89-1482 WHITE - CITV CLERK COUflCII
PINK - FINANCE GITY OF AINT PAUL
GANARV - DEPARTMENT �//��
BLUE - MAVOR File NO.
. � ouncil Resolution �71;
Presented By /
Refer d Committee: Date
Out of Committee By Date
RESOLVED: That application (TD # 2003) for the transfer of a Class A
Gambling License by Me rick Companies, Inc. at 1060 University Ave. ,
be and the same is Y�er by approved for transfer to 733 Pierce Butler
Route.
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
Dimond
�� [n Fav
Goswitz
Rettman `7
Scheibel A gai n s t BY
Sonnen
Wilson �� ,� f y�p�
iD�i� Form Approved by City or "
Adopted by Council: Date /
� �"'/��j
Certified Passe uncil Se tar B
By
Approve b Mavor: Dat � , � � Approved by Mayor for Submission to Council
By B3'
�UBLiSl�ED �+'J G 2 6 1989
.. . . . .. , ��—�'�'�'�
DEPARTMENTIOFFICE/COUNqI ^ DATE I ITIA D
Fi nance/l.i cense GREEN SHEET No. �L� 1
CONTACT PERSON&PHONE �Nmw DA7E 'INITIAUD TE
Chri sti ne Rozek/298-5056 ❑DEPARTMENT DIRECTOR �GTY COUNqL
NU F �CITY ATTORNEY �(�TY CLERK
MUST BE ON COUNCIL AOENDA BY(DAT� NO �BUDOET DIRECTOR �FIN.Q MOT.BERVICEB DIR.
H-17—H9 �MAYOR(OR AS8ISTANT) ��AU�C�� R
TOTAL#OF SICiNATURE PAtiES (CLIP ALL OCATIONS FOR 81GNATUR�
ACTION RE�UESTED:
Approval of an application fo�r e transfer of a Class A Gambling License.
Hearin Date: 8-17-89 ' Notification Date: 8-1-89
RECOMMENOATIONS:Approve(A)or ReJect(R) COU L MITTEEJRESEAR�1 REPORT OPTIONAL
qNp� PHONE NO.
_PLANNING COMMISSION _CIVIL SERVICE COMMISSION
I
—CIB COMMITTEE —
OOMM NTS:
_STAFF —
_DISTRiCT WURT _
SUPPORT3 WHICH COUNqL OBJECTIVE? �
INITIATINO PROBLEM,ISSUE,OPPORTUNITY(Who,Whst,When,Where,Whyg
Merrick Companies, Inc. requ sts Council approval of its application for
the transfer of location of C1 ss A Gambling License from 1060 University Avenue
to 733 Pierce Butler Route. All fees and applications have been submitted.
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ADVANTAfiE3 IF APPROVED:
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DISADVANTAGES IF APPROVED:
OISADVANTAOES IF NOT APPROVED:
�, Co�„c�l Research Center.
AUG � i�89
TOTAL AMOUNT OF TRANSACTION a COST/REVENUE BUDOETED(qRCLE ONE) YES NO
FlJNDING SOURCE � ACTIVITY NUMBER
i
FINANdAL INFORMATION:(IXPWN) !
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NOTE: WMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASIN(i OFFlCE(PHONE NO. 298-4225).
ROUTING ORDER:
Below are preferred routings for the five most frequent types of documents:
CONTRACTS (assumes suthorized OOUNCIL RESOLUTION (Amend, Bdgts./
budget ex�sts) Accept. Grants)
1. Outside Agency 1. Department Director
2. Initiating Department 2. Budget Director
3. Ciry Attorney 3. City Attomey
4. Mayor 4. MayorlAssistant
5. Finance 8�Mgmt Svcs. Director 5. City Council
8. Finance Acxounting 6. Chief AccountaM, Fin&Mgmt Svcs.
ADMINISTRATIVE ORDER (Budget COUNCIL RESOLUTION (all others)
Revision) and ORDINANCE
1. Activiry Manager L Initiating DepaRmeM Director
2. Depertment Accountant 2. City Attorney
3. DepsRmeM Director 3. MayoNAssistaM
4. Budget Director 4. Ciy Council
5. City qerk
6. Chief Axountant, Fln&Mgmt Svcs.
ADMINISTRATIVE ORDERS (all others)
1. Inkiating Department
2. Ciry Attorney
3. Mayor/Assistant
4. qry Clerk
TOTAL NUMBER OF SI(3NATURE PAGES
Indicate the#of pages on which signatures are required and paperclip
ea�ch of these pages.
ACTION RECIUESTED
Deac�ibe what the projecUrequest aeeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
isaue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the issue in question has been preseMed before any body, public
or prNete.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objecUve(s)your projecUrequest supports by listing
the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET,SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
COUNCIL COMMITTEE/RESEARCH REPORT-OPTIONAL AS REQUESTED BY COUNCIL
INITIATING PROBLEM, IS3UE,OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
,Indicate whether thfs is simply en annual budget procedure required by law/
charter or whether there ere specific wa in which the Ciry of Saint Paul
and its citizens will benefit from this prorecUaction.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past processes might
this projecUrequest produce if it is passed(e.g.,traffic delays, noise,
tax increases or asaessments)7 To Whom?When? For how long?
DISADVANTAC3ES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved? Inability to deliver service?Continued high traffic, noise,
accident rate? Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addreasing, in general you must answer two questions: How much is it
going to c�st?Who is going to pay?
. . l��-����-
DiVISION OF I.ICENSE AND P�RMIT ADMINIS RATION DATE � 3l o / / O / � /
INTERDF.PARTMF.NTAL KEVIEW CHECKLIST A.ppn ro essed/Received by
Lic Enf Aud
A �licant /� Y�G� l.p ')el>fn �G►^-�1/1-eltl,( �
P� e 1� �'Y►�h�PS nG Home Address /1��'( ����V��S
Rus ine s s hame Home Phone 7 7�- (O c��
Business Address 3 �erc �� Type of License(s) �Q� � ��mb/�/lti
Business Phone L 1 C,?.�ISQ, �a/15 �C �'
Public Hearing Date O � D License I.D. 46 q a u�3
at 9:00 a.m. in the Counc" C ambers,
3rd floor City Hall and Courthouse State Tax I.D. �� i1,7'�
llate Nutice Sent; Dealer �� U��}
to Applicant �l
I�'ederal Fi.rearms �� �I/Q
Public Nearing
DATE INSP CTIUN
REVIEW VERFIED (C MPUTER) CUMMENTS
A roved N t A roved
Bldg I & D �
� ,
Health Divn. �
� �
i
Fire Dept. �
j � �- �
I I
Yolice Dept.
�I3� � O ��
�1
License Divn. I�
8�� ��ti ` b
,
City �ttorney �
`6 l �� , � K�
Date Received:
Site Plan � 3� 6 Q 3 � 4
To Council Research v �
Lease or Letter --� � G C� Dat
' from Landlord � �
. . . . . . Y. , �t� .. . , . . . . . . . . . . . , . . .. . , .. - � . � , �.
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation;
New Officers:
Stockholders•
,
- ; . . � • City o Saint Paul
' ' Finance and ManagemenC Se ��ices/License & Permit Division (��"�����
INFORMATION REQUIREll WITli APPLICATION FOR ERAtIT TO CONDUCT CtiARITABLE GAMBLING GA,"[E LiJ
SAINT PAUL (To be used with the following New A � C application. renew A � C
Licenses, and new and renew B in Private C ubs.)
1. Full and complete name of organiaatio which is applying for license
Merrick Com anies , Inc .
2. Address where games will be held 73 Pierce Butler Rd. St. Paul, Mn =55104
umber Street City Zip
3. Name of manager signing tt�is applica ion who will conduct, operate and manage
Gambling Games Francine Kubits hek Date of Birth 5/26/63
(a) Length �of time manager has been ember of applicant organization 5 y ea r s
4. Address of Manager 7760 53rd St N . Lake Elmo, MN 55042
� Number Street City Zip
S. Day, dates, and hours this applicati n is for Sunday year around 6 : 00-10 : 00 p .tn .
6. Is the applicant or organization org nized under the laws of the State of MN? Yes
7. Date of incorporation 3/8/72,
8. Date wtien registered with the State f Minnesota 3/8/72
9. How long has organization been in! ex stence? 2 5 years
10. How long has organization been in, ex stence in St. Paul? 25 years
11. What is the purpose of the organizat on? To provide l�abilitation progracns
for ersons who are develo me tall disabled .
12. Officers of applicant organization:
Name Ja ne Frank Name Bob Faricy
Address 1055 Wilson St . St. P ul Address 350 Cedar St. #555 St . Pau_
551 G 55101
Title President DOB 10/23 2 Title Secretary DOB 11/15/26
Name Ann Mosher Name Barbara Ileintz
Address 5239 15th Ave . S . , �1 ls . 55417 Address 1821 Howard St. , Ma�lewoocl
551U9
Title Vice PresidentDOB 2 24 2 Title Treasurer DOB 2/29/60
13. Give names of officers, or any othe persons who paid for services to the
organization.
Name N/11 Name
Address Address
Title Title
(Attach separa e sheet for additional names.)
. - (,�,� -����.
�
� 14. Attached hereto is a Iist of names a d addresses of all members of ttie organizativi�.
15. In whose custody will organization's records be kept?
Name Kevin Martineau Address 1728 Gervais Ave. Maplewoocl
55109
lb. List all persons with the authority o sign checks for dispersal of gambling proceeds:
Name Kevin Martineau Name Jayne Frank
Address 1728 Gervais , Maplewoo 55109 Address 1055 Wilson St. , St. Paul
Ptember of Member of
DOB 4/20/51 Organization? Ye DOB 10/23/21 Organization? Yes
Name Bob Faric Name Barbara Heintz
Address 350 Cedar St . #555 St. Paul Address 1821 Howard St. , Maplewood
Member of 55101 Member of 55109
DOB 11/15/26 Organization? y s DOB 2/29/60 Organization? Yes
17. a) Does your organization pay or int nd to pay accounting fees out of gambling funds?
yes no X
b) If you do pay accounting fees, to whom will such fees be paid?
Name N/A Address
DOB Member of 0 ganization?
c) How are the accounting fees char ed out? (flat fee, hourly, etc.)
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? Yes
19. Attached here[o 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 J a yne Fra nk
1055 Wilson St. , St. Paul, MN 55106
Address
who is the President of the applicant organization.
Name
20. Operator of premises where games wil be held:
Name Militar Order of the Pu le Heart Ct�a ter #5
Business Address 208 Veterans Se vice Buildin St. Paul MN 55155
Home Address N/A
,
� . �� ��'a�
'L1. Amount of rent paid by applicant organiz tion for rent of the hall:
$650 . 00 er month
22. The proceeds of the games will be disbur ed after deducting prize layout costs and
operating expenses for the following pur oses and uses:
To Purchase equipment, events , a /or programs for the mentalLy
retarded adults who attend the d y habilitation programs provided by
Merrick Companies, Inc.
23. Has the premises where the games are to e held been certified for occupancy by the
City of Saint Paul? yes
24. Has your organization filed federal for 990—T? yes 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.
Merrick Companies , Inc.
Organization Name
n /n �
Date 7/31/89 By: �
Ma r in c arge of game
Organ zation res ent or CEO
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C ty of Saint Paul
Department of Fina ce and Management Services �
� License nd Permit Division ����1��
203 City Haii
St. Paul, M nnesota 55102•29&Sa56
APPLICA !ON FOR LICENSE
CASH CHECK CLASS NO. ew Renew
0 0 x �
. oace � ,s��
Code No. ' Title of License ' From 1�To J � 19��
a�.3� oZ �4.S5Q - � t'n���n •� �C /' —
,� ✓r l< < 0 ,�n��s -� n
n � AppllcanUCompany Nama
100
� 3 3 �i e ✓cc.. ���l�rz ���
100 Buslness Name
,oo �T• �a c,�.-f� l�7�
Business Address Phone No.
100
100 Mail to Address Phone No.
ioo �� V�,� /�''�G r����� �
ManagerlOwnet•Name
. �oo , �7-� � f
1 ��-� (�� vtx<.� 5 6a�G
100 AtanagerfGwner•Home Addrosa Phone No.
4098 Applicatfon Fee 2, 50
Recefved the Sum of t S- �Cf (.�. ' �Y� �'�j J �� �
I ���� `
ManagerlOwner•City,Stafa 3 tip Code
100 To I 100
LiCense Inspector 8y: �� ` Siynature ot Applicant
Bond: �
Company Name Policy No. Expiration Date
InSUfaf1C@:
Company Name Policy No. Expiration Date
Minnesota State Identification No a��7� Social Security No.
Vehicle Information: a�aier►umoer
Serial Number
Other:
THIS IS A RE EIPT FOR APPLICATION
THIS IS NOT A UCENSE TO OPERATE.Yourapplication f,or li ense will either be granted or rejected subject to t�e provisio�s of the zoning
ordfnance and completion ot the inspections by the Heatth, re, Zoniny and/or License inspectors.
$15.00 CHARGE FO ALL RETURNED CHECKS
�-l�rn 1 C� Co � n L v�✓s,`�
�s/�!!/n 4/ 8'—�[l Cl /�1 l � �