89-1479 WNITE - CITY CIERK 1
PINK - FINANCE COUflCll
BLUERV - MAVOqTMENT GITY OF AINT PAUL File NO. �� /��
Eou il. Resolution ��
Presented By
Referr Committee: Date
Out of Committee By Date
RESOLVED: That application (ID' #9 943) for the transfer of a Class A
Gambling License by the Nels Wold Chapter #5 Military Order of
the Purple Heart curren Ty Tocated at 1060 University Avenue,
be and the same is here y approved for transfer to
733 Pierce Butler Route.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Lo� [n Favo
Goswitz
Rettman � B
s�ne;n�� _ Against Y
Sonnen
�Ison
Adopted by Council: Date
AUU' � 7 �(� Form rove by C' torn
Certified Yas e b uncil S ta BY
c �—��
By,
I#ppr ed y Nlavor: Date AUG � Q Approved by Mayor for Submission to Council
By
gZ�,� �U G 2 6 19$9
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DiVISION OF LICENSE ANI) P�:RMIT ADMINI TRATION DATE � aZS (r� / 7 � O �
INTE,RDF.PARTMF.NTAi. KEVIEW CHECKLIST A.ppn Pro ssed/Recei ed by
Lic En� Aud
_,�/e�� CQr I ��(�Ct�ws/�l,
Applicaut (f I t' VH �Yd�►� d� _ /{��-llome Address ��(a �{ Ch�✓�PS �U�
,�t
Rusiness Name ' Home Phone aaa"�( 3
Business Address �33 IQ✓'C?J � �� Type of License(s) �Q$S�'T'��l.Yrl(7��!!�,
Business Phone ' Ll GPi11Se ' �rans �✓�'
Public Hearing Date g /1 O g License I.D. 4{ � �/ y3
at 9:00 a.m. in the Council Cha�nbers,
3rd floor City Hall and Courthouse State Tax I.D. �� IJIq"
llate Notice Sent; Dealer �� /V'p'
to Applicant 8'� g
Pederal I'i_rearms �� �1 1�'
Public He�.iring '
DATE TI3SP CTIUN
REVIEW VERFIED (C UTER) COMMENTS
A proved N t A roved
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Bldg I & D �
I�J I f}
Health Divn.
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Fire Dept. I �
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Police Dept.
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License Divn. !
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City Attorney �.
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Date Received: �'
Site P1an � 0� 2
To Council P.esearch � J �
Lease or Letter —7 � �^ ate
from Landlord t S �
CURRENT INFORMATION NEW INFOKMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Boud:
Workers Compensation;
New Officers:
Stockholders•
. City of aint Paul C��/��,/
' - • Finance and Management Serv'ces%License & Permit Division
INFORMATION REQUIRED WITH APPLICATION FOR P IT TO CONDUCT CHARITABLE GAI�IBLIVG GAME Iv
SAINT PAUL (To be used with the following: New A & C application, renew A & C
Licenses, and new and renew B in Private C1 s.)
1. Full and complete name of organization which is applying for license
Nel W �
2. Address where games will be held 7 3 Pierce Butl r
N ber Street City Zip
3. Name of manager signing this applicati n who will conduct, operate and manage
Gambling Games Bett Jean Falkow ki Date of Birth 7-6-29
(a) Length of time manager has been m ber of applicant organization �iT a,.�
4. Address of Manager 364 Charles Av . St . Paul , Minn. 55103
Number Street City Zip
S. Day, dates, and bours this applicatio is for Every Friday evening-7 : 30 -11 : 30 P. M
6. Is the applicant or organization orga ized under the laws of the State of MN? Yes
7. Date of incorporation June 8 1935
8. Date when registered with the State o Minnesota June 8 , 1935
9. How Iong has organization been in ex' tence? 57 Years
10. How long has organization been in ex'stence in St. Paul? 57 Years
11. What is the purpose of the organizat on? To aid and assist hospitalized veterans
and their families . To look after the good and welfare of the needy citizen.
of the communityand to promote the ideals of the Military Order of the
urp e eart , w ic are Patrio ic , Fraternal and Educational .
12. Officers of applicant organization:
Name Eugene P . McDonnell Name Eugene Capoistrant
Address 2194 Powers Ave . 55119 Address 218 E. &th St. St.Paul,MN55101
Title Commander DOB S/26/23 Title Sr. Vice Cmdr. DOB 10/15/25
Name H. Boyd Teig Name Carl A. Falkowski
Address 2131 Burns Ave 55119 Address364 Charles Ave .
Title Finance Office�OB 6/8/15 TitleAdjutant DOB 3/7/23
13. Give names of officers, or any othe persons who paid for services to the
organization.
Name Name
Address Address
Title Title
(Attach separ te sheet for additional names.)
. - . . C'��- ��19
14. Attached hereto is a Iist of names nd addresses of all members of the organization.
15. In whose custody will organization' records be kept?
Name Address 364 Char1PG AvP _
16. List all persons with the authority to sign checks for dispersal of gambling proceeds:
,
,Name Carl A. Falkowski Name EuQene McDonnell � �
Address 364 Charles Ave . Address 2149 Powers Ave .
Member of Member of
DOB 3/7/23 Organization? ye DOB 5/26/23 Organization? Yes
Name H B d Tei Name Bettv Jean Falkowski
Address 2131 Burns v Address 364 Gharles Ave .
Member of Member of
DOB 6/8/1 S Organization? y DOB 7/6/2 9 Organization? Ye s .
17. a) Does your organization pay or int nd to pay accounting fees out of gambling funds?
yes no
b) If you do pay accounting fees, to whom will such fees be paid?
Name Address
DOB Member of 0 ganization?
c) How are the accounting fees char ed out? (flat fee, hourly, etc.)
I
18. Have you read and do you thoroughly nderstand the provisions of all laws, ordinances,
and regulations governing the operat on of Charitable Gambling games? ves
19. Attached hereto on the form furnishe by the city of Saint Paul is a Financial Report
which it .emizes all receipts, expens s, and disbursements of the applicant organiza-
tion, as well as all organizations w o have received funds for the preceding calendar
year which has been signed, prepared and verified by
Address
who is the of the applicant organization.
Name
20. Operator of premises where games wil be held:
Name Nels Wold Chapter #S;Milit ry Order of the Purple Heart
Business Address 2�8 Veterans Ser ice Building , St .Paul , MN . 55155
Home Address 64
�.�.�_ ���9
21. Amount of rent paid by applicant orga ization for rent of the hall:
22. The proceeds of the games will be dis ursed after deducting prize layout costs and
operating expenses for the following urposes and uses:
23. Has the premises where the games are o be held been certified for occupancy by the
City of Saint Paul?
24. Has your organization filed federal f rm 990-T? If answer is yes, please attach
a copy with this application. If ans er is no, explain why:Welf are assi stance to the
hospitalized veterans and their families , Community Service. programs of the
i e or aaizations • Volunteer
service programs at the V. A . Ho pitals at Mpls . and St . Cloud ; the assistance
1 office Bld which
assist indi ent veterans in the r claims against the V.A. for injuries re-
Any c�i�r�g��sddel�irg�ebyt��� ��1��� �o� �ti�ogu�r�e made only with the consent of the
City Council.
ceived in the time of duty to t e country . We also assist the County Service
officersin furthering the educa ion of veterans and rehabiiatation back
into the community . M; l ; r_arv Order of the Purnle Heart #5
Orga i2at on Name �
Date �/��/�� ', BYs .7�'L �
�/- Manager n charge of game
c�
ganization President or CEO
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, _ ' " � City of 'aint Paul
Department of Finance nd Management Services /� yG _�� �q
License and Permit �ivision � 0 '7
203 ity Hatl
SL Paul, Minne ta 55102•29&5056
APPLICATIO FOR LICENSE
CASH CHECK CIASS NO. New Renew
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. oa�e � ��
Code No. ; Title of License From ��/ 192LTo � 19�
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,oa
ApplicanU pany Name �
100
100 8uslness Name
, ,� ��.:��� ��.
' Business Address Phone No.
,00 � � aaa-3a i3
,36�� ,,LQ��'� �cP o��
100 Mafl to Address �Phone No.
100 ��—t J L�( F 'G 1�c--l�-/ ���
ManapeNOwner-Name
100 � � .
X��Q–�
100 AtanagerlGwner•Home Address Phone No.
4098 Application Fee , 50
ReCefved the Sum of 100
ManagedOwner•City,State 3 Zip Code
100 Total 100
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LiCense Inspector � By: /� Siqnatute OI AppliCant
Bond•
Company Name Poliey No. Expiration Date
Insurance:
Company Name Policy No. Expiralion Oate
Minnesota State Identification No. Social Security No.
Vehicle Information: Pia�e Number
Serial Number
�tfl@f:
THIS IS A REC PT FOR APPLICATIOp
THIS IS NOT A LICENSE TO OPEHATE.Your application for lice e will either be granted or rejected subject to the provisions ot the zo�ing
ordinance and completfon ot the inspections by the Health, Fir Zoning and/or License Inspectors.
$15.00 CHARGE FOR ALL RETURNED CHECKS
�`��, Z , C� ��i lO,f�
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DEPAR7MENT/OFpb^••FJWUNqL DATE INITIA I D
Fi nance/l.i cense � GREEN SHEET No. 4413
INITWJ DATE "INITIAUDATE
CONTACT PER30N 8 PHONE pEPARTMENT DIRECTOR CITY COUNCII
Chri sti ne Rozek/298-5056 p� Tr aTroari�r g aTV c�RK
MU8T BE ON COUNCIL AOEN�A BY(DAT� ROUTINO DOET DIRECTOR �FlN.8 M(�T.8ERVICEB DIR.
8-17-89 MAYOR(ORA8318TANTl � Council
TOTAL#�OF SIC�NATURE PAQE8 (CLIP A� L ATIONS FOR SIGINATUR�
ACT�ON REQUEBTED:
I
Approval of an application for �he transfer of a Class A Gambling License.
Hearing Date: 8-17-89 Notification Date: 8-1-89
RECOUAMENDATIONS:Approve pq a Rejsct(R) COUNCIL I ITTEE/RESEARCH REPORT OPTIONAL
_PLANNINO COMMISSION —pVIL SERVICE COMMISSION ANALYST ' PHONE NO.
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_CIB COMMITfEE _
COMME
_STAFF —
—DISTRICT COURT _ I
SUPPORTS WHlpi COUNpI OBJECTIVE9 i
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INITIATINO PROBLEM,ISSUE,OPPORTUNITY(Who,Whet,When,Whsre,Wh»:
I
Betty Jean Falkowski , on behal� o the Ne1s Wold Chapter #5 f�ilitary Order
of the Purple Heart, requests �ou cil approval of her application to transfer
a Class A Gambling License fro 1 60 University Avenue to 733 Pierce Butler Route.
All fees and applications haveibe n submitted.
'
ADVANTAQE3 IF APPROVED:
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DISADVANTACiEB IF APPROVED: ^
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DISADVANTA�E3 IF NOT APPROVED:
T _ _ _ _ _ __ _ _ Cou^cil Research Center
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� �UG 3 i�89
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TOTAL AMOUNT OF TRANSACTION s � COST/REVENUE BUDGETED(CIRCLE ON� YES NO
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FUNDINO SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) I
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