89-1452 WHITE - CI7V CLERK //''11
PINK - FINANCE �� COIlI1C11 (��✓/,`��
CANARV - DEPARTMENT GITY OF AINT PAUL File NO. U `�
BLUE - MAVOR ��,
�' • �r.,.._.._..._,.,
Council esolution y.� ,
�..___.�
Presented By
Referred To Committee: Date �y��
Out of Committee By Date
RESOLVED: That application (ID #96 O1) for renewal of a State Class B
Gambling License by Trad Lake Camp at 6. V. Peppercorn's,
1178 Arcade Street, be a d the same is hereby approved�ec�,�,-
;
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Long In Favor
coswitz J
Rettman B
�be1be� _ Against y
Sonnen
Wilson ���+
AUl7 � �J pp9 Form pproved y Ci y rney
Adopted by Council: Date
Certified Vass y ncil Sec By �
BY
Appr by Mavor: Dat _��j�� Approved by Mayor for Submission to Council
B By
�P11BL1S.'i�'i '�'J� 2 c 1989
. � - �-�1_ ��5�'
DEPARTMENTIOFFlCE/OOUNdL DATE'INITIA D
Fi nance/�i cense GREEN SHEET No. 4 �3
INITIAU DATE INI ATE
CONTACT PERSON 8 PHONE pEPARTMENT DIRECTOR CITY COUNpL
Christine Rozek/298-5056 �� CfTYATTORNEY �CITYCLERK
MUST BE ON COUNCIL A�ENDA BY(DAT� ROUTINO BUDOET DIRECTOR �FlN.8 MOT.BERVICEB DIR.
$-],�j-89 MAYOR(ORASSISTANn � CQ(,�nC�� Research
TOTAL#�OF SIGNATURE PAGES (a1P ALL OC TIONS FOR SICiNATUR�
ACTION REQUESTED:
Approval of an application for a St te Class B Gambling License Renewal .
Hearing Date: 8-15-89 Notification Date: �
RECOMMENDATIONS:Approve(A)or Re�ect(i� COUNCIL MMI EE/RESEARCH REPORT OPTIONAL
_PLANNINO COMMIS810N _CIVIL SERVICE COMMI3SION �LYST PHONE NO.
—CIB COMMITTEE —
COMMENTS:
—8TAFF _
_DISTRICT COURT _
SUPPORTS WHICH COUNCIL OBJECTIVE?
INfMTING PROBLEM,ISSUE,OPPORTUNITY(Who,Whet,When,Where,Why):
E. Thomas Bauer on behalf of Tra e ake Camp requests City Council approval
of their application for renewal of a State Class B Gambling License at
B. V. Peppercorn's, 1178 Arcade t. Proceeds from the pulltab sales will
be used to serve retarded handic�pp d youth with athletics and summer
camp activities.
ADVANTAOES IF APPROVED:
If Council approval is given, Tr de Lake Camp will continue 'to operate
a pulltab booth at B. V. Pepperc rn s.
,
DI3ADVANTACiES IF APPROVED:
Trade Lake Camp has contributed o number of St. Paul organizations including
the Union Gospel Mission, City Y ut Fund and Boy Scouts. Trade Lake Camp
has also given a number of campe sh ps to St. Paul mentally disabled youth for
the Trade Lake Camp program. Tr de Lake has willingly complied with our
ordinance requirement that 51% o e penditure must be used to benefit
St. Paul residents.
DISADVANTAOES IF NOT APPROVED:
Council Research Center
AUG 2 i989
TOTAL AMOUNT OF TRANSACTION = COST/REVENUE BUDOETED(CIRCLE ONE) YES NO
FUNDINd 80URCE ACTIVITY NUMBER
FlNANCIAL INFORMATION:(EXPLAIN)
. . r��,-��.�.�
DtVISION OF LICENSE ANI) P�RMIT AI)MZNIS'�RA ION DATE CP 3v � / � � ��
INTERDF.PARTMENTAL REVIEW CHECKLIST Appn rocessed/Receive by
Lic Enf Aud
---� �-. `t"hos � u tr--
Applicaut ( Y�i� �.G,K� �u v►�'a�y1(,,, Home Address �.SCj �tmC� ✓�D►7
Rusiness 1V'ame ����,�, �.�K Cq y� �- Home Phone
Business Address ' � " 1 � ►r�'�d.�5� Type of License(s) ��n e�(� ` l� �q SS
�j. U �2�✓C�✓�"`5 �
Business Phone � � C�;� „-� L� �., �
� -� PC ,(
Public Hearing Date �� Q License I.D. 46 �(! 0� '
at 9:00 a.m. in the Council Chambers, I
3rd f.loor City Hall and Courthouse State Tax I.D. 4� �I-�
llate Notice Sent; Dealer �� � I�
to Applicant $�'�
rederal Pirearms �� Jl���'
Public He�.�ring
DATE INSPECTI N
REVLEW VERFIED (COMPU ER) CUMMENTS
A proved Not A roved
�
Bldg I & D �
���.
Health Divn. �
�(�. '
,
Fire Dept. i �
I N�� i
� � o�
Yolice Dept. `1I3I� I
�1 t-L. 0 JL-
�
License Divn. '
�����-�, � o ��
City Attorney �
s� � � � pr�
Date Received:
Site Plan �� � $ L �
To Council Research
Lease or Letter / G Date
from Landlord l0 �0 r�
' Ci�y�of Saint Paul �
Department of Fin�nc and Management Services
Division of Lice�se and Permit Registration /)r,� �i/�
��� Y
INFORMATION RE UIRED WITH APPLICATION F0 P RMIT TO SELL PULLTABS 6 TIPBOARDS IN SaI�T ?AL'L
(Class B Gambling License in Liquor Establi hments - Renew)
1. Full and complete name of organizat�ion which is applying for license
. � � , �
2. Address where games will be held � / /� ..SG� � /V �5��
N mber Street ity Zip
3. Name of manager signing this applic�ti n who will conduct, operate and manage
Gambling Games , 1 OS Date of Birth �(c !�
(a) Length of time manager has been me ber of applicant otganization �� ?,��/"�
, � �
4. Address of �Sanager �.5� / /? OIt� AI< �p � D v�,
Number Street Cit Zip
5. Day, dates, and hours this application is for �G�,rt, / /lk c� �DO M �D �� �Da �
6. Is the applicant or organization or�an zed under the laws of the State of DIId?
7. Date of incorporation 3
S. Date when registered with the Stateilof Minnesota c��� ��r 1�1 � 3
9. How long Eias organization been in exis ence? �S e}9/�S
:
10. How long has organization been in exis ence in St. Paul? .S S
c..�--+ .
11. What is the purpose of the organiza�io '. o � �
4'�+ t�tl t � I� � � C�S ,
12. Officers of applicant organization: ,,
Name (��= s'� A� Name �°�
Address � ' /(�, �. Address Ll1' �
. �
Title �e.f'• ' DOB ���� � Title , , DOB �-3
:1ame ! � 0� Name �q.j ���
Address /��p N �i,.Q 1„ Address 1�"; �, �li]6•'�(.y�NH,�[�'� ��-
Title � � P_C DOB � Title ��. ��, DOB �
13. Give names of officers, or any other pe sons who are paid for ServiCes t0 the
organization.
vame � a Name �/�/n� <��'��C�R
Address p S Address �7 �JM,g-f2R01J
. �
TiCle � � Title e 1�
(Attach separate s eet for additional names. )
_ . . , �������
1�. :�ttached hereto is a list of names and a dresses� of all members of the organization.
15. In whuse custody will organization's rec rds be kept? �
, (� / (�!'� /
Name �i ►'VI ;i E� JPC � Address ��/D 7 �D� /�1V � V(_
16. List all persons with the authority to s gn checks for dispersal of gambling proceeds:
.
�ame ��e LL�.�,�Q� r= Name �„ / ps. �GC��2 _
r'�� (� -•�
Aduress �3 DO "�/I �SOr� .� SU.��'9� L Address �j G���/t�{���q�
Member of Member of „ S
DOB _��_ Organization? L /� , DOB �o p Organization? J/��7�Q ,
Name Name , - �,(,
?.ddress Address 7 C�! ' D
Member of Q' Member of
DOB Organization? DOB v ? � Organization? S,
17. Eiave you read and do you thoroughly unde stand the provisions of all laws, o dinances,
and regulations governing the operation f Charitable Gambling games?
18. Attached hereto on the form furnished by the city of Saint Paul is a Financial Report
which itiemizes all receipts� expenses, nd disbursements of the applicant organiza-
tion, as well as all organizations who h ve received funds for t e reced' calendar
year which has been signed, prepared, a verified by
.5 5 �i' � o,� L PI s
Add�less
who is the Q of the applicant organization.
ame '
19. Will your organization's pulltab operat 'on be operated/ma aged solely by members of
your organization? yes no
20. Has your organization signed, or does i intend to sign, a consulting agreement or a
managerial agreement with any person or company to assist your organization with the
pulltab sales and/or recording keeping? yes no
Ir answer is yes, give the name and add ess of the person and/or company contracted.
:�ar�e - Address
, �
:�ame � Address �
If answer is yes, how will such a consu tant be paid? (percentage, flat fee, gambling
:unds, general funds, etc.) Attach a c py of said contract to this application.
.
21 . Operator of premises where games will b held:
tiame �
3usiness Address � �t; V , �/�_.7�dlO
Home Address
� � � � - ���--i��a
�2, a) Does your organization pay or intend o pay accounting fees out of gambling funds?
yes �/' no
—T�—
b! If you do pay accounting fees, to who will such fees be paid?
:�ame �►y�niso�'T ,nv�'PR �,n , ddress �b72 �ier��„rr�P. ��•
DOB ? Member. of Organ zation? �_ ; _
c) How are the accounting fees charged ut? (flat fee, hourly, etc.)
� " T�,P t4� �— � �, c — r E Cs
d) What do you anticipate will be your verage monthly deduction for accounting fees?
, p 0 ��
�3. Amount of rent p id by applicant orga�iz tion for rent of the hall:
B�. ��
24. The proceeds of the games will be dispur ed after deducting prize layout costs and
uperating expenses for the fol�owing pur oses and uses:
, j S ^
^ w� A iu s �`
1
25. Has the premises where the games are �to e held been certified for occupancy by the
City of Saint Paul? S
26. Has your organization filed federal fo 990-T? S If answer is yes, please attach
a copy with this application. If answe is no, explain why:
Any changes desired by the applicant associa ion may be made only with the consent of the
City Council.
��
��l C ,
. nization ivam
Uate ( ��� By: � ^
Manager in charge oi gatae
/. �
r iz tion Presid t or CEO
. � �'��a�/
� • 'City o 5aint Paul
Depanment of Finahce and Management Services �/����.., /�5°2
License and Permit Division
203 ity Hall �
St. Paul, Minne ota 55102-298•5056
APPLICATIO FOR LICENSE
CASH CHECK CLASS NO. New Fienew
a � � .?
Date �J d 19�
� q
Code No. Title of License From 19�To ���� 1g /�
� .3�9, ,o� , .�� C�
� � �� � � ��.
ApplicanUCompa�y Name
100 Lz�
,/�4.� ,.
.
100 BusinessName ,/���
- 74J
�oo //7� �, 06 �'3��
! ^ Busi�ess Address Phone No. ��
' 100
� ��2�0 ��,, �u� � �7�°. �.����
' 100 Mail to Address Phone No.
100 � �,�C.d/, ��Cf��/Z�
M�Own
100
�
100 Alanage0pwner-Home Address Phone No.
4098 Applicetion Fee , 50
Received the Sum of 100 ���i/ ��G� ���!��
� � ManagedOwner-City,Staie 8 Zip Code
100 Total 100
7 1 !
j �
LiCense InSpeCtOr By: Signature of Applicant
Bond:
Company Name Poticy No. Expiration Date
Insurance:
Company Name Policy No. Expiration Oate
Minnesota State Identification No. /c��'�.338 Social Security No.
Vehicle Information:
Serial Number Plate Number
Other:
THIS IS A RECE PT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your application for Iicen e will either be granted or rejected subject to the provisions of the zoning
ordinance and completion of the inspections by the Health, Fire, Zoning and/or License Inspectors.
$15.00 CHARGE FOR LL RETURNED CHECKS �
_ � �
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1�iK-Lc:'t�'�2!. /��/ :�) f` / /�--�i
-
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' Clcy of S�inc Paul Psge l ��
Daparcrosnt of Fi�ane and Nanagsm�nt Ssrvies�
Divisioa ot Licsns� ad Yensit Adminiscracion
UNIFORl4 CtWtITABLB G LING FINANCIAL REPORT
_._—,
o.�. v�✓e �9 /y'�'�
l. Nam� ot Orgsnization
2. Add�as� vhere Chaslcabl• Casblin` is � ndueced �� � ���a� �Y • ^.
!
' 3. R�port [or p�riod eovsrin� � 19� thtou�h ��/'SiY � Si' I9�
4. Total numbec oE day� pl�y�d
S. Cro�� r�csipts foc abov• p�ciod f �0� 0��• �
/� Oa
6. Gross prits payou u fot sbov• p ulod ( cclud• eu h shorc) i �7�• �
- S� �0 � �
7. N�t reesip u - lln� S ainu� lia� 6 i � ���
8. Exptns�� Seeurr�d Sn eonductin6 and o •racing 6 me:
A. Gcoaa v�`ea paid. Atcach vork�� i�c vich �p
nam�s, addra�s��, `ro�s vag��, �u ber ot hours : /D,/6�, �'-'
vorked, and amount paid psc hour.
B. Rent for �� veeks f � ��-
c. ti�.n.. t.. s ... D _
D. Insurance s _ � r
E. Bond = — a +
D 00
t. Dishonorsd ch�ck• not rscov�red f o•
C. Aecountin� Expenss ', i �a�p,y�, BO
H. Employ�r• t.L.C.A. I
s '�6'� °-
/� /��jD �1
I. Pvlltab Tax Paid to D�partm�nt ot R�v�nu• i /. / / 7i
: � 00
J. Nian. U.C. Tax �' �
��,� 00
R. isdsral Exel�t Tax 3 Staap =
L. Sett• Cnblio` Ta�c = ^ ��
!t. Mi�c�llanaou� Exp�a�s�. Id�neif th� �moune
and Co vho�s p�id. �t���
�5��4 AGae ds v.s�� : '7 2b'Zg,ao
2. �9c�v�ar,Z��G : / �f a/ °1
.
�. 1vR.�MAis r. G�d t�rw �Wj� /o'��,°�'
a. s
9. 1'otal Bxpsn�si =�'j'� _ �����• �
L0� N�t Ineos� - lin� T ainu• lio� 9 3 �����• �
11. Ch�ckbook b�lane• b�`innin� ot p�rio = � �
12. Tou1 of lia• 10 aad 11 = � ��7-J- �
�
13. ToCal concrlbutions (tTO� accach�d v rkrh��t) _ �S���� �-
14. Checkbook balane• snd of r�porcing p riod - S � �O�'7 �O
lins 11 leaa llns 17 ��
. ' � ' „�ti;=�Ry _�rn "�•=_: ��•" ;'�.: " ; �^'�. .�. '_ .,�w PAGE 1
Li+WFUI. PURPCSc' C�N��;3"':�"�5 - 'NCRKS�{E:T � I�
li ne �13 - Total Lawful Purpose Contri b ti ons . S see page 2
l,i5t below all CheCks written from gambling f�nd5 which are ��!�y�y,5a'
charitable lawful purvose contribu ions . ihe totai dollar «
amounts of these checks must maLCh the amount claimed in
line �i13. Use additional sneets a necessary.
CHECK 9 DATE PaYEE CHECI� AMOUN PUR_ POSc
.___.�_
1 . 2424 0-04-88 St. Paul Union Gospe
Mission S 300 . 00 Thanksgiving meal for St. Pa
- homeless
2 . 3356 0-18-88 Prader-Willi Syndrom
St. Paul Assn . 500 . 00 Research for help for the
handicapped
3. 3366 1-01-88 City of St . Paul 86 . 00 10� donation of Peppercorn ' s
receipts (oct. )
4 . 2476 1-18-88 Trade Lake Camp, Inc. 3 , 365 . 00 St. Paul Youth - Special ✓
Olympic training
5 . 3389 1-28-88 ity of St. Paul 310 .00 10$ donation of Peppercorn ' s
receipts (Nov. )
6 . 3422 12-29-88 City of St. Paul 232 . 00 10$ donation of Peppercorn 's
receipts (Dec. )
7 . 1025 01-23-89 City of St. Paul 341 . 00 10$ donation of Peppercorn ' s
receipts (Jan . )
8. 1030 01-28-89 Minn. Regional Pois
Center of St. Paul , 300 .00 Donation to support center
TOTAL CHECK AMJUN S
yOTE: These expenditures will be provided t Council Members at your Council hearing.
8e sure that your financial report is complete and accurate.
.
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� PAGE 2 LaWFUL PURPOSc CONT�:3U i :ONS • ��10RKS�E:T PAGE 2
Line �13 • Total Lawful Purpose Contribu ions . s see TOTAL
List below all checks written from ambling funds which are
charitable lawful purpose cvntribut ons . The total dolla.r
amounts of these checks must �natc� ne amount claimed in
, line �13. Use additional sneets as necessary. �
CHECK 9 OATE PAYEE CHECK AMOUN PUR,POSE
_^
9 . 2608 02-27-89 Trade Lake Camp, Inc. $2 , 250 . 00 Assistance to purchase arts &
crafts for handicapped
St. Paul youth at camp
-
10 . 3479 03-01-89 oncordia College Ybu
Athletic fund I 300 . 00 Girls ' Y'outh athletic activit
11 . 1042 03--06-89 A Medical Equipment
Supplies I 1 , 622 . 00 Kristine Price - special #500
wheelchair for disabled
' youth (Danny)
12 . 2661 03-24-89 Boy Scouts of Amer�ic 300 . 00 Donation for youth activities
13 . 1049 03-30-89 Cities Correctiona'1
Officers Division 115 . 00 pecial training - drug
division
i.d . 1050 3-30-89 City of St. Paul 515 . 00 0� donation of Peppercorn' s
receipts (Feb. )
15 . 1054 4-13-89 Trade Lake Camp, �nc
fund transfer , 5 ,000 . 00 amperships for St. Paul yout
16 . 2112 4-30-89 Minn. Assn. for 250 . 00 Assist in education of
Children with Learn g � children with learning
Disabilities � disabilities
707AL CHECK AhDU T 515 ,786 . 00
NOTE: These expenditures �ill be provided o Council Members at your Council hearing.
Be sure that your financial report i complete and accurate.
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