89-1230 WHITE - C�TV CLERK
PINK - FINANCE COUIICII �//���/ -w/
BLUERy - MAVORTMENT G I TY O A I NT PALT L File NO• � • '/^�� -
C unci esolution ;
j.r
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #1 06 ) for a State Class B Gambling License
by St. $ernard's High S ho 1 DBA Triviski 's at 173 So. Robert Street,
be and the same is here y pproved/�cL.
COUNCIL MEMBERS Requested by Departenent of:
Yeas Nays
Dimond �
�� In Fav r
Gosw;tz
Rettman (�
�he1�� Against BY
Sonnen
-�V�i}se�.
1 � Form Appro ed by City ttor y
Adopted by Council: Date .
Certified Vas un .il Sec eta By � � �g
By,
A pro y Mavor: Da Approved by Mayor for Submission to Council
By By
p�� J U L 2 2 1989
_ . ��-`.���
DEPARTMENT/OFFlCE/COUNCIL " ^ DATE INITI D
Fti nance%l.i cense GREEN SHEET No. 4����
CW�ITACT PER80N�PH�IE DEPARTMENT DIRECTOR �CITV COUNqL
Chri sti ne Rozek/298-5056 N��� CITY ATfORNEY CITY CLERK
MUST BE ON COUNCIL AOENDA BY(DATE) ROUTIN(# BUOOET D►RECTOR �FIN.6 MOT.SERVICES DIR.
7-11-89 � MAYOR(ORA8318TMIT) � Council R
TOTAL�OF SIGNATURE PAOE8 (CLIP AL LO ATIONS FOR SIQNATUR�
ACiION REOUEBTED:
Approval of an application for a ta e C1ass 6 Gambling License.
Notification Date: 6-27-89 Hearing Date: 7-��»f#9
REOOMMENDA710N3:Approve(A)or Reject(R) COUNqI ITTEE/RESEARCH REPORT OPTIONAL
_PLANNINO�MM18310N _CIVIL SERVICE COMMISSION ANALYST PFIONE NO.
_dB COMMITrEE _
_STAFF _ COMMENT3
_DISTRICT COURT _
SUPPORTS WHICH COUNqL OBJECTIVET
INITIATIN(3 PROBLEM,18SUE,OPPORTUNtTY(Who,What,When,Whero,Why):
John 0'Neill on behalf of St. Ber r 's High School requests City Council
approval of his application for a St e Class B Gambling License at
Triviski 's, 173 So. Robert Street. oceeds from the pulltab sales will
be used for educational advanceme . All fees and applications have been
submitted.
ADVANTA(iES IF APPROVED:
If Council approval is given, St. er ard's High School will operate a
pulltab booth at Triviski 's.
DISADVANTA(iES IF APPROVED:
DISADVANTAOES IF I�T MPROVED:
Council Research Center.
JUN 2 9 i989
TOTAL AMOUNT OF TRANSACTION = COST/REVENUE BUDQETED(CIRCLE ONE) YE8 NO
FUNDINQ SOURCE ACTNITY NUMBER
FlNANCIAL INFORMATION:(EXPLAIN)
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DiVISION OF LICENSE AND PERMIT ADMIN ST TION llATE �"J �.� �� / I �' �
INTERDF.PARTMFNTAL REVIEW GHECKLIST A.ppn ro essed/Received by
Lic Enf Aud
Applicant d`�� �e�'niir�S �r SC D� � Home Acldress
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Rusiness Iv'ame � U 0_`,Ki S Home Phone
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8usiness Address � 1 � ���• 'GL-�P Type of License(s) C,� �CS�
Business Phone (1�(Il�b��� � !�i," c_,� �`�! '�
Public Hearing Date �f % License I.D. 4� ��7J(D�>
at 9:OQ a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �6 �Jf�'
llate Notice Sent; Dealer 4� � fA'
to Applicant �q�rf
Pedera2 I'irearms �� '+._1
Pub.lic Hearing
DATE IrSP CT UN
REVI�,W VERFIED (C MP TER) CUMMENTS
A roved N t roved
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Health Divn. �
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Fire Dept. � �
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Police Dept. �� �'"� ��'� I D�
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License Divn. !
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City Attorney �
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Date Received:
Site Plan �� !�
To Council P.esearch Z
Lease or Letter D te
from Landlord � !4
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' ity f Saint Paul
' � Department of Fin nc and Management Services ����� p
License an Permit Division
20 City Halt
� St. Paul, inne ota 55102-29&5056
APPLICA 10 FOR LICENSE
CASH CHECK CLASS NO. ew Renew
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. _ Date -��� 19�
Code No. Tjtle ot License ' From ��� 19c�fo s�� t9�
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Busin s A dre � �s Phone No.
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4098 AppliCBtion Fee 2 p ^ A �
Recefved he Sum of � � �� • �(!���I r ' I � � S����
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l.iCense InspeCtor By: ���Z ' , Signature o(Applicant
Bond:
Company Name Policy No. Expintion Date
Insurance:
Company Name Policy No. Expiration Date
Minnesota State Identificatlon No. � o�-/� Social Security No.
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Vehicle Information:
Serlal Number Plats Number
Other:
THIS IS A RECEI T R APPLICATION
• THiS IS NOT A LICENSE TO OPERATE.Your application(or licens wiil ither be granted or rejected subject to the provisfons of the toniny
ordinancs and eompletion of the inspectiona by the Health, Fire, nin andlor Licsnse Inspectora.
$15.00 CHARGE FOR A L ETURNED CHECKS
D��s��� 5=/�—� � /` �
. � . � � ���,2�0
Cit o Saint Paul
- Department of Fi n and Management Services
Division of Lic s and Permit Registration
' INFORMATION RE UIRED WITH APPLICATION F P T TO CONDUCT PULLTAB/TIPBOARD SALES IN
SAINT PAUL (Class B Gambling License i Li uor Establishments - New Application)
1. Full and complete name -of organizat on which is applying for license
� � i
� .
2. Does your organization meet the def ni ion of a "large" organization as outli ed in
the November, 1988 revision of Sect on 409.21 of the Legislative Code? �
Attach to this application pertinen f nancial and/or organizational information to
support your answer to this questio . NOTE: Only 5 large organizations will be allow-
ed to open pulltab operations under th revised city ordinance. If more than 5 organi-
zations apply, qualified applicants wi 1 be selected randomly by the City Council.
3. Address where games will be held �. /,3 � � , /� .
N ber Street City Zip
4. Name of manager signing this applic ti who will conduct, operate and manage
Gambling Games ,�� � Date of Birth ,3-llp � �%
(a) Length of time manager has been e er of applicant organization 9 �
5. Address of Manager ��3/ . �lc.{,�,(C. /�/'� SS/��
Number S reet City Zip
0
6. Daq, dates, and hours this applicati n s for �� �� — /o� � /I?Ui✓- .SG�i✓.
7. Is the applicant or organization org ni ed under the laws of the State of MN? _���
8. Date of incorporation � �
9. Date when registered with the State f innesota l�j��
10. How Iong has organization been in ex st nce? �g-J�9
11. How long has organization been in ex st nce in St. Paul? 1���
12. What is the purpose of the organizat on. � � �/ ����L���.���Z�'��
13. Officers of app�.icant organization:
d
Name Name S
Address .37 � -�Lz�� Address �0 g� C l�i�
. Title I�Y � � � DOB Title �� �� B
� � I
Name Name �,
Address c�/�� �� � �� Address �03� o�.
Title /`�L'l�n�//1� OB�� Title �('C,l,� DOB ��1�D` -!
. . . ���-ia�°
14. Give names of officers, or any othe p rsons who paid for services to the
organization.
Name Name
Address Address
Title Title
� (Attach separa e heet for additional names.)
15. Attached hereto is a list of names nd addresses of all members of the organization.
16. In whose custody will organization` r ords be kept?
Name � f} �� 1J�11.,1.� Address /�Q �• /1�,j�i ����• •
17. List all persons with the authority o ign checks for dispersal of gambling proceeds:
Name K Name � r '
Address J� � �,cs�,(� Address 1a.3�
�r M ber of M r of
DOB 'J�o1�'�[Q Organization? ' DOB �-/(v - �� Organization? ��//�/
. . �
Name Name
Address �� Address
Member of Member of
DOB 3-3Q-5� Organization? DOB Organization?
18. Have you read and do you thoroughly d stand the provisions of all laws, ordinances,
� and regulations governing the operat n f Charitable Gambling games? �Q,r�
19. Will your organization's pulltab ope ti n be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or does it intend to sign, a consulting agreement or a
managerial agreement with any person r ompany to assist your organization with the
pulltab sales and/or recording keepin ? yes no /i-'
If answer is yes, give the name and a dr ss of the person and/or company contracted.
Name Address
Name Address
If answer is yes, how will such a con ul ant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a co of said contract to this application.
21. Operator of premises where games will e eld:
Name �"��'�.<� "� � � �
Business Address ��3 J�O. �(0 �
Home Address /�P'�� �(J�C1� �f �G� ��
� � � - . ��-i���
22. a) Does your organization pay or in e d o pay accounting fees out of gambling funds?
yes no �
b) If you do pay accounting fees, to ho will such fees be paid?
Name ddress
DOB Member of Or an ation?
c) How are the accounting fees charg t? (flat fee, hourly, etc.)
d) What do you anticipate will be you a erage monthly deduction for accounting fees?
23. Amount of rent paid by applicant organ za ion for rent of the hall:
� �UD. OC� G�. _
24. The proceeds of the games will be disb se after deducting prize layout costs and
operating expenses for the following pu po es and uses:
� �
25. Has the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization filed federal form 99 —T? /✓� If answer is yes, please attach
a copy with this application. If answer is no, explain why:
y� � � �75 ..
Any changes desired by the applicant associat on y be made only with the consent of the
City Coancil.
�, ,� �
Organization N
Date .S"�J 'O � By •
Man er in charge of game
.
✓
Organ ation President or CEO
- � . . � .� � ��-��3�
TO BE C MP ETED BY
ORGANIZATION PRESIDE T D GAMBLING MANAGER
I understand and will uphold Saint Pa 1 Ordinance 409, Sections 409.21
and 409.22 relating to pulltabs an ti boards in bars.
Further, I understand that my jarb r st meet city standards; that lOq
of the net profit from pulltab sal s st be returned to the City-Wide
Youth Fund on a monthly basis; tha m thly financial statements must be
filed with the City; and that 51� f t proceeds must remain in St. Paul
or be used to support St. Paul resi e s.
:,
/�„ ,��. . .
,
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Signature��-- Manager
f
Signature - rganization President
,�' '
rganization ame
. ,,� - � � �,
Gamb ing ocation
�- 1�- 89
Date
Please retain the att ch d ordinance for your records.