89-1373 WHITE - C�TV CLERK
PINK - FINANCE COURCII
CANARV - DEPARTMENT G I TY SA I NT PA LT L 3��
BI.UE - MAVOR File NO. ^'/
Cou c Resolution ��
��
Presented By
Referred To Committee: Date -�J�
Out of Committee By Date
RESOLVED: That application (ID 13 98) for renewal of a State Class B
Gambling License by T nn rs Lake VFW Post #8217, 1795 E. 7th St. ,
be and the same is he eb approved/�i�3.
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
Dimond
�� � In vo
�.ewltP
Rettman /
scne;ne� _�1'Z__ Agai st BY
Sonnen
.�i�ilee�r' �
3 9 Form Appr ved by Ci At rney
Adopted by Council: Date � • v ` ��
Certified Pas-ed by Council Secretar BY v
gy. 6��''��o�lit�.c, /�l L�=�-�
� � " � Approved by Mayor for Submission to Council
A► pro y Mavor: Da
By
�us�A �u � 1 � �sa9
. . , . . �-�y i��..3
DEPARTMENTlOFFICEICOUNqL f DATE INITIAT
Fi nance/�i cense GREEN SHEET No. 4 �7 5
CONTACT PER80N S PHONE DEPAHTMENT DIRECTOR INITIAU DATE ���NpL IN IAUDATE
Ch ri sti ne Rozek/298-5056 �� aT•Ano�N�r c�TV c�.e�c
MUST BE ON COUNCIL AOENDA BY(DAT� ROUTINO BUDOET DIRECTOR �FIN.6 MOT.SERVICEB DIR.
8-3-H9 MAYOR(OR ASSISTANn � Counci 1 R
TOTAL#�OF SI�iNATURE PA(iES (CLIP ALL OC TIONS FOR SI(iNATURE�
ACTION RE�UESTEO:
Approval of an application for a ta e Class B Gambling License.
Notification Date: 7-14-89 Hearing Date: " "`
RECOMMENOATIONB:Apprare pq a Rsject(R) COUNqL M RCII F�PORT OPTIONAL
pNALyS'T PHONE N0.
_PLAWNINO COMMI3SION _qVIL SERVICE COMM18810N
_qB OOAAMfTTEE _
CONAMENTB:
—STAFF —
_DISTRICT COURT —
SUPPORTS WHICH COUNqI OBJECTIVE?
INITIATIN(i PROBLEM.ISSUE,OPPORTUNITY(Wlw,Whet,When,WMre,Why):
Raymond Snouffer on behalf of Tan er Lake UFW Post #8217 requests
City Council approval of his appl ca ion for renewal of a State Class 6
Gambling License at 1795 East 7th St eet. Proceeds from the pulltab sales
are used for lawful purposes as p es ribed by the State Charitable Gambling
Control Board. Al1 fees and appl ca ions have been submitted.
ADVANTA4ES IF APPROVED:
If Council approval is gfven, T-a ne s Lake VFW will continue to operate
a pulltab booth at 1795 E. 7th St ee .
DISADVANTAOES lf APPROVEO:
DISADVANTAOE8 IF NOT APPROVED:
� vvH1�V��1 1\\rV`.NI V�� �enter
JUL 24��
TOTAL AMOUNT OF TRANSACTION a COST/REVENUE BUDOETED(CIRq.E ONE) YES NO
FUNDINO SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(D(PLAIN)
. . _ . . . ��"/3�3
UIVISION OF LICENSE AND P�:RMIT ADMIN ST TION llATE � o�� U I / � a � � /
INTERDF.PARTMFb'TAL REVIEW (:HECKLIST Appn Pro ssed/Rece' ed y
Lic Enf Aud
Applicant rl �I�pu--F� Home Address
Rusiness Name I1r1 S � Home Phone
Business Address � ��� � � �l ���Type of License(s) �.Q,�� - �-�455
Business Phone $ ��,W� �j1,,�� �� ��,,,, ��
Public Hearing Date ,�j � � � License I.D. 46 I ��.P�b
at 9:00 a.m. in the Council Ch mbers, �
3rd floor City Hall and Courthouse State Tax I.D. �1 '�J �
llate Nutice Sent; Dealer �1 ��/�
to Applicant � I� �
rederal I'irearms �� � �
Pub.lic Hearing
DATE II�SP 'CT UN
REVIEW VERFIED (C MP TER) CUMMENTS
A roved t roved
�
Bldg I & D �
uI� �
Health Divn.
1
i � �
i
Fire Dept. �
j �`-�)�' �
! se n� � � ��
Police Dept.
�► �3 ��� � 1�--
License Divn.
;
��� � � o� �
City Attorney �
� I�g(� , bc�
Date Received:
site Plan N �
To Council P.esearch � �
Lease or Letter � ate
from Landlord
. City of Saint Paul nj_!��/3'�
' Finance and Management er icesiLicense & Percnit Division (�"��
L:VFORI�4�TION REQUIRED WITH APPLICATION FO P R�fIT TO CONDUCT CHARITABLE Ga.uBLI�G G�.`!E I`;
SAI:VT PAUL (To be used with the followi g: vew � & C application, renew :� & C
Licenses, and new and renew B in Private Cl bs.)
1. Full and complete name of organizat on which is applying for license
i� iii� �i ' e os F �
2. Address where games will be held � u L� J~
N mber Street City Zip
3. Kame of manager signing this applic ti n who will conduct, operate and manage
Gambling Games , .S�/��Hi-� � Date of Birth �- l�7
(a) Length of time manager has been me ber of applicant organization t�j/�S
—7
4. Address of Manager �%o L`" . ,✓Gc S, . q� ��//
Number Street City Zip
5. Day, dates, and hours this applicat on is for o,�,r $',�}��' �-/l " .,S�r.c% �- 9: 30
6. Is the applicant or organization or an zed under the laws of the State of MN? y�
7. Date of incorporation y�j
8. Date when registered with the State of Minnesota j Q'� f
9. How long has organizatfon been in e is ence? �� �h? S
10. How long has organization been in e is ence in St. Paul? �Q �? S
lI. What is the purpose of the organiza io ? �/'Q,�,�'r�Y� .� d � /-oI?�I�JA/ W/�Rs
12. Officers of applicant organization:
Name .y c � C Name �a/�7 l�L _ L $%e/���2 yt..s
Address � Address ��f /'/G��A7't /7VrE__
Title �__>71+����G�s?� DOB Title �� �j C �.' __ _ DOB D /(v 'yj
Name ,� � C Name �'��gp y�C � S E L. �f�R�,S
Address Q L ! Address fi 5�5��ff $�csr/V; (lH/r���. 1 Z�V,
Title ��i7, I//C e DOB 3 Title DOB ��� s c?�i
13. Give names of officers, or any othe p rsons who are paid for Se1^V1C2S t0 the
organization.
Name /��i�,�R,� � C � Name �if6En�E � Sc`L�.H�?17 S
Address L e /t v ' Address ���p S��.57'• /�'j ���`�
Title p �t '� � Title QUA��rfy' /�'fAS'�f,�
(Attach separa e heet for additional names.)
� . � ��-�3�3
14: Attached hereto is a Iist of names nd ddresses of all members ot the organizat�cr..
�
I5. In whose custody will organization' r cords be kept?
Name �u�t=�dr ���.H.e>S Address lo�`f� 1'���,5'i A� DA��.��6.5'ai�y
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
�
�tame yl/ ,S' ��uF-E� ;Iame �i?f1,d��s �?'.pL�
address ��J % E D,C�.�l�is� Address ,��D,�yE/1 �A .
Member of Member of
DOB � g-.Z 7 Organization? F DOB t"7' z � Organization? �S
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
17. a) Does your organization pay or in en to pay accounting fees out of gambling funds?
yes X no
b) If you do pay accounting fees, t w om will such fees be paid?
Name j�(Z(� p, ,:,l( C.Fr Address �S`� (.,)1�.'�-c� Q¢� �`cr 5T Qa•%�.�
Mr� i���S
DOB � Member of rg nization? �t1J
c) Aow are the accounting fees ch rg out? (flat fee, hourly, etc.)
��n .
18. Have you read and do you thoroughl u derstand the provisions of all laws, ordinances,
and regulations governing the oper ti n of Charitable Gambling games? yC,r
19. Attached hereto on the form furnis ed by the city of Saint Paul is a Financial Report
which it .emizes all receipts, expe se , and disbursements of the applicant organiza-
tion, as well as all organizations wh have received funds for the preceding calendar
year which has been signed, prepar d, and verif ied by `[�t�,fL�c J �A�.'.l 1 ��'S- _
�S`� � � , - c� Rvti , i ��-- rv1� S�<<'�
Address
who is the � 1 �' of the applicant organization.
Na e
20. Operator of premises where games w 11 be held:
Name '(f\� ,��f'S Lal�,.¢, Po°� ��.J �' �'s3�1
Business Address �7� 'i '� Si' P r.�,;L M r� sS� i �
Home Address 5'�^'��
' � . � � ��-�373
L1. Amount of rent paid by applicant organ za ion for rent of the hall:
22. The proceeds of the games will be disb rs d after deducting prize layout costs and
operating expenses for the following p rp ses and uses:
I.�A1,.� �v� v� C S� A� �.�"S�iL. +b Z!� ` o m 1', N
f�:� �iSt-�
23. Has the premises where the games are o e held been certified for occupancy by the
City of Saint Paui? �'
24. Has your organization filed federal f rm 990-T? �E 5 If answer is yes, please attach
a copy with this application. If ans er is no, explain why:
Any changes desired by the applicant asso ia ion may be made only with the consent of the
City Council.
V�i.' �i�? T u�„f�s ��+,c� �s>
Organization Name
Date `- Y(���J� By: .C� ,.�
Manager harge of game
I � "�'C.��/1.. G�L `.t-��
Organization President or CEO
� 7 � 9 e 3� � � ^ � 1 _ �'
� 1 �� � :i :i + ..
^ ,� � .�I i O(` S � 7 + � � _
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�r 7
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9
- � - - /3�9�
V Cit of S int Paul
- Department of Finan e a d Management Services
License a d ermit Division ��J-/.373
2 C' y Hal1
St. Paul, Min eso a 55102•29&5056
APPLICATI N FOR LICENSE
CASH CHECK CLASS O. N Renew
� /�
� Date � �� 19 `-' �
Code No. Title of License From�L 19�To 19�
3 �. �,GS:� � - <* Irrt �i n' � � /
I � a �,r�a r �� C�l. r��, ��,5 � J � �
� � � ApplicanUCompany Name �� '� "7
/
? i y 5� ��-r, �`� .
00 8usiness Name
� �q �j
00 � 1 � J � L! � . � ( il �J I � !
Business Address Phone No.
OQ
00 Mail to Address Phone No.
r- ;
0o L.:�„�.cr; ... ,� 1I�,v� �
Manaper/Owner-Name �7 7
100 /...�GI J.
lo �`�( � S `?-r� �f � SD 7 0�
100 �tanagerlGwner•Home Address Pho�e No.
r4pQ8 AppliCatlon Fee
2 5`0 J �
Recelved the Sum of , ��4--� ��� �� � � `� � �� n �� ��
�� > Ma�aqedOwner•City,State 3 tip Code
100 Tot I 100
�` � � �.>jit� �'���� �
(�, 1 ,:
LiCBnSe In5p8CtOr �-,�� By: Signature of Applicant
Bond:
Compa�y Name Policy No. Expiratio�Oate
Insurance:
Company Name Policy No. Expiretion Date
Minnesota State Identificatlon No Social Security No.
Vehtcle Information:
Serfal Number Plats Number
Other:
THIS IS A R EI T FOR APPIICATiON '
THIS IS NOT A LICENSE TO OPERATE.Your application for I en wilt either be granted or rejected subject to the provisions of the zoning
ordlnance and completion of the inspections by the Health, ire, oning andlor License Inspectors.
• -
$15.00 CHARGE F R LL RETURNED CHECKS
�����i' � —a��� !� �- � ' J
' ' " ' • ' Cit of Saint Paul Page 1
� Depar[ment of F ane and Management Services
Division of Lic as nd Pernit Administration ��i3 7,3
UNIF'4RH CHARIT E LINC FINANCIAL REPORT
Date lo� 1 °l ' z i
1. Name of Organization �v_.�� ��Ef` = �-�� �)F�-� r �'� � �
2. Addreea vhere Charitable Ca�bling is ondueted ���� r =e•�en '�,,� S T ' (� � S �
1!
3. Report for period coveriag �''� l 19 5� ehrough �� t� 19 ��
4. 2ota1 number of days played
y � l.'� 7�
S. Cross reeeipta for above psriod ; -'
6. Groas prize payouta for above pa iod (ineluda caah short) s 3'1 a��3`f
7. Net receipts - line 5 miaus lin� 6 i ��' S a�
8. Expenses incurred in conducting nd pezating gma:
A. Gross vages paid. Attaeh vo ke list vith I � �„3
namaa. addreases, groas vag . ber of hours �
worked. and amount paid par ou .
B. Rent for veeks : — O -
C. License fee ; 3� �
D. Insurance ;
E. Bond = ��
F. Dishonored checka not reco re S
G. Aceoanting Expense ; '� v ? �
H. Employera F.I.C.A. _
�� < � 7
I. Pulltab Ta�c Paid to Depar ent oE Ravenue ; � � , �
J. Hinn. U.C. 'fax :
R. Federal Excise Tax 6 St ; �C� '�
L. Stats Casbling Tax ;
H. tiiscellaaeous Expsnses. den if� ths monnt
and to vhoa paid.
�. ��„�: ��. , r..L . . ..-, a�_ps �a�
z. c.�s- -^; :_��,o� _�,b = lyn� �
,____— �
3. �?e�t <s�.�� –�� �S � Gf���
�. _
9. 'Iotal Facpsnses TO?AL : 53 g y 3
10. N�t Inaos� - lina 7 �iuus li s 9 = � °�'���
11. Cheekbook balanca baglnniag f p riod ; �y y ??
12. Total of line 10 and 11 s ��� ��
�t�: 3 3o y� R�nw.M�.� c1=� �/ _
" 13. Total coatributions (from a tae d vorlu eet)� �_� �� � � �3 / ��
sr pw...-� �
14. Checkbook balanca ead of re rt ag period - I � ,�--� �
line 12 leas liaa 13 ; ' "- '°