89-1374 WHITE - CiTV CLERK COUflCll � /� �./
PINK - FINANCE GITY OF AINT PALTL
CANARV - OEPARTMENT i ff�
BLUE - MAYOR File NO• �
o ncil solution ������
_ �3
;
Presented By
Referred o Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #94 8) for renewal of a State Class B
Gambling License by Shop Po Gang, Inc. at E. K. LeMant's,
1199 Rice Street, be and th same is hereby approved��.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
-� _� In Favor
Gosw;tz
Rettman
s�6e;n�i _ Against BY
Sonnen
Wilson �����
fWp —� � Form Appr ved by City tor
Adopted by Councii: Date -
Certified a- ed by Council Secreta BY
����
�
By,
AUG — � � Approved by Mayor Eor Submission to Council
Approve y Mavor: Da e '
By
P116lfS�D AU G 1 � 1989
. . . . , ��i-�3��
DEPARTMENT/OFFICE/COUNGL DATE INITIATED
Fi nance/�i cense GREEN SHEET No. 4„�,E�,p�TE
CONTACT PERSON 8 PHONE D ARTMENT DIRECTOR �GTY COUNqI
Chri sti ne Rozek/298-5056 N�� C AITORNEY �arr c�K
MUST BE ON COUNCIL AdENDA BY(DAT� ROU7INQ B ET DIRECTOR �FIN.d MOT.SERVICES DIR.
$_3_89 � M OR(OR A8818TANT) � ` �1
TOTAL N OF 81QNATURE PACiES (CLIP ALL LO TI NS FOR 81GNATURE�
ACTION REQUESTED:
Approval of an application for rene a1 f a State C1ass B Gambling License.
Notification Date: Hearin Date: 8-3-89
RECOI�AMENDATIONS:Approve(N a Rek�(R) COUNdL RCFI REPORT OPTIONAL
_PLANNING COMMISSION _CIVIL 3ERVICE COMMI3310N ANALYST PIiONE NO.
_qB OOMMITTEE _
WMMENTS:
_STAFF _
_DISTRICT COURT _
SUPPORTS WHICN COUNdL OBJECTIVE?
INITIATINO PROBLEM,18SUE,OPPOR7UNITY(Who,What,When,Where,Why):
Sarah Kusterman on behalf of Shop P nd ang, Inc. requests City Council
approval of her app1ication for ren al of a State Class B Gambling License
at E. K. LeMant's, 1199 Rice Street. roceeds from the pulltab sales are
used to sponsor and promote amateur sp rts in the Como and Orchard Playground
areas. All fees and applications h ve een submitted.
ADVANTAOES IF APPROVED:
If Council approval is given, Shop on Gang wi11 continue to operate a
pulltab booth at E. K. LeMant's,
DISADVANTAOES IF APPROVED:
DISADVANTAOES IF NOT APPROVED:
Courcii Research Center
J�L 1'� i°89
TOTAL AMOUNT OF TRANBACTION : /REVENUE BUDOETEO(CIRCLE ONE) YES NO
FUNDINO SOURCE ITY NUMBER
FlNANCIAL INFORMATION:(EXPWN)
. » ,
. .
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAFLABLE IN THE PURCHASING OFFICE(PHONE NO.298-4225).
ROUTING ORDER:
Below are preferred routings tor the flve most frequent types of documents:
CONTRACTS (assumes authorized COUNqL RESOLUTION (Amend, Bdgts./
budget exists) T Axept.arants)
1. Outside Agency 1. Department Director
2. Initiating Department 2. Budget Director
3. Ciry Attorney 3. Gty Attorney
4. Mayor 4. Mayor/Assistant
5. Finance&Mgmt Svcs. Director 5. City Council
6. Finance AccouMing 6. Chief AccountaM, Fln&Mgmt Svcs.
ADMINISTRATIVE ORDER (Budget COUNCIL RESOLUTION (all others)
Reviaion) and ORDINANCE
1. Activiy Manager 1. Initfating Department Director
2. Depertment Axountant 2. Ciy Attomsy
3. DepaRmeM Director 3. Mayor/Aseistant
4. Budget Director 4. City Council
5. Ciy Clerk
6. Chief Accountant, Fin&Mgmt Svcs.
ADMINISTRATIVE ORDERS (all others)
1. initleting Department
2. City Attorney
3. MayodAssistant
4. City Clerk
TOTAL NUMBER OF SIGNATURE PA(iES
indlcate the#of pages on wh�h signatures are required and paperclip
each of these pages.
ACTION REGIUESTED
Describe what ihe projecUrequest seeks to accomplfsh in either chronologi-
cal order or order of importance,whichever is most approp�iate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the issue in question has been presented before any body, public
or private.
SUPPORTS WHICH COUNGL OBJECTIVE?
Ind�ate which Council objective(s)your projecUrequest su�orts by Hadng
the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDOET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
COUNCIL COMMITTEFJRESEARCH REPOFiT-OPTIONAL AS REQUESTED BY OOUNCIL
INITIATING PROBLEM, ISSUE,OPPORTUNITY
Explain the situation or conditions that created a need for ycwr project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is simply an annual budget procedure required by law/
chaRer or whether there are apeciflc wa in which the Ciry of Saint Paul
and its citixens will benefit from this pro�eCt/actbn.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past procesaes might
thls projecUrequest produce if ft is passed(e.g.,traiNc delays, noise,
tax increases or assessments)?To Whom?When?For how long?
DISADVANTAOES IF NOT APPROVED
What wfll be the negative consequences if the promised action is not
approved?InabiBry to deliver service?Continued high traffic, noise,
accideM rate?Loss of revenue?
FINANCIAL IMPACT
Afthough you muat taflor the information you provide here to the issue you
are addressing, in general you muat answer two questions: How much is it
going to cost?Who is going to pay?
. . ��—i3��
DIVISION OF LICENSE AND P�RMIT ADMINIS RA ION llATE � /� �� / � �� O �
INTERDF.PARTTfFNTAi, REVIEW CHECKLZST A.ppn Pro essed/Received by
_ n�i I Lic Enf Aud
f� t' �i'o s�l n <<c �"
Applicant �►'1,0 �prl� � ✓� Home Address �� °70 (,J, (.,� r�p,�tt'u r�
- Zo7
Rusiness Name �, k, � �q n'�S Home Phone
Business Address ���� �t(.Q �� Type of License(s) �f,n,p��,�— �l� S 5
Business Phone �1 ��' �� �{ �'P ,�j C`�q m b li nT�h cJ�Z- �p�
Public Hearin Date `
g � �3 �� License I.D. �{ � 13�
at 9:OQ a.m, in the Council Chauibers,
3rd floor City Hall and Courthouse State Tax I.D. �� ���
llate l�utice Sent; � /� �'� Dealer 4� /� ��'
to Applicant
rederal I'irearms �6 �Jj�
Pub.lic Ne�.iring
DATE II�'SPECT UN
REVIEW VEKFIED (COMP TF ) COMMENTS
A roved Not oved
�
Bldg I & D �
N !4-
Health Divn. �
�
� �
i
Fire Dept. �
� � � I
I
� SP_Y��'� � ( J
Police Dept. I
� I 5 `� p i L
�
License Divn. !
1 � Z � �L
City Attorney �
��� � o��
Date Received:
Site Plan �J��
o Council P.esearch � ( � ��
Lease or Letter G Date
f rom Landlord �Q 1 � 0 �
' � • City of Sa'nt Paul �����7�
Department of Financ a d Management Services
� Division of License an Permit Registration
IYFORMATION RE UIRED WITH APPLICATION FOR P T TO SELL PULLTABS 6 TIPBOARDS IN SaItiT ?AL'L
(Class B Gambling License in Liquor Establi hm nts - Renew)
1. Ful ^nd complete name of organization wh'ch is applying for Iicense
d'�c.�J�. �y� �
V
2. Address where games will be'� eld / f C '' � , � �L J �/
N mb r Street City Zip
3. Name of manager sig �ng this appli�ti n ho will conduct, operate and manage
/,ry
Gambling Games Gzl•-�H:-�L ��G,L- ��-�v Date of Birth /(�r �.3
/ '
(a) Length of time manager has been me be of app 'cant o ganization � �,�'
) ° �,� ' ,
4. Address of Manager �1 ..'� �i ��' -/�i►�c.� ,1'� /
Number S reet City Zip
5. Day, dates, and hours this application is for ,�� '� p�u� f��� ��r%/�, �%;pv��►�.
6. Is the applicant or organization or n ze under the laws of the State of :�IId? '�
, _iy✓G s
7. Date of incorporation � !�/� O �g�
8. Date when registered with the State of Mi nesota !�/Y�� !O� / q�'i"'f
9. How Iong has organization been in exis en e? �
10. How long has organization been in exis en e in St. Paul? � �4�
11. What ,is tre urpo e of the rganizatio ? � .���GG'�����
2;,`�G✓��� ��� � G�
� i' GZc� � �
, �,.
; � r
12. Officers of applicant organization: �
. � l' �/��
Name �'�(J � Name ' � o--�1¢r���:��c/
Addr s 3 a � ' � •�A7ddress/ �l � �' ^� ,�s�'�� d�G���Cct
, /3r.�/6o 4�1`'oLL: ; fj vn(Qf
Title � � �¢c�' DOB �3 ( Title y' � DOB � � �!
� O ,
.
;Iame � � l��i " Name l� '
,/ �/� �
Address ; 'f � .'�Z Address � :i • d�-�. r�.�
�NG5 �.
Title ..P.c� DOB � d Title ��-r�r DOB f a �-7
13. Give names of offi rs, or any other p rs ns who are paid for ServiCeS t0 the
organization.
Name Name
Address Address
TiCle Title
(Attach separate he t for additional names.)
>
. . . . i3��
� � � -�
1;. Attached hereto is a list of names and ad resses of all members of the organization.
15. In whose custody will organization's r co ds be kept?
Nam � ` d.�c=�;,�-C-Gc-C�N� Address p� �c�cl� �a7�
�� - r .
16. List aII petsons ith the authority to si n checks for dispersal df gambling proceeds:
, . �i � _ 7 � ��� L p
Nam�� f ���� Name ��-K�7' �o, �
Address �p� d � �c� '�a� �� Address ���Z�;�s.��` .,�e��,�1�
� ember of � Member of
DOB � � ,� 'U 'brganization? DOB 7� /�v U Organization? �
i �
Name ' �'%,Zr � � Name ,����'` .��
.
/ � �/
/ � � / �
:�dd ss��y��o�'". �•/�./ .�.� //7 Address �[��" (..,�"c�Y.c.�f�.- ���au.E. ���
Member of '' Member of ,
DOB � Organization? DOB ��� �'g Organization? 7�
��5'-
17. tiave you read and do you thoroughll un erstand the provisions of all laws, o� Ynances,
and regulations governing the operatio of Charitable Gambling games? !� ��
18. Attached hereto on the form furnished b t e city of Saint Paul is a Finan�ial Report
which itiemizes all receipts, expenses, an disbursements of the applicant organiza—
tion, as well as all organizations who av received funds for the preceding calendar
�. � ' ,. /} , (.�-��
year which has been signed, prepared, a erified by r1�..� c�'
, �
/ � U i'� � �J'���� auf_'� � . ��'�I/�
� ddress
(G �
who is the :.� of the applicant organization.
Na
J
19. Will your organization's pulltab operat on be operated/managed solely by members of
your organization? yes � no
20. Has your organization signed, or,,�does i i tend to sign, a consulting agreement or a
managerial agreement with any person or co pany to assist your organization with the
pulltab saies and/or recording keeping? yes no �
I� answer is yes, give the name and add es of the person and/or company contracted.
:�ame - Address
:�ame Address
If answer is yes, how will such a consu ta t be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a c py of said contract to this application.
�1. Operator of premises where games will b h ld:
ti'ame � I,i
Business Address � � � C� �'� ����v� /S'1/V� v.r//�
Home Address X ��� r<�G��� _ � 5 �. ��'UL-, /�'(�'`f� �l`���4�
. ' ,
����7T
2�. a) Does your organization pay or intend to pay accounting fees out of gambling funds?
yes 1/ no
b) If you do pay accounting fees, to wh m ill such fees be paid?
Name (�c�'i!LiR-Nl 1� , d.S�lgMf��! Ad ress �'`��' �O/�f�0 / �f1�t`, ,�r'?:Pv�, ;�!n(. ��/v�
C t
DOB 7 r� Member of Orga iz tion?
c) How are the accounting fees charged ou ? (fIa fee, hourly, etc.)
� �� ���
d) What do you anticipate wi�l be your av rage monthly deduction for accounting fees?
� ��U
23. �,mount of rent paid by applicant organi at on for rent of the hall:
24. The proceeds of the games will be disbu se after deducting prize layout costs and
op ating expenses for the following pu po es and uses:
��►-��.►�(/�� �C��v���� �c.1-J 0-�
.
�,�..,���'�,�.� G� ��a-�aJ��'. ,�—/� ��
r G��7 • `G��li`�1`�-��d� t4�au�/
25. Has t e premises where the g s are to be held been certified for occupancy by the
� � �
City of Saint Paul? �
26. Has your organization filed federa fo 9 0-T? e"�� If answer is yes, please attach
a copy with this application. If answe i no, �plain why:
Any changes desired by the applicant associa io may be made only with the consent of the
City Council.
�� � ��
� ,
rganization e
�r
il a t e �o `�`'� Y�,,��� �L�;?.�'�.+`ltL�_
\ Man er in charge of game
/�$r�g 'zation re ��\"'' /q'r CElJ /
. - � �:-��� /_ r�-� (�-[�-�LG��:�-/-t-�N'�
/i !� '��.-
/ /�`' %'-� �f' `V 1
_ —, ,.�— —� --�.____- � _ ____ � ,
_ , . . . � , 9`�y�.38
' City f Sa nt Paul
Department of Financ a Management Services
License an P �mit Division
20 Cit Hall �J����
St. Paul, Minn sot 55102•298-5056
APPLICATI N OR LICENSE
CASH CHECK CLASS NO. New new
� � �
Date �� ^� t9.�
Code No. Titie of License — ,
_ �
Fro � 19_To 19�
' � � �,� n C
,� .
�(� Applica Company Name� i
�oo : ,� F
/
100 Business ame ' '��l��,�_7/
n
°i�C
100 / .KL-Ci• ��
Business Address "one No.
100 /�' �D�
/a �o /r�. ��.���t��.,? ;
100 Maii to Address Phone No.
100 �/I'[�cX/�/���=�2,a-''./X�C—.b/
ManaperlOwner•Name
100
—�`�D �• �����%�1J �°Z°/
100 Atana9erlGwner•Home Address Phone No.
4098 Application Fee 2 50
Re¢eiXed the um of • 100 .�d(,{� �/j� ,
P� 1 3Jp�. ManageNOwner•City,SCSte d 2ip Code
100 Total 100
• ' ._�'-c�,�' C (' � •��� .v�-+'� ,c.<
i
LiCense InspectOr By: � ' , na ure of Appiicant
, �
Bond• '
Company Name Policy No. Expirotion Date
Insurance:
Company Name Policy No. Ezpiration Date
Minnesota State Identification No. ylso� '�J�D D ocial Security No.
Vehicle Information:
Se�ial Number Plate Number
Oth@f:
THIS IS A RECEIP F R APPLICATION "
THIS IS NOT A LICENSE TO OPERATE.Your application for Ilcense ili ther be granted or rejected subject to the p�ovisions ot the zoning
ordlnance and completion of the inspections by the Health, Fire,Z ninq and/or License Inspectors.
$15.00 CHARGE FOR AL R TURNEO CHECKS
_ o�,����� (-l� �9 ,� 7 � '-
. , . . _ . ' . � �_�_,� ��
City f S int Paul Page 1
Department of Fina ce nd Management Servicea
Division of Licene an Permit Administration
IJNIFORM CHARITABLE G LING FINANCIAL RSPORT
/� ' Date ! +
�� � � �.
1. Name of Organization /
' -, t;,
2. Addresa where Charitable Gam ng ie con ucted�� . • � .,5.�/�7
i : .,
3. Report for period covering 19� throush G� '� 19�
�
4. Total number of days played /�
5. Crosa receipts for above period ; �j 4�7'r• ��
6. Groes prize payouts for above period (in lude cash ahort) � �d�r7��' G�U
7. Net receipts - line 5 minus line 6 ; ��t��(7• Ta►
S. Expensea incurred in conducting and er ing game:
A. Gross aages paid. Attach vorker is with �
names, addressea. groea wages. n be of hours ; ��'���. ��
worked. and amoun[ paid per hour.
• B. Kent for �� weeka � �9 �j O. DU
C. Licenae fee : ��„��
D. Inaurance f "(7—
E. Bond s -^�--
` .� J
F. Diehonored checke not recovered i / �J`O•Z.�9
G. Accounting Expense ; f 3 U.UQ
H. Employers F.I.C.A. ; — ��
I. Pulltab Tax Paid to Department of Rev nue ; / ������
� J. Minn. U.C. Tax s ` �`
R. Federal Excise Tax 6 Stamp : ir�6���
L. State Gambling Tax s —f/'—
H. Miecellaneoua Expenses. Identify the amount
and [o vhom paid.
�.�,��,�- s 3
2. �� , s �:3
,
s. � s D.00
4. ;
9. Total Expenees TOTAL ; �9��0.3
10. Net Income - line 7 minus line 9 ; d�(Ot1 �lr�
11. Checkbook balance beginning of period � T�� ��
12. Total of line 10 and 11 = a�9 9�f��
�
13. Total contributiona (from attached vor ahe t) � ��� �3:.5�
14. Checkbook balance end of reQorting per od /
line 12 less line 13 � l������
� � ' � CI�'Y F T. PAUL ,. PA6E aZ
UNIFORM CHARITABLE AM LING FINANCIAL REPORT �I,�,u�� � � �f'
LAWFUL PURPOSE CONT IB TIONS - WORKSHEET �
. . @,=��i—/3��
Line #13 - Total Lawful Purpose Cont ib tions. $ f�����,5�
List below all checks written f om ambling funds which are
charitable lawful purpose contribu 'ons. The total dollar
amounts of these checks must ma h he amount claimed in
line #13. Use additio�al sheets as necessary.
CHECK # DATE � pAYEE CHECK AMOUN � PURAOSE
I� 4/�8 &'g ,d%�,�su.e�'�����;.-� 3.�0�,� �,:�--�`���'F'�s
�. i � / , f ,
l �.��` ,' �ac<-�i / �•Iv 3 a .`�� %'?��'�'�'"� .`��"y12�� �
2. rr?3 �� ��,�y� �� �,�� ; � i � -y��i��j� ,�°'``-- .
3. . �� �= v�-�l�S ��w�-�,��'°'`'�" /3 y�s� ���N��. _. ---=---
� ' ` � / ' / '!�,�� ;�,�%�,,,.1.��
, ; / � � '
4. i(�� /���'���8 ;'� ,�/ � /'7 a.�3 �/ •� ^ �
� j'� � ~ r � ��_ ��-r,�,t�;, �L��N''�
1 ,' � •�����/ ���. , L7 �
5. ,I � C /L)�J7�j'J� � i � s Y Jf.�'�?,�'ir�ts;gt„-�,:
� z-�..� /�
5. ���i i�/�i�/�� 1��������`,�`��` Jl 7��� ��, / ��,�_ i--� , ����
� ,. 9i5��_ ���►�--�,�
�p �� " ,
�. r�g,�- /��'��pS " y �/ t�62vi I°°ti1�/N'��'
(�j �? �,�` �y '� i�('r���1��C1/P(l�. ��E!
r /�-�r�✓���T^�"` � (.�.6�� ' � y,}M��f�`��h��
�. l��3 r�/ib;��� ��-- ,; , / G� i�/°j�?�.. �ir�,`�
9. l�� l l� �, �'1�� MCT�,� ��i¢'fl�Y �'wc�s TIP�+cTCR ;'`�cf'�trR
� f( /6
� .�v, 00 �' ' D�'E�
�o. �rg6 �r/��l�s R�L(E� Gifl��Z�X7'ESoFM'K �
, aa.�ov i�� ����-_ co,�o ���� ;�����
�L. /�9.� �y�5�88 �:f�rcK M��� ,rT
��. ,y�c�. �o �o��-E y � s�E�o 5�-�r;,��
���� ���5��� (�/I°r'�.� S J�0 R`f`� / C�vlF'MEiv'T5�-SvPP�-r GS
J3. � � I � ( !'l '�l�� �E Cl�' S��I�S iN�E/ql�' �(�•00 J�j°cEOS I�`�n/�!'��1�S E Y�
TOTAL CHECK AMOU T �030�. (�
NOTE: These expenditures will be provided o ouncil Members at your Council hearing.
Be sure that your financial report i c mplete and accurate.
_ � .. 3 „ . '»
�ti'V�Mnnn�v►, � � �1\��,- ,= i : � a .~i = '� � : e > w '-�i.:
� � r .. � • e� > °' o z � � c+
� � � , � � � � w .� /� '� ( A a � � � '��
� . � �`� � - � .'.. I�-' � '� ♦ O " � � a ; � "'�w
� < � w O � _ = Y � • t O >
� � p ��`� � � • O � � 1 r � `� w � 1> ._. �.�
�. .. � i � = s
t ^ _ -'� �. � T 7 � Z p � "' s a�1
p, � ^' � w � � � v • 7 � O �7�
_ . �_ (+ ` '� IA � i
� . .� � {\ �s N � '� � � a l � � � a
(�� A 1 � � �
f' _ ' � \, s � '�.ti� .� � �t a ' � � I � 1 f J
<' .' . .; ; a ' �s �\}` w O � � ; .�vv � � A vvv > >
y � 7
- - i �. � � � � • � � i � � � 4 7
�- , h v � v �
� .. ; ; � ��J •� _ .�. a t y � „ e a a � �
� � a � r � �
i �i 1�1`� � � • r s - �
J; ' � � � � w '� �
` � ' ^ � '�
1 � �
.> � �. � � r �t � q
:;�,,,r�.���� �� � � , � ; � i � j � >
� � �� � A -
� � �
� � � i '`�' � �
� \; '�� i I� �' � z
� � " CITY OF T. PAUL PAGE Z
UNIFORM CHARITABLE 6 LING FINANCIAL REPORT ����� �� Lj--
LAWFUI PURPOSE CON I TIONS - WORKSHEET �
. . ��-/3��
Line #13 - Total Lawful Purpose Cont ib tions. $
List below all checks written f om gambling funds which are
charitable lawful purpose contr bu ions. The total dollar
amounts of these checks must ma ch the amount claimed in
line #13. Use additional sheet a necessary.
CHECK # DATE � PAYEE � � CHECK AMOUN PURPOSE
1�- /l a� iI j�����4 ��"�.��- ,��/ .��3,�9� C�trY ti�'tv� y'a��� -r���c. �yN�
;
y .,, , � . � ^ tl-1;�• .� SNoP�n/'D �i�Tl`f f{ocKE y pLr�y��f5.
1� �%�11,� %r���g��'�' 1f'(,�,",�,z�,�'``'��t' °� ° fAR r;c!i'�Or('F'E7SNE G'�(�'i�i cC3%�y/b�q
� /N�cv airr(a C•nti/ES9s r��/t'�n!r5.
�� _ ��U� �a���;g� �?i r�/' �,f 5i. ;'"%�vL al rf,w.S c�ry w�oE�7"r�rt1'�rrft�r��;��
' !
�,�,1`��..��' ' 700,v v . � � "'�-'
�7 /�a ��-�� � '"� .f ,� w��-;�
� � � ~� , �� ` � .9 s'' ��.� T���-.�� ,sr�
�y �,��� f�,���y ,,,�.���� .;�-� � � � � ': ,� �-.�;��,�,�..�
102. I Il.l�� y',!��� , �iF�yr� �j-a v a /3�t.�u.e�i�h.,aJ���c
tq �� � � ,�
�� i'�T�li�'S
/��13�, �j''�-m/���'�`'�� /�fl, i.�, ,oc���/' : �����
�� 1°�f 3 � � " - � �6��c � ; � �,4,��h.,�-�-�
; �' �
�►I /a r`� i��8(8� � `�'�"`,`.�,ti'��- !,' , �'/ � '� G��.,�
� ..J��U�'o Y� -
�. /�.�� !/i$/�$y � � � • ` �
7 gs'o o �� a�.��.�
� /a r 6 ���s�(gq ��� ���
. ` 6 �-�� �o o. 8 0 ?" �`,�, ,
�u- Jd r� ��a f� ,�� ��- �
,, ��►�-� �`e".
�� /�f ;ly6�,g9 � �.�� /�,i�' J�`� °�
� � �
�,� �� 3ilS " 0 -�'c� ..'°,7`-�" Ca�ry'��rrv E��nf ����r�N�
/� /� , 9 °i� � -
TOTAL CHECK AMO NT $ (o ( .
NOTE: These expenditures will be provided to ouncil Members at your Council hearing.
Be sure that your financial report is mplete and accurate.
r • � � '� �
? v i T o � � _ ' �
� w ��
.. .. • C > a� � a � z � � C A
� w � .=i t� ' . ( •� � � A + �
• ; � Q w � .�i ♦ Q � ��
! 1 i � w � s s s i • � � o r
' ♦ e > r O w � � � � 3!1
w �. }�1 A � ? ! ,7� II
� ` .s. w S 2 � � � � � a n �
� ^ � � PI N � � � a ! � O A �
w a i � � • � s � � > � a
� a � w � t ^ 4 : j O !1
s A A O � • ] A � � i
. V ` w �.rv w n ...rv 7� � 7
i 3 � � y w • �
e �
� � r w � d ; � `��t � � �
� � � t � �a C
.�i O ^ � � i 3 � i � .
� '� 7 • • � n w � i
� s � 3 I � i
? n ! � -� 3 ,''�.��
� 1 ( a �R J _ =
� ; ; �-' i •
;� s �� �i a
a� y I I i I
i
� � CITY F T. PAUL PAGE 2
UNIFORM CHARITABLE AM LING FINANCIAL REPORT �ifE�T 3 of�
LAWFUL PURPOSE CONT IB TIONS - WORKSHEET
. ��/3��
Line #13 - Total Lawful Purpose Cont ib tions. $
List below all checks written f om gambling funds which are
charitable lawful purpose contr bu ions. The total dollar
amounts of these checks must ma ch the amount claimed in
line #13. Use additional sheet a necessary.
CHECK # OATE � PAYEE CHECK AMOUN PURPOSE ��
� ����y �,�.��,�.�.�.��*-�t-�� ,?�a oc� �.���l r'�'t'�`
�� r�a.� ; `( ` .
�� �a:�� �%a��g ���� ,����-�' i���`' ' , %'�� '
, �, �,,�..,�,�.:�,���'G
�� _ �� a���( �''-z ,,��'',r�..�. �.�����"
� /�'� -��/� Q` � .�'r�G� ✓<'f�cl`��'on�.c� �K� �'►t T=S �
�4 %v�c�ti4 =���(��� % G�'�-' � �- Fi�'' !� f'�7`Rc.S
.. O RM���- . _. ..�,��_ ' r .
/ " 7 �yti,� / � ���� ���0� ��`�`� ` •!,,;
�r 1�.ac1 �!�/�'q ��°f''�, ` � •f.--
� f � ��(r���
� , � 3� ��/�.�-% �, ;, ��-,�� 7P��r� Y4�����E �
3�- �a�� �f l 9 v � �, ; .� ,.
� !� '/ J 4 /, �� bi � � � U O ,[�`�L �� ,1G.i Lc�..� ��
3.7 ��u�8� � �-�' � � 'r� �� v ,� � �� x
� � i �D-U v �
� �� � , (�' /� � � � ,�ri�l��c •
�� l p� �� '�J�(i�b� , ) ' , , r��^�PKi4/'�1� �
'' J(\�} � � -� � � ..,,,�-�c�I"����k��� '1
3s �d�t� �l�a� //:y'.� ��,� ���•�'i ��` ����a�.1�'-�
. //.-,� ��. J ��;�� /
36 f � �(��� ����"� , `�9� �, J.d;.�.. M-f��'
a� �'��`� ;�
r� � /.��
/ �� � a� ���
�� �a�6 `��� �f ��'���� _ P,�� M -Y
i. �, ���
, /�-- �5 F� s'�°P
f / �� '1 tio�twf''
� ���.U� �� �� e�es �°�Rr��r PAr�rr�
.g l� � �r�`�I gq '.1,/� � � l �� �C�yr6�Fn�ECK"�rt�s,—�,�5�
f �Rto05. .
��c7W��K /" ��'�_
'�� �a�"1 `��oT�� /�?i�N'�sc�R Gv�4-L /po.00 ,t"'` ��
� �-� �
V'
V
TOTAL CHECK AMOU T ( .7j,0�
NOTE: These expenditures will be provided o ouncil Members at your Council hearing.
Be sure that your financial report i c mplete and accurate.
+ .. r = e� s � �=
� � .�. o C ! � � i C s � C"
� O
"" _ .1 ! O 2 � � !
� w .� .� l7 � � O .�s A O. i�'
� w ,y � v ,� p �a
" � ,. o . _ _ � r : : � � or
� � • � � .r o 3
♦ �. � 7� :. � w w ! _ �
j A s ,7�
� � .S. � � a o •. � s � � �
" � � n W � � � a �s
�' s � '� ° . a 7 i � � A
_ � .. a
vv s '�' � � � : � '
� +'1 � • a a e � � �7
r � w 0 � wvv � � � v�v � � 7
' a 3 y � i w s '� s 1
. � v .� • � .. v • � -�
�
7 A � � � A 4 4 � 1
> > � ! A = � •
• O � • ^ ' ^ � �
' � � I •
� ^ � I -1 � � .=
: -� � i � � =
� �
� .
a : , ,
� : � � �
� i I � i I
� - CI�Y F T. PAUL PAGE 2
UNIFORM CHARITABLE A LING FINANCIAL REPORT �.r.�EG� �oi�"
LAWFUL PURPOSE CON IB TIONS - WORKSHEET
. . �- ��� �y
Line #13 - Total Lawful Purpose Cont ib tions. $
List below all checks written f om qambling funds which are
charitable lawful purpose contr bu ions. The total dollar
amounts of these checks must ma ch the amount claimed in
line #13. Use additional sheet a necessary.
CHECK # DATE ' PAYEE CHECK AMOUN PURPOSE
� ��.� ✓�!�'� � .,��ccY���'�`'' � (v�o.�p ,�r /°c����
Y' . �� � '
, l
�.��
�r I.���� .����r� C��=�� �=� a ' � .�°�� `�;Q�'�`�r�-��
� � -e:�---- ---- ----�- --
�� � ia,��, ������ ���.���v°�',� 3�a•:�S � ' - �-
,.
� . . � � � ,��v
' 1,�.5� .✓�/o y � ,�'.-l'��'�'�`-o ' � t�.G e:- �`a-' a.da,�-a-�- .
�hs � r � � �i? , �� ,,�.Y.�—����
��� �
-� /, �c'O.9-Ci ,� `�"' � ..�...�-�-J
� '
�-� Iv�✓l� ��a(�� �a� . ��
� � .
��
� .
� '
�;
TOTAL CHECK AMOU T
NOTE: These expenditures will be provided o ouncil Members at your Council hearing.
Be sure that your financial report i c mplete and accurate.
.r � � .� w � r .� 3 w
_ � .�i i � > w � •� 3
�. � a � z � � C�
�1 � A �
� � � .1 l7 A O � A b ��
.� • a •� a. ,. o w
! 1 i w � � s s T i i � � o>
A r A I� � A � ^ � = 7 ? � Z �
' � w �s a o + � z � i
■'„ s w n � '� � � � a �
� e� tw ! � � •� O :�s
' ,� , ; � � : : ; � > �a
: i a � I " � o e � 'a �e+
, .o
• A 1 A �
� C
. r A � i 3 vvv A ��v � � �
A � i A • '� � 1
: � � � � � � v �
� .'. a t �- � e r �
.� a ,^� s .�. : �
� a • �
• w 7 � � ^ � � i
� � �
r � : � _� ; �=
� ; � � � � >
� I ^ '1 w
� s y i
.'1 S 7�i 7� �
�� i I � i
1