89-786 WNITE - CITY CLERK
PINK - FINANCE GITY OF AINT PAUL Council 7 /^
CANARV - OEPARTMENT File NO. ��`• �•
BLUE - MAVOR
• •
� C , unci esolution ►���
,, 3��
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (I # 9888) for renewal of a State Class C
Gambling License by Th Church of St. Peter Claver Worn-A-Bit
Society at 408 Main St eet, be and the same is hereby approved/
�
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
L.oa� In Favo
Goswitz
Rettman �
Sc6eibel �—__ A ga i n s t By
Sonnen
Wilson
MQY '" �f k7t1 Form Ap o ed by 't ttorney
Adopted by Council: Date . // /Q'!/
B �/
Certified Ya s Council cre Y
sy p/�
AY — � � vi7 Approved by Mayor for Submission to Council
A►pproved 6 14�avor. D
By � BY
PllBL�� i-`���, 1 �9 �
��- ° ' �
�
: . ' oae.m► w►,e c�D.
J: Carchedi
���?���"� �: a�2�3 7
��� - ,�,��;��, ,
Christine ftozek � — �.���� ��«�
. "°. aarr� — �� � Council Research
.—:._ .
' Finance & Mgmt. _298-5056 °"o�: � �m��.._. _ > , ;, _
Application #or renewal of a S t C1ass G Ca�Ibl"ing License.
- Notification Date: 4-14-89 ' : Hearfng aate: 5-4-89
'noMS:u�.�N o►�tA1 t �c�t _ .:_ n�noar: ; _
- :
..��� . �-� � PLAMAq f)OMNBBION�.. '. � CNL BERVICE COM�AIBSION DATE M . .. .DATE OUT ..: A1�EYST. . . .. � � PlqNE-tq, - . ..� .. ...
ZOtMq OOA�/BSION . � . . . 18D C28 8p1001.B�ARD . � . � . � ' . �.
� . � STAFF. �� � � � CFiAfMTER OOMMqSS�ON �. .. . �8 � ADDL N�iO.ADOEO* � R6T'O 7000ItTA�1' . GOIlBT11i1MR ' .
. . - . ._ . .. � __fOR AOD'L NipC). _F�0lAt�C ADOED*� � . .
OIBTRIC�OOCRICIL � � *D�INIR� � . - . . . . . -� .
. BUPPORf9 WMCN�COtMiql.09EGTNE9 - . � . .- �. �. . . - � .� ." . .
''. NflA1M1 M119�LEM.�SUEr OPP�ITtNNTY 1�.W1M1�YRIM�.YYlIMl.WhY1: ' '
Diane Nleyer, -an behalf of .the , e�er Cl.aver 1�ork-A-Bit St�ciety, r�quests
Council approval� of her applic i for rerie�a� of a C1ass C`Gamb�,�ng
Li.cense.at 4t}8 Main Street. i ng. sessions �r�e._ he�d on Mot�days be�►een�
the hours of 1:3p PM and 5:34 . Proceeds a�+e used for the support of
St. Peter Cl.aver Church and s� al
,�r+�►�+oM�.��: . .. . _ ; : _ . .
All fees and applications have ee subtnitted. :
. . . coi+�ea�aa r�a.�:�n+«�..�,a Taw�,�a:. ,. _. ;: . . , _ :.. . �
I€ CaunciT apProval is giverr, t t. Re�etr C�:�ver t�rn-R-�it Soc�ety
wi11 continue to operate a bing � g r+� at' 448� M�in Street. "
Kt�pw►,w�s: . _ . .; �,�... �
_ _ � 6
MSTf�IiYJiNlCEDEIiTS:
� APR 1 � ���J
��:
_
' „:'�'"'� �!r^=�l�"!�.°p"s�`.-_ ._
, , . . �(�����
T�IVISION OF LICENSE ANP PERMIT ADTiINI T TION UATE � �% / � / a !
INTERDF.PARTMENTAL REVIEW CHECKLIST Agpn ro ssed/Receive by
, Lic Enf Aud
�� �D�an� Mt�Q`r
Applicaut �• �,.�,�r Cf(�(JP� �,� � t� 'u Home Address � aOD� J�-��✓So� � �
v e `�
Rusiness Name Home Phone 7 rJ �- ����
Business Address �� b � !Q-�n �� Type of License(s) S�� �l{,�S C �
Business Phone �- �dm b�ir�r� (��S2 ��el�- �
Public Hearing Date �_ � � License I.D. # �cj��
at 9:OQ a.m. in the Council Chambers,
3rd floor City Hall and Courthause State Tax I.D. �i /v �}
llate Notice Sent; Dealer �f N��'
to Applicant � � g ���' � �
Pederal I'irearms �� 1�
Public Hearing
DATE INSP 'T N
REVIEW VEKFIED (C ER) CUMMENTS
Ap roved N t roved
Bldg I & D � �
r� �"
Health Divn.
' � I�
�
Fire Dept. � �
i
I � � �
I (
Police Dept.
3���f �j � � �
�
License Divn. �
� i
�! ��
City Attorney �,�f� �
L o ��
Date Re eived:
Site Plan � �( �j� � �� p
To Council P.PSearch 0
Lease or Letter � �� ��, Date
from Landlord � �
. � � � ��-���
Charitable Gambling Control Board For Board Use Onl
Rm N-475 Griggs-Midway Bidg. y
- 1821 University Ave. Paid Amt:
-�� St. Paul, MN 551043383 Check No.
:-•��:��� (612) 642-0555
Date:
GAMBLING LICE SE ENEWAL APPLICATION
LICENSE NUMBER: r'-y;la�-?3� /EFF. DAT : :)fir�l;�� /AMOUNT OF FEE: ;5d.��
1.Applicant-Legal Name of Organization 2.Street Address
CNBRi;I �fi SI '�r" :'i_itiVE? ":@CIF•,( :IORN �1 ?I? ?15 '�orC!1 tlXfnrd
3.City, State,Zip 4.Counry 5.Business Phone
it �3ui �'1 ;5i�ia 3e:ts2y �:: i�b-t?91
6. Name of Chief Executive Officer 7.Business Phone
, ..,,',,y !.._ �;i, ;;q5-li4]
8. Name of Treasurer or Person Who Accounts for Revenues 9.Business Phone
?!ai'? . ;v4r. i�� � _:�-.;�1i
10. Name of Gambling Manager 11. Bond Number 12.Business Phone
�';i:1:, "c,�:. ;i�a"�3.! _. '�i .:i,+;
13. Name of Establishment Where Gambling Will Take Place 14.Couny 15.No.of Active Members
:& , s'. 'u. �;,i75^Y .7�
16. Lessor Name 17. Monthly Rent:
�IJ; �,. _.. . ... . � �..
18. If Bingo will be conducted with this license, please specify days nd ti es of Bingo.
Days Times Days Times Days Times
:"f:.. � �i: - ,� J �
19. Has license ever been: ❑ Revoked Date: ❑ S spended 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? �I Yes ❑ No(If"No,"attach copy)
GAMBLING SIT AUTHORIZATtON
By my signature below, local law enforcement officers or agents of t Bo rd are hereby suthorized to enter upon the site,at any time, gambling is
being conducted,to observe the gambling and to enforce the law for ny nauthorized game or practice.
BANK REC RD AUTHORIZATION
By my signature below,the Board is hereby authorized to inspect th ban records of the General Gambling Bank Account whenever necessary to
fulfill requirements of current gambling rules and law.
O TN
f hereby declare that:
1. I have read this application and all intormation submitted to the B ard;
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 a tiviti s to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota res ecti g 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 Sigrfature(Chi�f xec trve Officer) Date Title
�
S i ��:7c �_ ����,���� :�o��� � , , � � �!;�,�. �� j�>:� r����y v' �J -- •
ACKNOWLEDGEMENT OF O,T� BY LQ�tAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application. By ackno ledg g receip�, I admit having bee served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if approv by the Board,will become effectiv�days from the date of receipt(noted
below), unless a resolution of the local governing body is passed whi h s ifically disalbws such activity and a copy of that resolution is received by
the Charitable Gambling Control Board within 3�days of the below n ted ate.
24.City[Gounry Name(Local Governing Body) Township: If site is located within a township, please complete items 24
, . --,", and 25:
� . � � . . �._.L �. ��_/
Signature of Person Receiving Application: 25.Signature of Person Receiving Application
, , _�
Title Date Received(this date begins! day pe� Title:
�
Name of Person DeGvering Application to Local Governing Body: ownship Name
' �,.-i,'.i r%�%
:
CG-00022-01 (5/8� � Whi Copy-Board Canary-Applicant Pink-Local Governing Body
. . �9���
, � ' cfey t saint Pau�
Oeps�tment o! Fi s and MansgenNnt SerWe�s ���
Licens s PernNt Dtrision �`
City Hall
St. Paut, in sota 5510Q•29&5056
APPLIC TI N FOR LICENSE
CASFI CMECK CLASS NO. Re�r
aa � xo � � � ,g �,
�.
Cod�No. Titl�of Lieenss F�om_ ` 19�0 � 1�
-. �
3u� � ' ��� c l' -- �r �,-. � ��, � 3, �
�o0 5 1 � P.��� r"C�Gvf✓ Seci2`�
L� �_,:�i,,• �., � �;lQ c..J��� �aa��es�acomwn�►w«�.
t00 ��� ��Es1 �� ► �'��
100 Busin�ss Nam�
�- ( �
100 --�� ' , �i l,� !� ,U �:1 �J J Z-
ewin�ss�a � �ar No.
100
100 Matl to Addrosf VIaM Ne.
�oo �ccc ;�-� I�Q�n�?� �h � �
M.�.o.No,�+...N.�+. � (oy�f"1
,00 � , � �.
% .,(l�O � \�.Q --�.�/�r� �.
100 Alsnsq�NGwnN•Mom�Addwss /Iqn�Ne.
� �DDlication FN . Sp �
«+. ��,o� � _ ,� ��a� t, � , /t'�Yt � =�``�f 3 �
°� .. ' Mansps�r0+�'ewr•Clh►.Slat!i DO�od� �
100 T sl 100
_____,�.-v i, i?/�-L�/L[J
Licins�Inspeeta �� 8Y � ,�� sro a�opks�w
BOnd•
Comp�ny Nsme Poliey No. E:O�ntion
�nsursnce•
Conip�ny Nsnw PbIkY NO. E�OMaHO�O�M ,
Minnesots State Identttication No Social Security No
V�hicl�Information•
Spllal NwnbM �
aner
THiB IS A RE FOR APPIiCAT10N
TFIIS t3 NOT A LICENSE TO OPER1►TE.Yow appliwtion lor II will eitt�W pranted o�rejected suDject to th�provisbns of 1M tonin�
O�dinanu and con+pl�tion ot th�insp�etions by th�Nealth. � ninq s��feens�Insp�etas.
�15.00 CHARGE FO L RETURNED CHECKS
� -� �q � �� / :c�
� • � ' � City of Saint Paul ��J`7O �
Finance and Management er icesjLicense & Permit Division
INFORMATION REQUIRED WITH APPLICATION FO P IT TO CONDUCT CHARITA.BLE GAMBLI:IG GA,�fE I:V
SAINT PAUL (To be used with the followi g: New A & C application, renew A � C
Licenses, and new and renew B in Private 1 s.)
1. Full and complete name of organizat n hich is applying for license
�`rFR c/�U F,� � C��ry
2. Address where games will be held /,t� �ST P�lL M� .S�s/�Z
Nu ber Street City Zip
3. Name of manager signing this applic io who will conduct, operate and manage
Gambling Games ,�f /V C /N�'y Date of Birth // y�j
(a) Length of time manager has been em er of applicant organization
4. Address of Manager �20� 3P S � ST B�Q iv�- M v
Number Street City Zip
5. Day, dates, and hours this applicati n s for ,�u�.�d�ris ��3�- s:30 G�//�9 - ����90
�
6. Is the applicant or organization org ni ed under the laws of the State of MN? �,S
. 7. Date of incorporation � /
8. Date when registered with the State f innesota /f G�
9. How Iong has organization been in ex'st nce? �� UG�LS
10. How long has organization been in ex'st nce in St. Paul? /9 t�Cad�CS
11. What is the purpose of the organizat on YDL �� �`/,U�[�G/K� S 4 Da102f �
7' E 2 e/�3-UFC.. c„1�
12. Officers of applicant organization:
Name T Name y11J4/'`��/'�T kDFU/`
Address x.o� - Sf 0 �oS� Address 90/ C• Co�"q�t St p�6IL
Title (�E(� DOB IS Title� � /111�t�A�GEP DOB 7 3 /D
Name /19 Name /�'1L�1�i .Si[�O�I�C..
Address � � �,�,t � .�/3� Address �y�l,3 ���u,r,�,�rr ST�D�/� �lw .
Title /►����� DOB // Title��'��$qrG� DOB
13. Give names of officers, or any other pe sons who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separat s eet for additional names.)
. � � � ��=���
14. Attached hereto is a Iist of names nd addresses of all members of the organization.
15. In whose custody will organization' r cords be kept?
Name E EyEJ� Address /uj0 g ��KSO�t S`f
�Iq r.rc. Al� SS�/9
16. List all persons with the authority to sign checks for dispersa� of gambling proceeds:
Name rll�tlC SUyOL��- Name �/��6 /tIFyL�JC�
Address T D ! �tJ. Address /Lp0 Y T�-�tK,50� ��e��s,. I�irc,J
ember of Member of
DOB / � Organization? DOB � // y! Organization? � ,�$ _
Name �� ,SfAv s/e Name
Address � . Q �os! Address
Member of Member of
DOB � /f Organization? DOB Organization?
17. a) Does your organization pay or in en to pay accounting fees out of gambling funds?
yes no ✓
b) If you do pay accounting fees, t w m will such fees be paid?
Name Address
DOB Member of rg ization?
c) How are the accounting fees cha ge out? (flat fee, hourly, etc.)
18. Have you read and do you thoroughly n rstand the provisions of all laws, ordinances,
and regulations governing the opera io of Charitable Gambling games? �/L%S
19. Attached hereto on the form furnish b the city of Saint Paul is a Financial Report
which it .emizes all receipts, expen s, and disbursements of the applicant organiza-
tion, as well as all organizations o ave received funds for the preceding calendar
year which has been signed, prepare , a d verified by y�/f},VE ��yE�
b o�1 ,� 4� � A��r, ssy
Address
who is the I1l/FNAG 2 of the applicant organization.
Nam
20. Operator of premises where games wi b held:
Name 1� , f/�SS / �/oN
Business Address /1'f gfAfJ ,s rp��- �AV. !D L
Home Address /�
. - GG�,--���
21. Amount of rent paid by applicant or an zation for rent of the hall:
� D S � E,c S�SS./�
22. The proceeds of the games will be d sb rsed after deducting prize layout costs and
operating expenses for the followin p rposes and uses:
c /�ETE� CIi1�E4. Uva�c.c�. /}a�(
23. Has the premises where the games ar t be held been certified for occupancy by the
City of Saint Paul? �
24. Has your organization filed federal fo 990-T? /�_ If answer is yes, please attach
a copy with this application. If a we is no, explain why:
L
Any changes desired by the applicant asso ia ion may be made only with the consent of the
City Council.
s T, f�E-7L P �/�-vE�L.. Sot�i�T y
Organization Name
D a t e ��// y� By: �/�}Q1E /1'I EyE�. ,(Y,lliX,�/�'�1 Gc/
Manager in charge of game
• f�'�,t� �
Organiza on Preside or CEO
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Ci y o Saint Paul Page 1 ����o `�'
Department of nan e and Managemenc Services
� Division of Lic nae and Perait Administration
llNIFORM CHARIT LE AlfBLING FINANCIAL REPORT
nace .� � Y9
1. Name of Organization
2. Addreas where Charitabl� Ca�blin is onducted �/D g A1A I� �
3. Report for period eovsring 19�through '1� �7 19�
4. Total number of daya played
5. Crosa raceipts for abova period S �� �� �• c4 0
6. Crosa prize payouta for above pa od (includa euh ahort) ; .� .�9G • �D
7. Net r�c�ipta - line 5 minua line 6 3 � ��S. .�4
8. Expanaes incurred in conducting eratins gaa:
A. Cross vagea paid. Attach wo ker list vith
names. addzeeaes. grosa vage � a b�r of honrs i
worked. and amount paid per our
� B. Rent for '� � weeks ; �{ 9��.Od
C. Llcense fee ; �/ a • sn
D. Insurance f
E. Bond ; , �d� 0�
P. Dishonored checka not recove ed S �J ��Q
G. Accounting Expenae ;
H. Employere F.I.C.A. �
I. Pulltab Tax Paid to Departse t o Revenue ;
J. Hinn. U.C. Tax s
R. Fedaral Excisa Tax b Staap =
L. Stats Cambling Taa i I. 6��•��
H. Hiscellaaeou, Expens.a. Ide tif ths �oant
. and to vhoa pa1d.
i, 'A�sf-+��r CSt�M�S� s /S o0
z'c�`,op6.D,��� : �a ..S,S
s. M�► Y o 8aii� s /o �.'I 4�
�.C+h�h��Ma„�h�c s /0 '� D�
No�t� sr�r lc )
9. 'Potal Expenses '�'r� ;
L0. Nst Ineoae - lins 7 airn�s lina 9 ; �.,/
11. Checkbook balance beginning of ri ; �.��� �� �
. 12. Total of line 10 and 11 � D
' 13. Totsl contriDutions (frou attac d rkshset) � �
14. Checkbook balaace end of report g siod -
� line 12 lees liae 13 , � /,�OO���
�l � u �� . rNu� ' "
- . �� UNIFORM CNARITABL MBLING FINANCIAL REPORT /�J,.,.-�;����
LAWFUL PURPOSE CO TR BUTIONS - WORKSHEET (�-
line #13 - Total Lawfui Purpose Co tr butions. 3 9 ,�01� �/7
�. List below all checks written f m qambling funds which are
charitable lawful purpose con ri utions. The total dollar
� amounts of these checks must at h the amount claimed in
line �13. Use additional she ts as necessary.
CNECK # DATE � PAYEf CHEC K AMOUN PURPOSE
1. /JSo s/L/�rY 3'l' p�°'!'E�2U4o� �� �s�. �o � �, �� Sy�,�a,a.
cJi aA.�.h //7.o �
2. l�S� 6�5��yy .. ,. . � /� ST PETFJ� C/�W�K- �liyiit�!►
'/5//YY .. .. .� i, a.�s po 5 choo! • , r
3. /1 S7 ,, .. � Y2/. G , , , `
4. II G .�- �'��Y /, �o�. c o " �
5. /1 GS `�/��YY �� •, ,• �� r � �
/SlS'•oo ✓
6. ll� Y �/Ly/�'X ,, „ , , �
,� ii /lOL�. 3� � / � / /
7. ll ��- ��/��Y sr '' � �
G�la . `� i ' � . i
s. /l 9s ��13°l�� ' ' ' ' �
3SG . Gc� � i� ri ��
9. /I �9 //3/�9 � � .. � � Ir i �
�� „ � /o3a• y� �/
10. 1� Y/ /�3 o�Y 9
11./� �(� 3/L��9
�, �� . � G3� •� � r / � � �
12. . �
13. �
TOTAL CHECK ND NT $ o .y?
NOTE: These expenditures will be provi ed to Council Nlembers at your Council hearing.
� Be sure that your financiai rep t 's complete and accurate.
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