89-1036 WHITE - CITV CLERK
PINK - FINANCE COURCIl
CANARV - DEPARTMENT GITY O AINT PAUL
BI.UE - MAVOR File �O• �a�� -
Co nc l esolution ��i�
�
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #6 120) for renewal o a State Class A
Gambling License by he 4th District VFW, partment of Minnesota
at 1060 University A en e, be and the same 's hereby approved/
�.
COUNCIL MEMBERS Requested by Depa ment of:
Yeas Nays
Dimond
d�' IR FaVO
cosw;tz
Rethnan
Scheibel �— Against BY
Sonnen
Wilson
JU� _ 8 Form Appr ed by "ty Attorney
Adopted by CounciL• Date '� _
Certified Pas e b Council Se tar BY � �(���
�
By
t#pprove Mavor: Date _
� -. g Approved by Mayor r Submission to Council
By
PUBIISli�D J U N 17 19 9
.- . . C��r�v��
OEPARTMENTlOFFICE/COUNdI DATE IN o 17 8 9
Fi nance/l.i cense GREEN S�H T No. ,Nm,�A�
CONTACT PERSON 8 PHONE DEPARTMENT DIRECTOR �GTY COUNdL
Chri sti ne Rozek/298-5056 �� cmr nTroaNer �dTY CI.ERK
MUBT BE ON COUNqL ACiENDA BY(DATE) ROUTING BUDOET dRECTOR �FIN.&MOT.SERVICEB DIR.
6-H-H9 MAYOFi(ORA881ST � C�i,n�tl R
TOTAL#�OF 81ONATURE PAGE8 (CLIP AL LO ATIONS FOR SICiNATURE)
ACTION RE�UESTED:
Approval of an application fo a tate Class A Gambi ng License renewal .
Notification Date: 5-18-89 Hearing D e: 6-8-89
REO�AMENDATIONS:Approve(A)a RsJect(R) COU CO MITTEE/RESEARCH REPORT IOMAL
ANALYST PNONE NO.
_PLANNINO f�MMIS810N _CIVIL SERVICE COAAMISSION
_qB OOMMIITEE _
OOMME .
_8TAFF —
_018TRICT COUFIT _
$U�TS WHICFI COUNqL OBJECTIVE?
INITIATINO PROBIEM.ISSUE,OPPORTUNITY(Who,Whet.When,Where,Wh�:
Fred Wanner on behalf of 4th is rict VFW Departmen of Minnesota requests
City Council approval of his pp ication for renewa of a State Class A
Gambling License at 1060 Uni rs 'ty Avenue. Procee s from the bingo
sessions are used for youth ti ities , veterans pr grams and school programs.
All fees and applications ha en submitted. Bi o sessions are held Friday's
between the hours of 1:30 PM an 5:30 PM.
ADVANTAQES IF APPROVED:
If Council approval is given t e 4th District VFW ill sponsor a bingo
session at 1060 University A en e.
DISADVANTA6ES IF APPROVED:
DISADVANTAOES IF NOT A�ROVED:
TOTAL AMOUNT OF TRANSACTION s COST/REVENUE BU ED(CIRCLE ON� YES NO
����:�_� �cesearch Center
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) I d�HY l.�i � ��O J
. . . . ������
DIVISION OF LICENSE AND P�RMIT ADMI IS RATION llA � � �( / � O � �
INTERDF.PARTMFNTAL REVIEW CHECKLIST A.ppn P oc ssed/Receiv d by
Lic Enf Aud
Applicant �Y�Gd �,(��{�n{ � _ Home Address �i a C-� _
Business Name �-f�r� t UFW Home Phone �I -�! —U3 `��
�.t pf 0� i'n n C�C�SS �
Business Address �p h��� 1 Type of Licen (s) �.�,y�l,QGv
Business Phone �l» Ll�S�'�'
Public Hearing Date (Q � � License I.D. �9 ��a�
at 9:00 a.m. in the Council a er ,
3rd floor City Hall and Courthouse State Tax I.D lt ���'
llate A'otice Sent; e � � � O Dealer �� ���
to Applicant J �
I'ederal I'irea s �� � �
Public He<.iring --T
DATE IN PE 'TIUN
REVI�,W VEKFIED CO UTER) CUMMENTS
A proved No A roved
�
Bldg I & D +
� L�
Health Divn.
� �,�� �
�
Fire Dept. : �
i
i N � I
i c,
Police Dept. ��I� 1 I ��
S �iz`� �K
License Divn. 5I� �� ��
� !
City Attorney ��1��� � �
Date Received:
Site Plan � � �G
To Council _search � a�' o (
Lease or Letter � � I G� Dat
from Landlord � �
_ _ .
....�-.:e-.s�s:Fr.'^�IY.6%'n.4sr:w���.�:.��,� .�FSa a ' . -,..i,. . ..:,.r . _„. . _ . , s:Y42- _ .=.w:.' - d' .. .,. ... ....
_. . . . .
�'• . :... _. ,.. .: �....'
� ���� . , ' �.��1 10��
j �
Charitable Gambling Controi oa d FOR BOARD USE ONLY
Room N-475 Griggs-Midwa Bui ing �NN�
1821 University Avenue
St. Paul,Minnesota 55104- 38 PAID
(612)642-0555 AMT
.;,
, . ,,. �, �.
CHECK#
s . . , DATF
GqMBLING LICENSE APPt ION � .
INSTRUCTIONS: . .
A. Type or print in ink.
B. Take completed application to local governing bod o in signeture and date on al opies,and leave 1 copy.Applicant keeps 1
copy and sends origina�to the above address with ch k. .
C. Incomplete applications may be retumed.
D. Enclose license fee with application.
Type of Application:
G�lass A— Fee 8100.00(Bingo,Raffles,Paddlewhe Is, �pboerds,Pull-tabs)
❑Class B— Fee S 50.00(Raffles,Paddlewheels,Tip oar s,Puli-tabs) M cn«*•p"Y'a't°°
❑Class C— Fee S 50.00(Bingo only) ��'���O"°fO��
❑Class D— Fee S 25.00(Raffles only)
Check one: ❑1 A. Organization has never been licens . �
❑1 B. New site—Give base license num r. �
_ C�"(C. Renewal of existing license—Give om lete license number. � - n � - 0
❑1 D. Chan ge in class of an existin g licens — ve com plete license number. � - � - 0
❑Yes C�No 2. Has organization ever received a La ul G mbling Exemption Permit fr m the Board? If yes,give complete
permit number
G�'Yes�No 3. Have Internal Controls been submitte pr iously on a form provided the BoardT If no,please attach copy.
4. Applicant(Official,legal name of o�ganization) 5. Business Addres f Organization
� — U F - ' o � � !/ s i r, v.t'
6. City,State,Zip 7. County 8. Business Phone Numbe�
s'_ - Oy "' S� . 1 � Z 1 -03
9. Type of organization: �Fratemal ❑Veterans Re gious ❑Other nonprofit"
,.
C�'ffss❑No 10. Is organization inco rated as a no pro organization�If yes,give mber assigned to Articles or page and
book numbe�: �L Y`�y A copy of csrtiflcate. °
s�No 11. Are articles filed with the Secretary f S tel
C�'Yes ONo 12. Is o�ganization exempt from Minnes ta o Federal income tax7 If yes, ease attach letter from IRS or Department of
Revenue declaring exemption.
�Yes l�No 13. Has license ever been denied,susp d or revoked7 If yes,check al hat a ly:
❑Denied ❑Suspe�ded �R ok Givedate: - -
14. Number of active members 15. Number of ea in existence Note: Attach evidsnce of
three years existsnce.
16. Name of Chief Executive Officer(Cannot be 17. ,-Name of�easu r or person who accounts for other revenues
Gambling Manager) of the org�niza n�an ambli anager)
6 � SS !r�e t
rti� _ '�� �Rre-
- : , ��
� r
nI�E�C �S; •
Business Phone Number Business Phon umber
1 ji/ }►-) �/? �r 1 / 1 �/ % �/a ` ' .� � l'I /1
, 18: Name of establishment where gambling wiD be 19. Street address ot P.O.Box Number)
. conductedo _ • .
,, . . / /y �yA/7i� r. �, �i� � I Nf I / T� i/F . `
20. City,State,Zip - 21. CouMy(where embling premises is locatedt .
T 4 �S/U'T f+ s.�
CG-0001-0318/881 White Copy-Boerd Canary-Applica Pink-Lxal Goveming Body
� Psge 1 of 2 .
.T, , __ . . , __ .-.. .
. _. , . . . . . .
. _
� r , �.,...- . ,-....,_ . . .. . � � .. :. . .. .�K
.� e' • � • , °��•Y'_/0.3�,
Gambling License Appli�ca�ion '
Type of Application: C-FClsss A ❑Class B � ass C ❑Class D
D�ss�No 22. Is gembling premises located within c y li its?
❑No 23. Are all gambling activities conducted t t premiaes listed in�18 of is application7 If not,complete a separate
appiication for each premises(except. affl s)as�a seperate licanse is uired for each premises.
. �YesO'No 24. Does organization own the gambling re sesl If no,attach copy of Issse with terms of at least ons year,and ^
attach a skstch of the premises indi tin what portion is being lea .A lease and sketch ere not required for
Class D applications. , '
25. Amount of Rent Per 26. Do you plan on condu in bingo wrth this license?If yes ive days and times of bingo xcasions.
Month or Bin o Occasion Day Ti e Day ime Day Time
$ �a,nr►y !•'3o s. 3v
SFS °-� Md �
L�JYes❑No 27. Has the S 10,000 fidelity bond required y Mi nesota Statutes 349.20 bee btained?
28. Insurance Company Name I�not agency name) 9. Bond Number
N' ✓",<.
' �Q.�. I.SS? �4L1
30. lessor Name 3 . A dre/ss, '3 32. City�,State,Zip
� i�N �7N Tt �i ✓i�Vi✓. �{✓- �i. I.�Nr. �it+ '�,J�r JJ�
33. ambling Manager Name 3 . A dress /� 35. City,State,Zip �
� , .r/ dE.G ,{" rA"A' �� ✓ S r. ��` /y.� �-�d+
36. Gambling Manager Business Phone 37. Date mb ng manager became
( L�1� �-�� �C�_ ��y� memb r of rganization: Mon Year y
❑Yes❑No 38. Has the license termination form been c mpi ted7 Attach copy.
Q5(es ONo 39. Has the compensation schedule been a rov d by the organization?Attac opy.
40. List the day and time of the regular meeting of the org niza ion.Day � •�'» ' � Time ' A���= � �
41. Bank Name 42. B k A dress 43. Bank Account Number
S i A iv i�F ' T rC �� ..�+ ri�/v , tJ a . u� 6 e�.�� .rZ�U �/ `�
GAMB IN SITE AUTHORIZATION
By my signature below,local law enforcement office or gents of the Board are her y authorized to enter upon the site at any
time gambling is being co�ducted to observe the ga blin and to enforce the law fo any unauthorized game or practice.
BANK EC RDS AUTHORIZATION
By my signature below, the Board is hereby authori ed o inspect the bank record of the gambling bank account whenever
necessary to fulfill requirements of current gambling ule and law.
�
I hereby declare that: OATH
1. I have read this application and all information s bmi ed to the Boa�d;
2. All information submitted is true,accurate and m ete;
3. All other required information has been fully dis los ;
4. I am the chief executive officer of the organizati n;
5. I assume full responsibility for the fair and lawfu op ation of all activities to be onducted;
6. I will familiarize myself with the laws of the St e o Minnesota respecting ga bling and rules of the Board and agree, if
licensed,to abide by those laws and rules,inclu ing mendments thereto;
7. Membershi list of the or anization will be avail ble ithin seven d after it i e uested b the board.
. �ff' ial,Legal Name of Or anizatlon 45. Si twre(mu �s,sign �y ief.Executi e Officer)
�i r: LcJ - � T u F �� X �+'3--< ir
Titls,f Signer � Date
/ • - C_ 4 ,., P .s'" /
ACKNOWLEDGEMEN O NOTICE BY LOCAL GOVE p11G BODY
I hereby acknowledge receipt of a copy of this applic ion By acknowledging receipt admit having been served with notice that
this applicatiort will be reviewed by the Charitable G mb ng Control Board and if ap roved by the board,wil!become effective
60 deys from.the date of receipt (noted below) un ss resolution of the locaf g eming body is passed which specifically
disallows such activity and a copy of that resolution s re eived by the Charitable G bling CoMrol Board within 60 dsys of the
below noted date. �
�,/ 46s Name of City or Coun (Local Goveming Body) If site is located wit a township,item 47 must be completed,in
_ `� -}- �_,/ addition to the cou signature. If township is not organized,
" ,!�� � ,�� �-�' county must sign.
� Signature of r n receiving application 47. Name of Towns ip �
. Xc' ', .�����`-�✓ x--�1
''V;� �"�'�e Date rec ` ed(60 day p r' Signeture of person ceiving application
;�� �� ����°"�-.. begins from this�a p
��1C.;�.� .:;�- .--�Y�5� °' !) X.
_48. IV�me of person deliv�ring application to Local Go ing Title
, j
CG-0001-03 (8/88) White Copy-Boa Canary-Applic t P'ink-Local Goveming BodY �
Page 2 of 2
� ' C ty o� Saint Paul ��J�/03�
Finance and Manageme t ervices%License & ermit Division
INFORMATION REQUIRID WITH APPLICaTION FO PERMIT TO CONDUCT CHARITABLE GAMBLIVG GA►KE I:1
SAI:VT PAUL (To be used with the foll wi g: New A & C appl ation, renew A � C
; Licenses, and new aad renew B ia Priv te Clubs.)
. 1. Full and complete name of organi at on which is applyi for license
�,O�S r - /�E T
2. Address where games will be held �E �T f�✓ Ss. /� v� /oy
� Number Stree Citq Zip
3. Name of manager signing this app ic tion who will cond t, operate and manage
� Gambling Games �/�ED Date of Birth /��/7�a.f�
(a) Length of time manager has b ea member of applican organization �y 9 - L,�E�J�y�
4. Address of Manager Z O/S ,q T � S��/�J
Number Street City Zip
5. Day, dates, and hours this appli at on is for � � , - � •(� L .'3Q -.5�.�3v�''I
6. Is the applicant or organization or anized under the 1 s of the State of I�J?��
7. Date of incorporation P/� � �Ye�^
8. Date when registered with the St te of Minnesota �6 �
9. How Iong has organization beea i e istence?
L0. How long has organization been i e istence in St. Pau ? ��2. 7 A//,r.
11. What is the purpose of the organ za ion? SF,F✓� : d�L ; v fo � �.
-G �/s /V ' ,J S
12. Officers of applicant organizati n:
Name �on/ n/ , AN� ,1ame c�A .� A�J'Ir/
Address / �L� w � � WNir .t�t���r� Address � � � ,J
Title �oHr�a�DE2 mB � � Title ic;� • DOB cZ3 �
Name (� o,c� Name SS i rE D v f L
Address S� ve.�E�2 ✓ Address fo3 /�G TE
Title JR ViC E �B � � Title ,�E,t,/1At?l,CDOB �S"/i3/a/
13. Give names of officers, or any o he persons who paid r services to the
organization.
Name Name
Address Address
Title Title
(Attach sep ra e sheet for additi al names.)
. . . . ���---�o��
r
14. Attached hereto is a Iist of name d addresses of all embers of the organization.
I5. In whose custody will organizatio 's records be kept? �}HBu��G /��t°v'��1
Name Address d /.T A� A cE ✓•
16. List all persons with the authori y o sign checks for spersal of gambling proceeds:
. p
0����Name Name `/r a,�N �
l
p� � Address oZ�/S ..a a � E Address / a?/ � cv !�'�-l��/�? L-
��N�� Member of Member of
DOB 102�/7 f�,r Orgaaization? DOB 8 ,? a Organization? ES
Name o � Name
Address S ,N/ '� �� .e.�.D Address
Member of Member of
DOB 7 a 3 1 Organization? DOB Organization?
17. a) Does your organization pay or nt nd to pay accounti fees out of gambling funds?
yes no
b) If you do pay accounting fees, to whom will such fee be paid?
Name Address
DOB Member 0 ganization? -
.\
c) How are the accounting fees ar ed out? (flat fee hourlq, etc.) \,
\
�
18. Have you read and do you thoroug q nderstand the prov ions of all laws, ordinances,
and regulations governiag the op ra on of Charitable G bling games? ��5.
19. Attached hereto on the form fum sh by the city of Sa t Paul is a Financial Report
which it .emizes alI receipts, ex en s, and disbursemen s of the applicant organiza-
tion, as ��rell as all organizatio s o have received fu s for the preceding calendar
year which has been signed, prep re , and verified by �J ,✓ it.
20 /,� ..4�.4� v� S'.-. ��v�.
Address
who is the T�',l�f c..l�✓G e � of the applicant organization.
�
20. Operator of premises where games wi 1 be held:
Name _� /, n • - i,/A t'T •e ��
Business Address O� � v .f �}' % �/
Home Address
• • • ' �� '`^"��
21. Amount of rent paid by applicant or anization for reat f the hall:
�� �
� r5 .✓T�-/�
22. The proceeds of the games will b d sbursed after dedu ing prfze layout costs and
operating expenses for the follo n purposes and uses:
o v�H e�� ,riE.i - �c • �q r�.�� .. � y �c� �E c v�r
!/ TFiCA•d �' ' N7Qi � io..� i l> (/f 7 S ol�- SOLJ�.tJ' /�rdflf - �T C.
��,/00 � 'QO �R r9�'7s -1 v a�� O < Uf OC�.4c✓ �
23. Has the premises where the games ar to be held been c tified for occupancy by the
City of Saint Paul? f
24. Has your organization filed fede al form 990-T? �� f answer is yes, please attach
a copy with this application. I a swer is no, explai why:
S • S .✓ '' ✓E t o A✓� 3' HA < oj'--
9yv � � o -r— .
Any changes desired by the applicaat ss ciation may be mad 'only with the consent of the
City Council.
� ,r T , • ,- 1/F�
Organization Name
Date �/c��/�/ By:
nager ia charge of game
w
Or nization Presid nt or CEO
a � _ _ � zt : ,- _ � .. — �
� � � �� � i ' � 5 9 , :
^ � � s �- � _
A 1 't � y � � 7 � `� � �
�. .� � ' t �0 3 �
lf R � �' '� .�
= � 3 5 T r0 .. C � '�
� .e �e �+ �+ A ►" -+ 3
� C
r7 .1 , � � �
�
� 3 � � � 3 ? r+ 1 a 3 3
� 3' 3 A � = A r► s 3
. .► . � I � 3 I •. O J! 7
T A A rr �t � �A
9 a � � � �
� Z � � •
� � 3 ,
= � = = r � �9 a
,9 � + 1 s ( � `� v v v
1 7� '
. O �' — I � o o = ' f ( a
,... . �
r e ,; ; �: � T � T ; �
n ' - � ,� ' � "
A c� : -� � `� ; -• I n s
� � r. a
� : � i .�I � � � �+ 3 � — �+
� A � '� f f '0 � ; ti �f �
� �� �
�
� ' I � I � = b ? � ?
A i ; � 1 <
� 4I � � � A
� � '� , � � � � � v
�. � �,
A 1 =
� � ! I � � �
� . i �
. . . . .` ... . .- . . � . Jw+� ��� ��
Cit ot Saint Paul
DepaKment of F a e a�a"Management S ices �4�°��
Licen e d Pennit Division 7
St. Pau MI �esota 55102•29&5058 ��`�—��°� �
APPLI T ON FOR LICENSE �
CASH CHECK CtASS N0. N Rsnew . '"`
y t :yy� ,
' � � _ � 'i
�. : �,
Due � 19�
! Code No. TItIe of License � �./{
Fro 19�To 1� � v
� a v�b��n 1 -Sv
,00 �.�. �� -�-r, �-� U F�(.J �
� Appl �Name
100 � • �� .
t00 Bus+MSa N '
,� I v U C,f ,� t ��� 5,-�
� Busin�ss A nss ���
• 100 `���`
5 TC � �� �• � J� v �I
100 Maii to Add sa Phone No.
� ioo P J, )� , n v�Z� �
Manap� et•Nam� � 9 y+ �
: ,� � � � -t f a � .-�.J �3 Y�
100 A1an ner•Nom�Addross Pl�on�Na
� 4pg8 AppliCatlon Fee 2. gp / � ��r
• Recefved ths Sum of ,1l00 � , `�Gt C� � <� S ..� �U�
� S U•V� Manaqul na•City,StaN 3 Zip Cod� ,
4 100 Tot I 100 ,, �
`\�(' ' / �
. Uce�ae Inapector ' v By: ��� Siynature of Applieant
I : .
; Bond•
Company Name Policy No. ExDiration Oats
j Insurance•
, Compa�y Nams Poticy Na Explration Dat� .
� Minnesota State Identtficatiort No Social Securiry N
I Vehicle Information•
� Sttltl Numbsr at� utnbN ,
t
! Other
; THIS IS A RE EIPT FOR APPLICATI ,
? THIS IS NOT A LICENSE TO OPERATE Your applicatton or li enae will either be pranta0 iected sub�ect to the provisions of the zonin�
� ordi�ance and completlon of ths inapsctions by the Hea th, re,Zoninq andlor Lice�s�In ctors.
�
� -
i ` �
� . .
� � $15.00 CHARG F ALL RETURNED CHEC :
i
+ _. �.
i � � . . . � - . �
' •T . � " . � � - � � '� � �� .
� �---��' � ,��
� � � it of Saint Paul Pa6e 1 ����3fO
Departmaat o F s and Maaagem�at Ssrvi es
Division of c a a� Perit Administrat on
UNIFORM CAi�LING FINANCIAL RE
Dats -3����
1. Nas� o� Organiution � it i ��(,()
� 2. eda:.s. .rtse:. charieabl. ca.b1 eondaceaa /D�d V �d vFe
3., R�post ior period eov�rieK � / 19�� ehsou ��3 I 19�
4. 2ota1 numbss of daqs playsd �
S. Cro�s reaeipta Lor abov� pasi : � y y i y�
6. Gsoss priz� parouts fos sbar� (i�lud� eaa6 s6ort) # � 9/ ��� '
. 7. Ifet rsceipes - lin� S aiaus 1 n� _ `�� D y�
8. facpan��� iaeurrad ia conduet ; op�ratiai �ss:
A. Gross vs`ss paid. Attac6 wr r 1Lt vith �
namaa. address�s. gro�s v as msb�r oi honss : /p � L 0
worked� aad asount paid p s h s.
.7 ��
• B. Rent for �a- weeks : / �`� `�
O°
C. License fea ; G �0 -
D. Insurance ; ���� /� '
• �D �_
B. Bond ;
!. Diahoaored checks not re ov� ed i �4 7
: G. Aecounting Expsnsa � �
h��
. H. Faplo�ers F.I.c.s. ; i y�`'.°'
. I. Pulltab Tas Paid to D�pa ts� t oi Rre�e : �9 y/_ 9`�
� .r. risAA. u.c. r� : �9 P"°
� ia.�� oY
1C. r.a.ral rsosas rai a se ;
� L. S�at. �..���� T� : 9 y 9. 9�
H. Hiseellaaeoua Expsnses. Id neitp th� a�onne
. and eo vhaa paid.
�. �00.��2 �����- �� ,��_ �G�G �-r
�.�S� - T��. �y ��
2. ��/S r y /,�i�% i
3. ,QovA.�a.4 � aRa ; 7!! �.
a. � J;,a Z� ; �p '_
9. ioeu �v.n.� mrnr. s �d 7/ ,�. 3 9
to. x.e z�o.. — �sn. � .�. 9 s ��3a3 G . lo /
lI. CAeckbook balaae� bs;iania oi pariod ; ��`/ �
. 12. Total of liae 10 and 11 s �9 y 9� 3/ �
' .. 13. Total concributlona (fsoi tt h�d votbhaat) s /9 F f 7 �f �
14. Checkbook balanes �nd ot por iaf pariod - ; �3 S-�/ � 2. �✓
' lia� 12 less lin� 13 .
� ... �:�:. � �H� p vES,a G E o Es FR o .�r �,�a s i� ThrE
� � a CPp iI ij- S R✓ �G f rJ E�f �T BE���
� cf¢ ��r:�c� �� /nr N� o �✓ %� .
E C7 /ff��y/�I� � �G� C�OSi T H s ��
/�i4.�S`�.�t� ?d .
Syou:.d �i4df BEB /4 C'ovPl� B� � c�A�r ,Bp�7`�_ l
GCJ�•�-�
� � Ni' ,j 1 . � .'!br
, • . UNIFOR,M �;�ARI�� L= ;�;►�lBI:aYG ;iN�NC:�,L E�OR�
LAWFUL PURPOSE ON IBUTIONS - 'rJORKSNE i ��(/43�0
Line #13 - Total Lawful Purpase on ributions. 5 /���,'• �
List below all checks writt n rom qa�ling funds hich are
charitable lawful purpose c nt 'butions. The tota dollar
� amounts of these checks mus tch the amount clai ed in
line �13. Use additional s ee as necessary.
CHECK � OATE ' PAYEE CHECK AMOUN PURPOSE
, ��_� ,
i. ���1 �/�� y� D,s : �/�:�y� �;y ���.�.y �Ef - ,�.�� �
�4
�FrN3�.r;c NfNs w ' i�;;•%vr jSf�
2. . i .!�f1p e"` T �� y`
/ G�� '� '" ,��yy•
3. �s�s �/�� P.��.;.��c��y i�'E �H ^ f�1',�' � - f,A��. r/.r�c�E'v r,���rr�r iG � `-
. � `•��,.,� ���.j�a�/.'�"► �'d /y,�y `',
��� � �l v'► ' ' o„r /.0: _...--
4. �� '1� . .¢Gc.A;a� �• iqrr
/ '
Ilvr rIIF�C'!/.Ey_ �/A �v :�, *��� J- • v;/'�. Y F c { v'E;t .,/vt/�,
5. �.s 3 �. ���� . � v.. ,���-<<�
�, ., ��r.�,a..
6. ,� ry� �/� � .
✓F u.� ,Je� % °:. •� i�
' A�,� jc i� �� .._��,; C'v�s-.
��b �:s ; OrF�c:�crFx+° a>' .
7.3.f�Y�'' s SS L �r�i�'• ... c . iiLrA"i C:�/'
s ti �4�%. C.��
LK .s o�'
8. js�9 �is r� �;cK STr�,��,� � �� � � —�`��n//,: ,.
a - Uv%ti ,
�/3 ✓�F�w� �E�E� ��� � ,,�c�P :.> . :� .
43s'L! rcJ, I
. r /�� vc �•_' jXPFN T �.. ?EA�/ %vv�l" �ov.?�e�
'�'�.� (IE•J,u;J' I�i.�iNir J`- A/C�r� iPii
Z � � ,6' L EA�aE
10. 3�� 6 i `; ,�,✓c��,� ' /-° '� �
�/� ��,�(C E�.�,o �i � � . � ,,�:T v,v /e e' T.r��E'
I1. 3S6 3 , � 3z Y' ,���.��'�r�*�
� �.r i.: +/ ��7�!'���f1 1 r .� ��
��% �
IZ. � � �' y F/ ' �Up �_ �/'Nf,i SB�✓;C t ���.u:Eir. Ar
,
13. ��r-c7
���a c $'i.�✓•�:c.�/E,� C ,✓.- .2 iP P�:c %
L3y��v
TOTAL CH CK ,�t�UNT 3 /��'
NOTE: These expenditures will be p v ded to Council Me�nb rs at your Council hearing.
Be sure that your financial ep rt is complete and ccurate.
nNw�nnn�►• � .
�
� � • • � � .� . a e � w ��
,s• '� � � a s � �= e � � ~ : s'
� � .. a " � � •. � w �,
� : w ` � ^ � . ; • a � '� a
� e .� x ` s . e � as
I 3 • � _ �v " � = � � '1C a s
s
� '� ? s ��x � s t � �i
s � � o \
^ � w + .�o � � i ri
O • � � � ~ ��a
A 1 � � � � � �
� ! 4 � l ' � � � � � �Y
• • � � • � .�.r� � �
r ` �rv '� -'1► 4mf � y � s i s �
: � r � O J � •1� "f • f� �
• c�,� p � �� t
i s � O . '� _ � � � �
�i 7 w . � � � �� w � �
s 1 w
r
� � � \ ;tn.^. f`� � ;�
� a ° � A d ' j� r' :
� � , r
�
� � a� � � s
J � � '� � � I
� �
�� i � �• �
� ��
- " ,- � �G�-�o�
. �p
__ G7K d . '4�,� . f /�i?�/Be �Il/�'tl� ! vP. tos�.-
� .
3 s� �. � 9/ l !� � `
9 a 7 y�- �F��c�z r c-a•�E.�-� s .�'�v s S,- �o�:� ("p�vhf.t�.vCf
�S9w- 9.i �/s�/!' , c _, , ` �O - � .
,✓ � �, �yy � C9i9�.Bt,iN� �f� //Lc t/s�L
�L a 2� i�/a 9��Y S-� P � f� . _ J _ _ _
i gY� �a�/r7'"' EG� �i�(/os O �G� (k�i9 SE�I�►�"Vi+.fi'i�s�r t'G�
��3� ��r,i�� �rw ,ti%� T� y�� .��� °� ��.;,�,� L;,�� ;� Y�;. �v��: ,c,�,� �a�,�
.��s 9 r�?/�-y �,�;� .�1.; C"�s� /��' `�' o � ' � � <�«,�:�
i°� C�.�.���,y,� L-
,i.� �P'o%%T-I(�T.IYS'c�,r.�! ,,.- ;63Ecd.rs,.
_�G�/f -3 70� 3//� ,3 -G',.c G.� /c;,d.��'�r,� ,, �` ,�.�.i+� ;',o Y u('�<"�.� P�i.��., .
M+ a+: �n _
o� 70/- ' t 7! � � �P� "c.t
_ �y .�i�� y D��;�E�s :� ��� � ,-� ;��;�W:�:-E� �°���.
�
3T yl 3 7�.� 7 �.�i,y f f S; �',� � /�� '`? ; j `'� �', � �� .Qssc.s�'rn�,r. -
�
,� 7vY .�%s/�-r' C�,-y ��: S; �v� joo Y�� � .� ., -
- ;
,
�� �
���a � �
i
,
_ _ i
i
, _
�
1
�
;
i
�
i �
� ;
� �
-- .. j
1
- - - _ ._ _ - -- - _ - - . .- - _ _ _ __ _ ;
i
_ +
. _ ;
;
_ _ • i
- _. _ __
_ .
�
.. � j
f � ��
r
(
� i