i-! �,'. /�! r-il„ ��.
MansqeHOwnN�NanN /
100 �, _. ,- \-
S } -.�,� J'+ 3 � �
100 Atanaqe�KrwnN•M�an�Addwas /Aa»Na
IOM Appliwtion FN 2 � �;�'
!M wn o 1�0/0 -�' Q Ll.� � �� tl 5 j ���
•3 / Mana�er/Owner•Cfty.&Nt i ZIP 6od�
10� ots 100
Uc�ns�Insp�ctot �By; � � Si9Mtur.of Aao�aiN
BOf1d'
Compae�y Nune Poliey No. Eap��Non at�
Insurance:
Compsny Nam� Policy No. Eapirsti0�Oab
Minnesota State Identificatlon No. Social Security No.
Vehicle Info�mstion:
SfH�NWnbs�
a�
TNIS 18 A R CE rT FOR APPLICATION
TMIS t8 NOT A LtCENBE TO OPERATE Your application fo► cen will eilher be�ranted or reje�ted iub�eW fo IM p�odNons of fM toNnp
ordiMeq and eon+plNion of th�infp�etbna by tM Hqlth, ir�.Zonlnp�nd/a Lic�ns�Insp�ctora.
$15.00 CHARGE F R LL RETURNED CNECKS
.-� �- ��� s �.�- � i� � -�- ��, - -���� �i �� � �,�-- ��
�
� � ;, �� ���� �-�
.Jc l��-�.,�i 3�:��:�'���� 7 / � .
. ��F ����
.�:�:...�-'_ �;r-
. ..... �
Charitable Gambling Control ar FOR BOARD USE ONLY
Room N-475 Griggs-Midway uii ng ��
- 1821 University Avenue
St. Paul, Minnesota 55104-3 83 PAID
(6121642-0555 AMT '
Y CHECK# � = �
DAT
GAMBLING LICENSE APPLI A ON
INSTRUCTIONS:
A. Type or print in ink.
B. Take completed application to local governing body, bt n signature and date on all copies,and leave 1 copy.Applicant keeps 1
' copy and sends original to the above eddress with a h . ' � ° ..;u v. , _ , ,. _
+ C. , Incompiete applications may be retumed. r . � ,. . . ,.;:, � . .� , � � ` . ���
D. Enclose license fee wkh application. , � , _. , �'"� _ � r,_��� �.��
, ��,
,�. ;:Type of Application: � -,...> f..,;�.:,.:. �-�.�.�:°,.:ti�.: ��:' ' �{ - '. �:,.;,:. .k�:,� .��;jz>�� ;�::.. .��;�� �����r t� „���� ���
' 'OClass A— F,ee$100.00(Bingo.Reffles.Paddlew .,Ti boards.PuH-tabs), . _ �`�'' °,
�$Glass B— Fee S 50.00(Raffles.Paddlewheeis.Tip ard .Pull-tabsl ��s�'�tO: _ ,
❑ClassC — Fee 8 50.00IBingoonly► �"'°b�'��O"�"�B°°`d
❑Ciass D — Fee S 25.00(Raffles only) �
Check one: ❑1 A. Organization has never been license .
�1 B. New site—Give base license numbe . ��
❑1 C. Renewal of existing license—Give c mp ete license number. � - � - 0
C)1 D. Change in class of an existing license Gi e complete license number. 0 - '�° '`• f - °" '"
OYes�No 2. Has organization ever received a Lawf I Ga bling Exemption Permit from the Board? If yes,give complete
permit number � _>�� -r-
❑Yes ONo 3. Have Internal Controls been submitted re ously on a form provided by the Board?If no,please attach copy.
� 4. Applicant(Official,legal name of organization) • 5. Business Address of Organization
R rG E S-t• v F� !'asf ..' 977 J/ 3 'y A� rC£ ,:+
6. City,State,Zip 7. County 8. Business Phone Number..
�- � M�: ssrr7 �A ,f� s � S/ � 4��. z► y.� � ro�'
- ' 9. Typeaf'otganizafion:- �Fraternal �,Veterens � Reli ious ❑Off�er nonprofit' � -
,¢�lfissONo 10. Is organization incor orated as a non rofi organization?If yes,give number assigned to Articles or page and
book number: copy of c�rtificats.
�Ysa ONo 11. Are articles filed with the Secretary o Sta e?
�Yes�No 12. Is organization exempt from Minneso or ederal income tax7 If yes,please attach letter from IRS or Department of
Revenue declaring exemption. - ���� 4: ?
❑Yes❑No 13. Has license ever been denied,suspen ed r revoked?If yes,check all that a ly:
❑Denied �Suspended �Re oke Give date: - -
14. Number of active members 15. Number of ars in existence Note: Attach evidence of
three years existence.
yz � y_ y ; ,
16. Name of Chief Executive Officer(Cannot be 17. Name of treasurer or person who accounts for other revenues
4 �. Gemblin Mana er1 0 orga tio Cannot be Gambling Manager) , .
4 . 9 9 f the niza n(
�,��( t �� .�.�:y �7� . i� r;!:', ta��\aai� vX Y,'y'i. ,3 '�,Mt°� ,•a� .�'iv "S a �° .��i � ..
�' ,: . . �y, , i��yH�, ... �
A},y 'k�. �^�y��.f�'8. �. x��� {'�'. �.:a'4 '.�� � � • �,� ��e ...., i.y: ' ,p,��1' �.-�;. 0.;xq,�]e}�. 'i� ��
� t , �i
t�t���s«+'y�'��i°"'��s� !�':,4Y@'�v'A1p`'�'w1;�, d��L�%r q'A�C-.!'t''M 'a0. yj:.�.' e 3�':l�':;�4,�s,�..•�. x <���.� �.?'.,��,.:� °'�S {."i�;r.��,. "����'�
G o m �4 N d c�.R 1 E �t. !H s�S-l� f 2
Business Phone Number Business Phone Numbe� ,
t t.. l 1 �,/S� _ � � 08 IGi2 1 ✓�3 � - X -' v P
18. Name of establishment where gambling will be 19. Street address(not P.O.Box Number)
conducted
� r
�� < <,� �, - �,�� �,� � _; r � /! z c/ ,• � c _ � �-
20. City,State,ZiP 21. County(where gambling premises is Iocated)
' � , 'a✓ ,t ,41 .a< <' ' !! 7 �:= , .�� _ � ±�
CG-0001-0318/88) White Copy-Board Ca�ary-Applicant Pink-local Goveming Body
age 1 of 2
-- � . ; ��
• . , /��,{�.�
,r ,�.-.�_-�,�- �, Q 7
Gambling License Application
Type of Application: ❑Class A �1Class B O lass C OClass D
��Yes❑No 22. Is gambling premises located within ' y li its?
[�Yes ONo 23. Are alI gambling activities conducte at t e premises listed in #18 of this application? If not,complete a separate
application for each premises(excep raff s1 as a separate lice�se is required for each premises.
,QYes ONo 24. Does organizatio�own the gambling re ises?If no,attach copy of the lease with te�ms of at least one year,and
attach a sketch of the premises indi atin what portion is being leased. A lease and sketch are not required for
Class D applications. .
2 5. Amount of Rent Per 26. Do you plan on condu ting bingo with this license?If yes,give days and times of bingo occasions.
Month or Bin o Occasion Day Ti e Day Time Day Time
S
�. � . �
�1Yes❑No 27. Has the S 10,000 fidelity bond required Mi nesota Statutes 349.20 been o tained? � f
:;
28. Insurance Company Name(not agency n�ne) . . ::- < ._:'; 29 Bond Number . ;.. ,. �.::
. ,. -:
, ... .. , �
T � �t � .0 �C�+$ . ;. , -�,.° � 's f �_ � S �.+:; ��
, •;S
30. lessor Name 31 A ress ' 32. City,State,Zip �
t
33. Gambling Manager Name 34 Ad ress 35. City,State,2ip
� . n, !y ;.<ii ,v' , =',i�. �. . '1,. '�" `
36. Gambling Manager Business Phone 37. Date g bli g manager became
( , , ,_ � � � ; ? membe of o ganization: Month � Year � l
❑Yes❑No 38. Has the license termination form been c ple dt Attach copy.
❑Yes�No 39. Has the compensation schedule been app ove by the organization?Attach copy.
40. List the day and time of the regular meeting of the organ zati n.Day_ ' �� - ' ` 'Time
41. Bank Name 42. Ban Ad ress 43. Bank Account Number
� z. ;� � = �- , ,
, _ ..
.... �.,�: ,-� ,� G.. L',��n� K _ , 3 �f - o i _3 �/�f
�_ �-� �
� � S _ 'C-;..�,r%"I�'....-- �� ;
- - � GAM G E AUTHORIZATION
By my signature below,local law enforcement officers r a nts of the Board are hereby authorized to enter upon the site at any'
time gambling is being conducted to observe the gamb ing nd to enforce the taw for any unauthorized game.or pcactice:-=:•-�- •-
�..��.r _-.�,._...�, , ...____-. - -��-- BAN1E AUTNORIZATfON_'_ _ . .
. __ -- - - �
By my signature below, the Board is he�eby`authoriz to nspect the bank reco�ds of the gambling bank account whenever
necessary to fulfill requirements of current gambling ru es d law.
I hereby 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. All other required information has been fully disclo ed;
4. I am the chief executive officer of the organization;
5. I assume full responsibility for the fair and lawful o era on of all activities to be conducted;
6. I will familiarize myself wiih the laws of the State f i�nesota respecting gambling and rules of the Board and agree, if
licensed,to abide by those laws and rules, includin a ndments thereto;
7. Membershi list of the or anization will be availabl wit in seven da s after it is re uested b the board.
44. Official,Legal Name of Organization 45. Signature(must be signed by Chief Executive Officer)
- . X
Title of Signer Date � ;�.
;� �' ,
ACKNOWLEDGEMENT O N ICE BY LOCAL GOVE�RNING BODY
I here�b�j�ce nowled �egri ceipt of a copy of this applicatio .By cknowledg�ng receip�.l admit haying been�se�ved with notice thst. t
, ,.Y , 9
•: this � e�r'�BC��c:C�tabre i'q. ontrot Boa��#�ap{�conre¢�hy�t#5e bQ�It�&p,�nl�become�Offe�tiv
,�-• 'q Q
60 days f the date of r �pt noted below{"unless a re olution of t�is Coca�goveming bo+dy i's•passe�which spec�if'ically.: .
.�.�, disallow�such activity and a copy of that resolution is r eiv by the Charitabla Gambling.Control Boa�d within 6Q�ays of,tf�e a.
below nQted dete. . ,. f . ;.,, n � r- a� -
46. Name of City or County(Local Governing Body) If site is located within a township,item 47 must be completed,in
/� , !1 � addition to the county signature. If township is not organized,
l�v�, � r�.c�--�--� county must sign.
Signature of perso ceiving application 47. Name of Township
`���' � � ���.�.�
X ,-r�.A _C�/�.��,'� -.�
Title � Date received(60 day period Signature of person receiving application
` � ' " � begins fro, s date�l- -�
...t.-t:�l.��-i�1 �\.:'�i���- � oi ' X
48. Name of person delivering'application to I Goverrw�g dy Title
CG-0001-03 (8/88) White Copy-Board Canary-Applicant Pink-Local Goveming Body
,, Pag 2 of 2
' . • • ' C'ty f Saint Paul ��7�9
Department of in ce and Management Services
Division of L'ce e and Permit Registration
INFORMATION RE UIRED T�TITH APPLICATION FO PERMIT TO SELL PULLTABS 5 TIPBOARDS IN S�.ItiT ?AUL
(Class B Gambling License in Liquor E ta ishments - Renew)
1. Full and complete name of organi at' n which is applying for license
=C✓ c-r '%�
2. Address where games will be held i��t ���G. st S�'t,PAv � S5 r I 7
Number Street City Zip
3. Name of manager signing this app ic ion who will conduct, operate and manage
Gambling Games � F N it ,� , �, ,�v Date of Birth i� - ,t - �=
(a) Length of time manager has b en ember of applicant organization � Y�S'
4. Address of �ianager � z � : !_ ��-� ti/ S"�� �'� �'`�`�� .�S i/ �
Number Street City Zip
5. Day, dates, and hours this appli at n is for ? p a v 5' R � t C �
6. Is the applicant or organization or nized under the laws of the State of :Q1.' ,��_=
7. Date of incorporation yF S
8. Date when registered with the St te f Minnesota J"� �y �� � ��? �
9. How long has organization been i e stence? M A R � N 1 1 'f�
10. How long has organization been i e stence in St. Paul? � �� C. H (> y�
11. What is the purpose of the organ za 'on? H F� �i F .� f- � A � S d FQrH 1 /y
�. �; �- c v �Y7 v R.' r-F- /'R o c' c -�.S
12. Officers of applicant organizati n:
vame ' _ L.� - _ Yame � '
Address � . `�/ '• y� �' _ = Address � � r> ;{� :- ? ��- t= c- n-
,�
Title c,;; �-, �, �y �ts d r I� DOB - ' `/c� Title � ��'t DOB i c� - r i � z.s'
Name ��� 5 f a F,�-E ,� _ '�� H E N R y K o P L � �
Address 7 7 � ,F�� A r �?. Address a .z/ S Y �. l/ Ad/ Sf
Title �c• t/�cE GCM/►7. DOB S ' 1 - �! Title (',aM BL�ti'c� i'1�n'. DOB 10 - z•-- xF
13. Give names of officers, or any o he persons who a1^e paid for ServiCes t0 the
organization.
Name J�/�v � i ^� t: '., � s i a: N3IIt8 J a S r r' J�ti'c I'1 c �:"L q ii M c � Y
Address ^ ;, i s y ;: ,,� ,, w� ;-� , Address �r j 9 � �c 3 �M A� �- � S f- �
Title -T. � K` -� � � � c e. Title (�c CIE� S� �-� c �
(Attach sep ra sheet for additional names.)
- . . . C����'l
14. Attached hereto is a list of names an addresses of all members of the organization.
15. T_r. whose custody will orgar.ization's ecords be kept?
:Vame H � � v ;<� f' �- � ti' Address ;� z j Sy l. ,, :a � St
16. List all persons with the authorit t sign checks for dispersal of gambling proceeds:
Name D r+�� r Q P r = � Name �( c .i: ,� y /�'c ,p[. � ti'
=—,
Address ,� � N G F(p �Z l� _ $ Address � ,z r S y L. �,a .c.-
Member of � Member of
DOB H - � - z b' Organization? E DOB �o �z - L L Organization? Y.E_s
�—_
Name Tc � R � c l� Name -
�ddress / � g c'v E 5`-� 1 Address
Member of Member of
DOB ;c� - i� - z S Orga.^�izaticn? � DOL Organization?
17. Aave you read and do you thoroughl u erstand the provisions of all laws, ordinances,
and regulations governing the oper ti of Charitable Gambling games? y � ;
18. Attached hereto on the form furnis ed y the city of Saint Paul is a Financial Report
which itiemizes all receipts, expe es, and disbursements of the applicant organiza-
tion, as we11 as all organizations ho have received funds for the preceding calendar
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 inter.d to sign, a consulting agreement or a
;�anagerial agreement with any perso o company to assist your organization with the
pulltab saies and/or recording keep ng yes no ;
I� answer is yes, give the name and ad ress of the person and/or company contracted.
Nar�e - Address
tiame Address
If answer is yes, how will such a c s tant be paid? (percentage, fldt fee, gambling
funds, general funds, etc.) Attach c py of said contract to this application.
21. Operator of premises where games wiI b held:
:�'ame H E N` �2 � a L i �:'
Business Address l l ,��/ . 1Z r G-E _. $
Home Address L� � / .j L. V �1!l/ f-
: . . . ��-��
�2. a) Does your organization pay or i te d to pay accounting fees out of gambling funds?
�es � - ; no
b� If you do pay accounting fees, o hom will such fees be paid?
:�ame �'_ �z � v ��� , i , � Address � i �;. z t,t� � S '; ,= �� ,U
DOB �c� - �f - :�,. �� Member of Or anization? � �^
c) How are the accounting fees ch rg d out? (flat fee, hourly, etc.)
G�.a
d) What do you anticipate will be yo r average monthly deduction for accounting fees?
� z�o , 00 c�i �� fl �,
23. Amount of rent paid by aFpl.icant o ga ization for rent of tha hall:
�v.� ,l, �.
24. The proceeds of the games will be is ursed after deducting priZe layout costs and
operating expenses for the followi g urposes and uses:
, -, -�- + -�,' ia �. , ✓ , �- ,
' �= EcI / E E �2 ll.� i' rYriL E
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25. Has the premises where the games a e o be held been certified for occupancy by the
City of Saint Paul? '
26. Has your organization filed federa f rm 990-T? �tF 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 nade only with the consent of the
City Council.
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Organization Name
Ua t e 3 - .2. .Z - �' � BY: �`-�`�i L'- /�-�----
nager in arge of ine
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Organization or CEO
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