89-1360 WMITE - CITV �LERK
PINK - FINAN�E G I T F SA I NT PA U L Council
CANARV - DEPARTMENT
BLUE - MAVOR File �O. �_/���
� a cil Resolution 3�
Presented By ��=� �
Referred To � Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #92287) for the transfer of a Gambling
Manager's License cu rently held by Sheila Smith DBA Highland
Flockey Associatio a Joses' , 825 Jefferson Avenue, be and the
same is hereby ap ro ed for transfer to Susan M. Purvis DBA
Highland Area Hoc ey Association at the same address.
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
Dimond
�� In av r
Goswitz
Rettman � __ A a n s t BY
sche�n�� g
Sonnen
Wilson
_ Form Approv d by City Attor ey
Adopted hy Council: Date - -
Certified Passed Council Secr ry BY � /� �
By �
App ov y Mavor. Date _ Approved by Mayor for Submission to Council
By - BY
PUBl.lS#ED ��G 1 . 19 9
�,' - �-�q- /��
�, ,
DEPARTMENTIOFF.t�JCOUNCIL DATE ITL4 D
�i nance/�i cense GREEN SHEET No. 4 3 7 3
INITIAU DATE INITIAUDATE
CONTACT PERSON&PHONE �DEPARTMENT DIRECTOR �GTY COUNqL
Chri sti ne Rozek/298-5056 �M CITY ATTORNEY �CITY CLERK
MUST BE ON COUNqL A(�ENDA BY(DAT� NO �BUDOET DIRECTOR �fIN.8 MOT.SERVICES DIR.
8-1-89 �MAYOR(OR ABSISTMIT) �GnunriL Re
TOTAL A�OF SIGNATURE PAQiE8 (CLI AL LOCATIONS FOR SIGNATUR�
ACTION REQUESTED:
Approval of a transfer of a G mb ing Manager's License.
Notification Date: 7-12-89 Hearin Date: 8-1-89
RECOMMENDATION3:Approve(A)a Re�ect(R) COU CIL MMITTE[/RE8FARCH REPORT OPTIONAL
_PLANNIN(i COMMISSION _CIVIL SERVICE COMMISSION ANAL ST PHONE NO.
_CIB COMMITTEE _
—�� — COM ENTS
_DISTRICT OOURT —
8UPPORTS WHICH COUNdL OBJECTIVE9
INITIATIN(i PROBLEM,138UE,OPPORTUNITY(Who,Nlhat,When,Whers,Why):
Susan M. Purvis DBA Highland re Hockey Association at Joses' ,
825 Jefferson Avenue requests Co ncil approval of her application to
transfer the gambling manager s icense currently held by Shiela Smith
at the same address. All fee a d applications have been submitted.
All required divisions - Poli e nd Licensing have given their approval .
ADVANTAOES IF APPROVEO:
DISADVANTA(3ES IF APPROVED:
DISADVANTAOES IF NOT APPROVEO:
Cour;cil Research Center
JUL 17 iQ89
TOTAL AMOUNT OF TRANSACTION a COST/REVENUE BUDGETED(CIRCLE ON� YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPWN)
'� �� � �c�i i��o
DiVISION OF I.ICENSE AND PERMIT AD IN TRATION llATE � � CI p� / 7 3 J �
INTERDF.PARTMFNTAL REVIEW C:HECKLIS Appn P oc ssed/Rece ve by
Lic Enf Aud
► , 1
Applicaut Jl.(SGl rl � � �U�(Ut S Home Acldress /(p S� (..�/C�t Sprl
Business Name ► K � Home Phone �q �0 'Sa �v
Business Address Ov�J��� �S r1 U� Type of License(s) �Gcm�j�lnc� ��j�- 1 ✓unS�✓�
Business Phone
Public Hearing Date U � 0 License I.D. 4� -! `3` `� � 7
at 9:00 a.m. in the Counci C auib rs ���
3rd floor City Hall and Courthous State Tax I.D. �t
llate Notice Sent; Dealer 41 �'A
to Applicant — a—
I'ederal P'irearms 4� ��
Public Hearing
DATE NS EC'TION
REVIEW VERFIE ( OMPUTF.R) CUMMENTS
A proved ot A roved
�
Bldg I & D �
�.J,f} ,
Health Divn.
�
� �
i
Fire Dept. �
i N (} �
Police Dept. � `�� �
���� I � �
License Divn. � I �
nl �z biL
City Attorney �I(�� � Q !�
Date Receive :
Site Plan � I� G
To Council P.esearch � r? 0
Lease or Letter NI(� ate
from Landlord r�
' � ' C'ty of Saint Paul (,�4 7 ����
Department of in nce and Management Services
. Division of L ce se and Permit Registration .
INFORMATION RE UIRED WITH APPLICATIO FO PERMIT TO CONDUCT PULLTAB/TIPBOARD SALES IN
SAINT PAUL (Class B Gambling License in Liquor Establishments - New Application)
1. Full and complete name of organ at on which is applying for license
T�RE A �GK 5 �A'i
2. Does your organization meet the ef nition of a "large" organization as outlined in
the November, 1988 revision of ct on 409.21 of the Legislative Code? h.cT� ON�
Attach to this application pert e financial and/or organizational information to
support your answer to this que tio . NOTE: Only 5 large organizations will be allow-
ed to open pulltab operations u er the revised city ordinance. If more than 5 organi-
zations apply, qualified applic ts will be selected randomly bq the City Council.
3. Address where games will be hel �j J�. 5'�'• � tOa
Number Street City Zip
4. Name of manager signing this ap li tion who will conduct, operate and manage
Gambling Games Sv�SO„h '[Yl. VI Date of Birth (� . �2� • lk9
(a) Length of time manager has ee member of applicant organization �,f�
5. Address of Manager '�. Q l �
Number Street City Zip
6. Day, dates, and hours this appl ca ion is for M�.. -t=,�� 3-/ae. - n�_
7. Is the applicant or organizatio o ganized� under the laws of the State of MN? �
8. Date of incorporation
9. Date when registered with the S at of Minnesota m�c,i ly, /973
10. How long has organization been n xistence? �9,$"!�
. �
11. How long has organization been n xistence in St. Paul? /9SS
12. What is the purpose of the orga iz tion? �
• �t,�et�
13. Officers of applicant organizat on
Name Name ��2. � P"�1��,�1
Address (, �2�� Address /7�/ ��I�ii7 �r_
Title �E,�/p� DOB Title �ls�G � DOB /�-/a-�g'
Name Name �-�o�R..�kcrn I_`e.P�,tn2
Address Address 1 �� ��l
Title DOB Title ��►�1'S�1,iP.�(L DOB ('i9-a3
. .�� , (��i-i���
14. Give names of officers, or any o he persons who paid for servfces to the
organization.
,
Name DT Name
Address Address
Title Title
(Attach sep ra e sheet for additional names.)
15. Attached hereto is a list of nam s nd addresses of all members of the organization.
Ov Gt1,t
16. In wEiose custody will organizati n` records be kept? �
Name �. � � Address /�s"$��q��a��J�
17. List all persons with the author ty to sign checks for dispersal of gambling proceeds:
�
Name Name �LSQ,v� u,rq,�l S
Address �jQ,V�, Address �n5� (�g�3�p�� �tU�
Mem of Member of
DOB �2 a, � �-�;� Organization? DOB � -��-�.�j Organization? �/��
��—
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
I8. Hane you read and do qou thoroug 'ly nderstand the provisions of all laws, ordinances,
and regulations governing the op ra ion of Charitable Gambling games? V ES
19. Will your organization's pulltab op ation be operated/managed solely by members of
your organization? yes n� �
20. Has your organization signed, or o it intend to sign, a consulting agreement or a
managerial agreement with any pe so or company to assist your organization with the
pulltab sales and/or recording k p g? yes no _�
.
If answer is yes, give the name d ddress of the person and/or company contracted.
Name Address
Name Address
If answer is yes, how will such a' co sultant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Atta h copy of said contract to this application.
21. Operator of premises where games il be held:
Name E. �C:,� '�'
Business Address G� ZS�
flome Address ✓}'
� . ��-����
22. a) Does your organization pay or in end to pay accounting fees out of gambling funds?
yes �_ no
b) If you do pay accounting fees t whom will such fees be paid? r
�t'.�.4.u-�1
Name Address (�9� ,�r �„ � ,��AS
DOB �2-2l -��o Member f rganization? Ue,_�
�—
c) How are the accounting fees ha ged out? (flat fee, hourly, etc.)
d) Wh do yo anticipate will e our average monthly deduction for accounting fees?
��DO. o b
23. Amount of rent paid by applicant 'or anization for rent of the hall:
� �
24. The proceeds of the games will b d sbursed after deducting prize layout costs and
operating expenses for the follo in purposes and uses:
� ��
25. Has the premises where the games ar to be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization ed fede al form 990-T? p�p If answer is �yes, please attach
a copy with this application. I a swer is no, explain why:
�
Any changes desired by the applicant ss ciation may be made only with the consent of the
City Council.
i��c�►HLAN�� ��� �K�y �soc.�as�o�
Organization Name
Date By: , � ,
Manager in charge of game
� • w�
Organization Presi ent or CEO
�����
• � ' C�tv vt Saint Paul
Depanment f�F ance and Management Services
Li en e snd Permit Divislon �9���
203 City Hell
' St. Pau Minnesota 55102•298-5058
APP IC TION FOR LICENSE
C� CHECK ClASS N�. N�ew Rea
�x�
Date � �9 t9�..
Code No. Title of Lice�se From —�9 1�To .��� ���.
i
� :�,6 �.� � ' m _ � .
, � ��-�.�.,.�- .,�;'��-w'��--;
`�f, � Applfwet/ComPany Name
/ 100 ^
��� � ��� i/ - -
OC:�Gd..l1-(1i�G��'��`�.�"�'i'� �.�G�/.
' 100 � Ge�us�nesa Name
�1 ,, �/'' Ga
,00 �a�' �����x�.�r�
Busine�6 Addre7s Phone No.
�oo `� i
` �.- � / / ,o%%��C�
//T�h� �/iG�-Lct-�71/ �.
r 100 Mail to Address Phone No.
�' ,
100 _��� `// . � �,Gf�I�
Msneper/Owner•Name
100
l ��Gl� /E
� !��!�1�
100 Atana9eNGwnar•Home Address Phone No•
4098 APPIiCation Fee 2. 5p -
;: � }�
Received fhe Sum of 1� ��'�•` �(.L� ////if .
ManapsrlOwnsr•City,Slate 6 2ip Code
100 tal 100
� �
LiCBnse InspBCtOf ` By: _ Sipnature ol Applicant
Bond:
Company Name Policy No. Expiration Dale
Insurance:
Cort,a�y Na,ne POticy No. ExpiralfOn Date
Minnesota State ldentificatio�No Social Security No
Vehicle Information: ate Numbsr
$alal Numbe�
Other•
THIS 1S R CEIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your applicatfo for icense wflt eithe�be flranted or rejected Suttject to the provisfons ot the zoning
ordlnancs and completion of the inspectfons by the H Ith, Fire,Zoninp and/or Licanse Inspectors.
$15.00 CHAR � F R ALL RETURNED CHECKS
(�-" ,,�yl -��'� �' ��,,2l�t �
/
,�:
. r-'� .r_ -�; � .�-• � f�l.i'.
_ ��� _ _ �• -✓ _ �� L: '
' " � ' /3-��
_ ���.
T B COMPLETED BY
ORGANIZATION P SI ENT AND GAMBLING MANAGER
I understand and will uphold ai t Paul Ordinance 409, Sections 409.21
and 409.22 relating to pullta s nd tipboards in bars.
� Further, I understand that my ja bar must meet city standards; that 10�
of the net profit from pullta s les must be returned to the City-Wide
Youth Fund on a monthly basis, t at monthly financial statements must be
filed with the City; and that 51 of net proceeds must remain in St. Paul
or be used to support St. Pau r sidents.
C/�
Signature - Manager
Signature - Organiza on Pres de t
/7`��'sH[,Q�tJi — d c.
rganization ame �
�osc s �
Gamb ing Location
0
S" 9�
Please retain t e ttached ordinance for your records.