89-1121 WHITE - GTV GLERK '
PINK - FINANCE COURCIl �//�
CANARV - DEPARTMENT GITY OF AINT PAUL File NO. ��r�`� /
BLUE - MAVOR -
Counci esolution ���� ��
��`
Presented By
Referr To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #3 97) for renewal of''a State Class A
Gambling License by ua lupe Mexican Education Society at
1494 N. Dale St. , be an the same is hereby'approved��l.
�
�
COUNCIL MEMBERS Requesied by Department of:
Yeas Nays
Dimond
Lo� In Fav
�
Rettman �
s�ne;�e� Against By
--6e�npa
Wilson �
�N 2 0 � 9 Form Approved by City A torney
Adopted by Council: Date � '
Certified Pas• Co ncil Secr BY � /� �
Y
By
Approve �Na or. � 2 4 � Approved by Mayor !for Submission to Council
�����
B By
POBL�9 J U L ' 1 98
. . . . C� �9-/>a�
DEPARTMENT/OFFICE/COUNpL DATE INITIA o 17 9 0
Fi nance/�i cense GREEN SHE T No.
iNmnu o � iamwonre
()ONTACT PERSON�PHONE DEPARTMENT DIRECTOR �CITY OOUNpL
Ch ri sti ne Rozek/298-5056 N� GTY AITOHNEY �CITY CLERK
MUST BE ON COUNqL AOENDA BY(DATE) ROUTNiO BUDOET DIRECTOR �FlN.6 MOT.SERVICES DIFi.
6-20-89 �u+Y�c�� � Council Research
TOTAL#OF SI�NATURE PA�iE8 (CLIP ALL OC TIONS FOR SIQNATURE)
ACTION REWESTED:
Approval of an application for en wal of a State Clas A Gambling License.
fVotification Date: 5-25-89 Hearing Da e: 6-20-89
REOOMMENDATIONS:Approve(A)or Reject(Fi) COUNqL RCN i�PORT OPTIO AL
_PLANNING COMMIS810N _qVIL SERVI(:E COMMIS810N A�YST PFIONE NO.
_p8 COMMITTEE _
COMMENTB:
_STAFF _
_DISTRICi COURT -
SUPPORTS WHICH COUNqL OBJECTIVE9
INITIATIN�PR08LEM,ISSUE,OPPORTUNITY(1Nho,Whtl,Whsn,Where,Wh�:
Agnes Meihofer on behalf of Gua 1 e Mexican Educatio Society requests
City Council approval of her ap li tion for a State Class A Gambling License
at 1494 N. Dale St. Proceeds f m he bingo session w 11 be used to raise
money for Our Lady of Guadalupe hu ch and school . Bi go sessions are held
Fridays between the hours of 1: P and 5:00 PM.
ADVANTAOES IF APPROVED:
If Council approval is given, Gu da upe Mexican Education Society will
operate weekly bingo sessions at I4 4 N. Dale St.
DISADVANTAOE3 IF APPROVED:
DISADVANTAOES IF NOT APPROVED:
�� ���i �esearch Center
f�AY 3 0 i989
TOTAL AMOUNT OF TRANSACTION a WST/REVENUE BUDOETED(G E ONE) YES NO
FUNDINO SWlRCE ACTIVITY NUMBER
flNANqAL INFORMATION:(EXPLAIN)
�
. '. ' ' ' � ��o�-�
DIVISION OF LICENSE AND PERMIT ADMINIS RA ION llATE '�{a�S� g / � Q 0
�.7�
INT�,RDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Rece'ved by
Lic Enf Aud
Applicant n� S � �o �i-� � Home Address j��j5 C-�li rn b�(r ��'
Rus iness Name _�l,{tid� Ik,p�/��C,�,-�, Home Phone
�CQC( LG co,-, Sc�c�F��,
Business Address 1 y�j yl�l.�,�� � Type of License(s�l �2wc��� ' C /uSS
Business Phone � �'�A rr1 �j�� (�((�in S-C:.�
Public Hearing Date (p / �(� � License I.D. 4{ 3 3 � 7 �
at 9:00 a.m. in the Counc�Cham ers,
3rd floor City Hall and Courthouse State Tax I.D. �� �1 /-�
llate Notice Sent; Dealer �f N '�
to Applicant 3 p7���
I'ederal I'irearms � �l�
Public Hearing
� DATE IrSPEC IU ��
REVIEW VERFIED (CO UT,R) i CUMMENTS
A proved Not A roved
�
Bldg I & D � '
��� ,
Health Divn. ' I'
N`,� ' i
-- -�_
Fire Dept. �
� �� � �
� �
� � �Police Dept. � ��a � �
5 IZ �` 0� '
License Divn.
;
5 �3 �1' � � ��
City Attorney � ( ,l��� ,
S ��
I -
Date Received: ,
Site Plan � a fj (� ( /
To Council P.esearch � �� �
Lease or Letter fj ate
from Landlord � U �
. _ . . � � ��-��a �
:.t� �
� Charitable Gambling Control Board
�� ;� Rm N-475 Griggs-Midway Bldg. _„ For eoard Use Only
1821 University Ave. _ Paid Amt:
- _' St. Paul, MN 551043383 - � Check No.
�� �......: (612) 642-0555 .. �. rq Date:
- GAMBLING LlC .��F �W�lt1�PL�ICATION
�. UCE�SE NUMBER: A-i4�5I-�iY3 I EFF. OAT : i8 f�E�38 /AMOUNT OF FEE: S1i1.J6
1.Applicant-Legal Name of Organization 2. Street Address
. �[�#DA:��F` +1ExIr!!M fG�)C1'IbN °,�JCi`TP 1535 Cha�b�r St
3. City,State,Zip 4.County 5. Business Phone
. �r, ^,,uj � yN ;c�?r, �aeise9 oi� i7�-T;BS
6. Name of Chief Executive Officer 7. Business Phone
,�.n: _ ,��'- l_ "'i-:t."
8. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phone
??;!i ,,::t.,`" ^.1i %� .",i,
10. Name of Gambling Manager 11. Bond Number 12. Business Phone
�i4i1�S '�2!'?d' . ,..�4 "1: •�. •�q�
13. Name of Establishment Where Gambling Will Take Place 14.County � 15. No.of Active Members
l�j9a: .... ;i. ,'�>i}: i:3t�3"Y � ;l�
16. Lessor Name � 17. Monthly Fient:
;15?pr. ;�,i•', ' r?�'
18. If Bingo will be conducted with this license, please specify days a d ti es of Bingo.
Days Times Days Times � Days Times
, ;ti.,
�' �. ,�..
19. Has license ever been: ❑ Revoked D t :
ae n
Su e ded Date: b Denied Date:
P
20. Have internal controls been submitted previously? � Yes ❑ No(If"No,"attac�copy)
21. Has current lease been filed with the board? �r,l Yes ❑ No(If"No,"attacin copy)
22. Has current sketch been filed with the board? �'c,l Yes ❑ No(If"No,"attach copy)
GAMBLING TE UTHORIZATION
By my signature below, local law enforcement officers or agents of the Boa are hereby authorized to enten upon the site,at any time,gambling is
being conducted,to observe the gambling and to enforce the law for y u uthorized game or practice. ,
BANK RECO DS UTHORIZATION
By my signature below,the Board is hereby authorized to inspect the ank ords of the General Gambling Bank Acc�unt whenever necessary to
fulfill requirements of current gambling rules and law. '
• . OA H
I hereby declare that:
1. I have read this application and all information submitted to the Bo d;
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 act 'tie to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota res ing gambling and rules of the board and agree, if licensed,to abide by thase
laws and rules, including amendments thereto. i
23.Official Legal Name of Organization Signature(Chief uti e Officer) Date Title �
�'/ � �� -�' � � �
',:; r i .. � :
ACKNOWLEDGEMENT OF N CE BY LOCAL GOVERNIN(3 BODY
I hereby acknowledge receipt of a copy of this application. By acknowl in receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if approved th Board,will become effective 30 days from the date of receipt(noted
below), unless a resolution of the local governing body is passed which i ically disallows such activiry and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the below not dat .
2�Ciry/Counry Name(Local Governing Body) T nship: If site is located within a township,please complete items 24
� ; a 25:
Signature o�Person Receiving Application: 2 Signature of Person Receiving Application
.t. ;Jt t
1?
e� Date Received(this'date begins 30 day period) Ti :
�, ��
�f.
Namaq�..Pe[�on Delivering Appfjcation to Local Governing Body: To nship Name
/i - �' .-r.�_ J
�• \� / �
CG-00022-01 (5/S� ` � ite py-Board Canary-Applfcant Pink-Local Governing Body
. , City of aint Paul � ` ' '/J�/
Finance and Management 'ces/License & Permit Division
INFORMATION RE UIRED WITH APPLICATION FO PE IT TO CONDUCT CHARITABLE GAMBLI.TG GAME I:V
SAINT PAUL (To be used with the followi New A � C application, renew A � C
Licenses, and new aad reaew B in Private lu s.)
1. Full and complete name of organizati n hich is applying for license
C� � �c ec�ic-f•
2. Address where games will be held � -S'f SS//•
N ber Street City Zip
3. Name of manager signing this applica io who will conduct, operate and manage
Gambling Games � -� �e � l Date of Birth S"��'�Z c,�
(a) Length of time manager has been em er of applicant org�nization �� y RS
-T
4. Address of Manager / SS 3 S �� �j , � ,S't- � t- f h u,,l� 5 S/ 06
Number Street City Zip
5. Day, dates, and hours this applicati n " for �R�u�� � S�%� j�� - 'I-3-- `1 c` /. ec•����/� .S:oc�t��i
6. Is the applicant or organization org iz d under the laws of' the State of MN? �/�S
�—
7. Date of incorporation — �/ -- �
8. Date when registered with the State nnesota /�i 7 3
9. How Iong has organization beea in ex te ce? ��/- tf��S
10. How long has organization been in exi te ce in St. Paul? ��� �/R C
11. What is the purpose of the organizati n? �1} i S �� /fl� �� �=� �,? �:ti u �e.�, A��v��
�J
�c� �.
12. Officers of applicant organization: �
Name e S /' � � Name , „. I',
, �
Address /.5 ? � C /�� m�, l. e Address ^�'��. �iy,y,�,�- S� �iu �. Ss't�y
Title ��y�,�G e,� DOB S .� Title e, ��`. DOB �y
Name . :� �r Name
Address c `� c � Address
Title�e q S a,� e n� DOB �-��._/ Title ` DOB
13. Give names of officers, or any other rs ns who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separate he t for additional names.)
. . . c�-�-��a �
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?
NSme Pr ��e �� Address JS�.S �J� r�'�r��2 � =5-�-
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
Name � �e e Name �,� iE- F �( r� H h1 A �- e
Address �S - �� ��� f�3�c S Address S C�/ I S e � cc �tii o r./1 S`f
Member of Member of
DOB 5 j� �� c Orgaaization? �; � DOB S -��- r y Organization? � p S
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
17. a) Does your organization pay or int nd to pay accounting fees out of gambling funds?
yes v no ,
b) If you do pay accounting fees, to wh m will such fees bel! paid?
�-,
Name �,� � � c•� ���c �.-�iir� �� ��• r. � Address �F(c/fr' /�ii R k R i U C-.•�'
DOB � �lb��� Member of 0 ga ization? ��S
c) How are the accounting fees char ed out? (flat fee, hourly, etc.)
�� �.�.�
18. Have you read and do you thoroughly d stand the provisions of all laws, ordinances,
and regulations goveming the opezat' n f Charitable Gambli;ng games? 1/L=�_S
19. Attached hereto on the form furnished by the city of Saint Paul is a Pinancial Report
which it .emizes all receipts, expense , nd disbursements of' the applicant organiza-
tion, as well as all organizations wh h ve received funds for the preceding calendar
year which has been signed, prepared, an verified by • � ����21/ _
� r�� - Q.� CL I (V �S
� �
Address �
who is the of tt�e applicant organization.
Name
20. Operator of premises where games will be held:
Name c�o S� �c /c � v� �
Business Address /� y ,( h �C� S� -S f fij <.c��. 7.ri
Home Address � �% ��/3 / p , ��f" �h J�. � M�v
, . . . � 89_� ,�,�
�
21. Amount of rent paid by applicant or an zation for rent of the hall:
� ` -
/ 7•SC e Sa �s� �
22. The proceeds of the games will be d sb sed after deducting prize layout costs and
operating expenses for the followin p oses and uses:
� - � � � e ia � � �..
23. Has the premises where the games are to be held been certif�.ed for occupancy by the
City of Saint Paul? <
24. Has your organization filed federal 0 990-T? � If answer is yes, please attach
a copy with this application. If an e is no, explain whyc
� r�c�u;�'e� �� o r , .;�i -���.+-�ur �.��-; 1 ���q � 1�
-�� 1'�'1 �s � - �
Any changes desired by the applicant assoc at on may be made 'only with the consent of the
City Council.
C"r'Cl N 1��1 �KL h F �IP X/(��1 N/ �c1�t('H�i c*�t.' �nf' ��'C�
h°i: rg�aization Name
J' ,
,
Date �Z� By: � ���.r �
�N � Managex in cha�ge of game
Z�� .1
C,�, F j�c,,_,..�� �._���
� ' Organization President or CEO
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• � ' ' �� " /
. . Ci y of 'aint Paul
Department of Fina ce nd Management Services
License nd ermit Oivision ' � �� �/a, �
03 ity Halt
St. Paul, MI nes ta 55102•298-5066
APPLICAT O FOR LICENSE
CASH CHECK CLASS NO. N w Renew '
a � a �
_ Date � � 19�
Code No. Zttle ot License -I`� � t9$�To {/ d S 19��
FtOm
o�3G -/I � . o �ln� i,�„a y , s� � � F'�u!'�-�a�..�
_ %� I � � l'�'i0(�: 1�.��P ,�/i.,or �.^�,st --Sur',�,,�..,,
� j ` C nvpteanuCompany Name
' 10
'_\ � �Yj J �
1 0 Busfnesa Name i'�•� ?�.� `�
.-� ' �-,�' '
� o l�/�'�C/ l�_ -� ��a.� . 73� S
8usiness Address 'G/`Phons No.
1 �
�{ � 1 ��� �
/_J-� s �rG 17� "�rr--J —.��
1 0 Mail to Address � Phone No.
, o v
M eNOwner•Name
1
1 0 AtanageNGwner-Hame Address Phone No.
4098 Applicatfon Fee 2 p
Received the Sum of � 1 0
s V Q MansgerlOwner•Gty,State 3 Zip Code
100 Total 1 '
� /, \ ��
(
LiCenae InspeCtof � % `�� By: � / II ignai e of Applieant
�./, '
Bond• �
Company Name Poliey No. Expiratfon Oate
Insurance•
COmpany Name Po11Cy N0. Ezpirati0�Date �,
Minnesota State Identification No. � Social Security No.
Vehicle Information: �
Serlal Number at�Numbsr
Other:
THIS IS A RECEI T OR APPUCATION '
• THIS IS NOT A LICENSE TO OPERATE.Your application for licen e wi either be granted or rejected subject to the p�ovisions of the zontnfl
.
ordinance and complstion of the inapections by the Health, Fire, oni y and/or Licenas Inspectors. �
$15.00 CHARGE FOR LL RETURNED CHECKS
�--9�r � � � ,- " - i
- . . - C� �9-�1��(
' ' Ci y o Saint Paul Paga 1
Department of F ns� � and Mana`ement Seroices
Mrision oE Lie nsa aad P�rsit Adminiseration'
. UNIFOR!! CHAAI? LE LING FIHANCIAL REPORr
o.e. � 1`? 8
� f ,
�-- � �c.�r� Z)C:�t�
1, 8as� ot Ocsanisatioa -
2. Addres• vhert Charitabl� Cublins 1s onducted �C�Pl1}L l tCJ�.�i �
3. Report for period eoveries 19�a throu`h �?��'� 19�,�
4. total numbes of day� playad
3. Gros• r�ceipu for abova p�riod = '
6. Gross Prise payouta for abov� p�r od inelud� eaah shost) � ��,� v¢ 1"�Q
7. Nat r�c�iQts - lia� S siaus lin� ; O `�
�� 8. Exp�nse• laeurred in conductiag a d o eratins Eaa% ����'��
� A. Grosa va6�s paid. Attach vor er iat vith
{�as�S L��h�Q� n�m�s. �ddresses, 6ro�� va;e� n �r of hours �
�'� vorked. and smount paid par h ur.
Z..,t,l u.��S � , --
B. Rent foc veeks ;
F�'C'A � e ' �Up•i�0
�j-'�G U.C, C. Lieense fee � �J�Ues. ;
D. Insurance f
E. Bond = I vO•��
!. Dishonoced chscks not recov�r d ; � �O�OV
C. Aceoanting Eapena� _
H. Emplorers t.I.C.A. ; —�
. I. Pulltab Tax Paid to Departa�n ot R��eew ; 1 ���'�b
, !
J. Niaa. U.C. Taz — _
. R. l�deral Lxcis� Ta�c 6 Seasp ;
L. Suu Gaabling ?a: �t� r `�`"^v ; � �!^
• 5�-!Q, 1 °�.�4�-
M. Hisc�llanaous Ezp�n��s. Id�a if� tA� ronat
. and to vho� paid. '
�. M i sc. s,�pl�c s : •
Z. �w�i -ra,,b-��. : ;
3. ���� �-� s;� : a4 ,S
�. �.q�,.��•e� : 3y3.! �
9. '[otal E:pantes ��' _ ��iD�
� �7�. 3y : ao, s33.��
10. ll�e Ioeo�� - lia� 7 ainu• lin� 9 � J
I1. Checkbook balaaee besinain` of p• lod '�g�.�,'7 �r°� _ ����•v�
�.d,� Q�� ��-�. , �o, i 9a• ��-
. L2. total of lin� 10 and I1
• 13. 'fotal coatzibucions (Eroi attuhe vo h�at) _ � � ���•�U
. 16. Checkbook balanea end o! raportin pe od - _ ' l�,�9�Q a �.
� liaa 12 leas lin� l�
- C� S9- iia l
�. i r �� . rr�u�
� � UNIF�RM CHARITAB E AMBLING FINANCIAL R�PaRT ��- � y
� LAWFUL PuRPOSE C nT iBUTIaNS - wORKSHEEt l �
' f�.
Line �13 - Total Lar+ful Purpose C nt ibutions. S �> �-3
• List below all checks writte f gambling funds which are
� charitable lawful purpose co tr butions. The total dollar
amounts of these checks must ma ch the amount claimed in
line �13. Use additio�al sh et as necessary.
CHECK # OATE � PAYEE CNECK AMOUN PUR_
i� ��)b�� O(�-� � o� C�, I�Oc�o-� �N,,��ea�...e /�:d�u.c`-�io�
i. 3 �
z. ��c��
g����� ,� ,, „ � � �,�o�-� . . , �
q � , , � , , � t,Suo.cx� ` � � �
3. l o�i f��I�s
4. � 0�.3 ��1ay1� �� , , ' ` ' '
v��C�C30 U � • � �
5 . � io3 �►lae�s� ,, � , t ,
� ��Ob0�c,�CZ t � � 1
� ,� � � l �o�oo � . + �
6. , � � � ����Is� � , , � .
� • ` �
�. 1 ��.�. �Ia�J� , . , , < < � �, o��� �
� . t � , , � � 1����UUC^ ' ` t�
s. l 14'l �ac�l� ' � � � ,
9. i t b'a- ��,�e��9 '.` `` `` , o�,c>Cx�.cx 'il
t� �� a s� C� v� S'�-, a3.�o ��i� y�.�-.�t ,r�c�z.��s
ia. 1 � � �l '�-�
��. I ��a ��lasl�� C��� � s�. �3�4$ ' � � � � ' �
� �Sg� , . � � , ,
�z. � I 30 ��ac,jS9 � � '' `` � '
1 � i9,�ag , , , � � �
13. �1� � ���1U1��1 � � � � � .. � ,
TOTAL CHECK NT � �
NOTE: These expenditures Nill be P eV rt S�complete andbaccurateour Council hearing.
Be sure that your financial p . .
r
r' � '� .3 y i � 3
,� � I' -� a � � � � � Ca � � �y
'' .�. : e� s • ,�, .. � w ' .,..
� � � .. .� e�i ` . I y' • � ♦ a u ♦s
� • � � e � . e • os
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� ! //���- `� � � i � ; � �� v O r w � f •= \ � s
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, - ' UNIF�RM CHARITA6 E AMBLING FINANCIAL REPORT � a �
LANFUL PURPaSE C NT IBUTIONS - WORKSHEEt � �
' .5���.3.00
Line �13 - Total LaNful Purpose C nt ibutions. =�
�� list below all checks writte f om gambiing funds which are
� charitable lawful purpose co tr butions. The total '' dollar
amounts of these checks must ma ch the amount claimed in
line #13. Use additional sh et as necessary.
CNECK # DATE � PAYEE CNECK AMOUN PUR�
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TOTAL CHEC UNT S 1���3 '
NOTE: These expendltures will be pro id to Council Members aate�ur Council hearing.
Be sure that your financial re or is coaiplete and accur .
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