89-1484 WHITE - C�TV CLERK
PINK - FINANCE C I TY O SA I NT PA IT L Council
CANARV - DEPARTMENT
BLUE - MAVOR File NO. `/
Counci esolution �q ,
Presented By
Referred To Committee: Date L�./�/��
Out of Committee By Date
RESOLVED: That application (ID 12905) for renewal of a Class B Gambling
License by Johnson, Ar a Hockey at Governors, 959 Arcade Street,
be and the same is he eby approved/�_
COUNCIL MEMBERS Requested by Department of:
Yeas Nays '
Dimond
�ng [n Fav
Goswitz �
Rettman
Scheibel __ A gai RS t BY
Sonnen
Wilson
A� � ( � Form A ove by Cit orne
Adopted by Council: Date c
Certified Pass d y ncil Se e r By � —
g� �
Approved Mavor: Date Approved by Mayor for Submission to Council
By By
�l� AU G 2 6 1989
. �� � ���y��
DIVISION OF I,ICENSE ANI) PERMIT A.DMINI RATION DATE �Q � O�/ � 3 g
INTERDF.PARTMF.NTAL KEVIEW GHECKLIST A.ppn roc ssed/Receive by
Lic Enf Aud
Applicaut J��h,SC�i'1 t-F�1�Fet,� C�p Home Address � �Q S /Tr�/nl'j�OI'�
Business Name C 6U� vn0+f'S - Home Phone �7 � -��JV
Business Address Q� ! Cf"1�CQ�� Type of License(s) C�a,SS � --
Business Phone �GL►�'����/�!j �-IeQI�S� �ItQC�/�-�
Public Hearing Date g �1 �� License I.D. 4� fa9os
at 9:00 a.m. in the Counci Chambers, n
3rd floor City Hall and Courthouse State Tax I.D. �� �'/"�
llate Notice Sent; , Dealer �� �
to Applicant �l"-�
I'ederal Fi.rearms 46 � �
Pub.lic He��ring '
DATE INSP CTIUN
REVtEW VERFIED (C MPUTER) CUMMENTS
A roved N t A roved
�
Bldg I & D �
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Health Divn. ' �
��� �
i
Fire Dept. � �In �
I ��� �
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� �nE �
Police Dept. I
�f,Z � b �
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License Divn. � � I Q �
City Attorney �}I �
t) � � , p �
Date Received:
Site P1an � �' �
To Council P.esearch
Lease or Letter D te
from Landlord 3� g
- «
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
,
Stockholders•
. � City f Saint Paul ���_����
• • Department of Ein ce and Management Services
Division of Lice se and Permit Registration
INFORMATION RE L'IRED WITH APPLICATION FO PERMIT TO SELL PULLTABS � TIPBOARDS I�T SaI�T ??�UL
(Class B Gambling License in Liquor Esta Iishments - Renew)
1. Full and complete name of organizat on which is applying for license �o�n s 6�y_
. r o� se . -
2. Address where games will be held � "�'•�Il �5 �V�•
Number Street City Zip
3. Name of manager signing this applic tion who will conduct, operate and manage
Gambling Games G � �� e�✓1 Date of Birth �0 �� ��
(a) Length of time manager has been member of applicant organization � �/�GAlr,s
-T
4. Address of �fanager � 5 � '{'�N� 5 'S� � �
Number Stre City Zip
�p� — 1'��"o ti�%3+C�Q•w+ . !a :3 Oawti
5. Day, dates, and hours this applicat on is for Sq�{- f s�h 1� :OOpN^. - 1�:��"^
6. Is the applicant or organization or anized under the laws of the State of �IId? V Q,S
_.�_��—
7. Date of incorporation � a70 "')
8. Date when registered with the State of Minnesota at�3
9. How long has organization been in e istence? '�I y �A�3
10. How long has organization been i;n istence in St. Paul? � �1 y �r S
11. Wha[ is the purpose of the organiz tion? �'O M�. y�'4'� aC'�'f��1"�'1!S
12. Officers of applicant organization
Name A✓O � ✓`� Name ��1' 1'�`��✓�
Address � 1 -E- Address ����5 ��V✓'
Title ��,��•� DOB � � d Title � DOB ` y y/
;Iame i ��V�SOM' Name S-� �ar�}+,/
Address �V�lt� Q• Address .�3���• C`sln �Tl�l�t W
Title V� rlrlSi�h� DOB q � '3 Title �'�►sb►l.✓' DOB � �� �
13. Give names of officers, or any oth r persons who are paid for ServiCeS t0 the
organization.
:Vame Name
Address Address
Title Title
(Attach sepa te sheet for additional names. )
. �. - C��-����
14. :�ttached hereto is a list of names a d addresses of all members of the organization.
15. In whose custody will organization's records be kept?
Name Ad'O d r•,A✓ Address '�t, � �h IL
16. List all persons with the authority o sign checks for dispersal of gambling proceeds:
.Name S�VL ��,W Name �1"'iAGt. W l t+�'!1/�
Address '�.�� �hG��f s Address I�I�iS A�l�'�► �'9s ✓�
Me er of Membe f
DOB ���a1 ) J � Organization? S DOB �� �� �� Organization? vQ'S
_�_
Name j V��� Name -
:�ddress �a�� �O�h � Address
Member of Member of
DOB � ay t,�I Organization? S DOB Organization?
17. Iiave you read and do you thoroughly nderstand the provisions of all laws, ordiaances,
and regulations governing the operat 'on of Charitable Gambling games? v •�5
_T`
18. Attached hereto on the form furnish by the city of Saint Paul is a Financial Report
which itiemizes all receipts, expen s, and disbursements of the applicant organiza-
tion, as well as all organizations o have received funds for the preceding calendar
year which has been signed, prepare , and verif ied by ���-!� �'�@q�. ��L� •
71"'1 ' "l'��'` S�I-. �fi�av.� U11 h � 10 l.
Address
who is the aGGOtAV�e�� a►h�' of the applicant organization.
Name
19. Will your organization`s pulltab op ration be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or do s it intend to sign, a consulting agreement or a
managerial agreement with any perso or company to ssist your organization with the
pulltab saies and/or recording keep ng? yes � no
It answer is yes, give the name and address of the person and/or company contracted.
. ,r - .7.�...? � �.�.�,,, 5...�...
i�ar�e W��'+'t- R�A�. �w �r`� Address
tiame A/VG l� /� • A EC Address �'iIl�i tt l�ec� /�cc,►u,�t.',�� �?77�7��3-i
If answer is yes, how will such a c nsultant be paid? (percentage, fZat fee, gambling
:unds, general funds, etc.) Attach a copy of said contract to this application.
21 . Operator of premises where games wi 1 be held:
:�ame � •�E�N��
Business Address � C f9 sf, s��� �4'� � �'V
Home Address
. �-�i��f
�2. a) Does your o ganization pay or inte d to pay accounting fees out of gambling funds?
yes no
b) if you do pay accounting fees, to hom will such fees be paid?
Name �^I�'G �A� QGCT Address ��� L �� S� .
,DOB Member of 0 ganization? h�
c) How are the accounting fees char ed out? (fIa[ fee, hourly, etc.)
o1r►✓t - �o y' 0 - �la � g,�� / 7S,ac e� a -�� ��,P/No.uf�/✓,Pp,�t
Gt�. �:,/I �f '� -Yr^ y.. �
d) What do you anticipate will be y ur average monthly deduction for accounting fees?
23. Amount of rent paid by applicant org nization for rent of the hall:
��Qb�po � �z
24. The proceeds of the games will be di bursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
l�rvrn, ak c-��Li-I-�'� IK S'�• 1�a�.�
25. Has the premises where the games ar to be held been certified for occupancy by the
City of Saint Paul? � `�S
26. Has your organization filed federal form 990-T? � If answer is yes, please attach
a copy with this application. If a swer is no, explain why:
Any changes desired by the applicant ass ciation may be made only with the consent of the
City Council. ,
�d 1�V�S�+1r� �Y'e I� l�T��
Organization Name
ilate �p ._o� C'7 ' �S' By: �1��1CQ� w i���t.h
Manager in charge of game
�'�.vnl� �ha✓
Organization Presi ent or CEO
�
���, ����
/a-9o�
Ci y of Sai�t Paul
• . Depshment of Fina ce and Management Senices ������L�
License nd Permit Division �'7
City Hall
St. Paul, Mi neaota 55102•298-5056
APPLtCA ON FOR LICENSE
CASN CHECK CIASS NO. w Renew
� � �
Date 1�.�
Code No. Titleof License pro — 19�To ' �19�
�
�.���..2.� �� \� �t- Cl►1���� n � �( ,7�
.
-� ' 1 ,00 , � • :�o.t� ; v 5srl
'��, F,v; "1 �� Appl unUCompany Name
100
C� !) CrFvr'��;r S
- -
100 eualness Name
( � /� —
,oo �.S� i`�-r c c�.c1-e� �� =�(v
Busineas Addres� Pho�f No.
�oo J i • f G ��. I
100 � MailloAddress PhoneNo.
1 �
� j
�100 �(,( ^ l,�✓� G y"\ �
Manaper/Owner•Name �-1v �
100 � � �� .�`f / //i)�`+f� 1 �'7 `�C7
.100 Atanaqer/Gwner•Home Addreaa Pho�e No•
�
4098 App�cation Fe� Z, 5p � "�- � /
Recefved the Sum of ' 100 � 1 � �CL��� (J
v� •�� M�naqtdOwner•Gty.Stale d Zlp Code
/00 Tot 1 100
�
� / � .
Ucense Inspector �"� `"� 8y: ` � Slqr+aturo o1 Apptie
BOnd'
Company Name Policy No. Expinlfon Oale
Insurance:
Company Namf Poticy No. Expintlo�Date
Minnesota State Identlflcatlon No Social Security No.
Vehicle Information:
Ssrlal Numba ��� ���
Othef:
THIS IS A RE EiPT FOR APPLICATION '
THIS IS NOT A LICENSE TO OPERATE.Yow application for lic nse will either be p�anted or rejecled subject to tAe provfsfons ot the zo�inq
ordlnance and completion of the Inspections by the Healt�. Ff e,Zonfnfl andJOr Llcens�Inspectori.
�15.00 CHARGE FO ALL RETURNED CHECKS
� \� / ��
�� � � �- ��1ti-� ����% '�l� '
� ��� �
' • � C1 y of Saint Paul pag• � ��r����
' . , _ Depattmaat of F nance snd Mana�amanc Setvlce�
Division ot Lie nas aad Psrait Ad�inistcstlon
' {lNIFORlt CtlARIT L6 CAl18LINC FINANCIAL REP�R?
�acs 6/29/89
t. Naa. ot Oc`anisatioa Johnso Area Hocke Association
2. Addt�s� vhsr� Charitabl� Ca�blin !� coaduetsd 959 Arcade Street
, 3. R�porc for period eov�rin` May 19 88 throu;h I"�8Y %19,�,�
4. Total nuobsr oE days pltysd 2 58
S. Ccoss reesipu Eor abov� p�riod i 898.088.�Q
6. Gross priss payouts for sbov� ps lod (ineluda e�ah �hott) S
705,214,00
_ _ 192,874.00
7. N�[ rsceipts - lin� S alau� lin� 6 -
8. Expen�e� ineusred in eonductia` nd op�Tatin� �as�: �y�,o0
A. Ccoss vs�ss paid. Attaed v k�r li�t vich 19,�.�
nsm��� addr�ss�s, tto�s va� . nusb�r ot hous� _ --
vorked, and amount psid psc our. , � y,s'y 6 Q
y2 � vs�ks Q- 7 C = �
B. Rant fot 3 �Q �G
�. � �� �"�� : -
_
D. Insurancs '
E. Bond = ,
Y. Dishonorad ch�cks not teeov red ;
= 2,��2.00
C. Aetountin; Eapsnse
= 1,457.00
H. Employsr� F.L.C.A.
i. Pulltab tax PaiJ to D�par �nc OL A�V�OY!
= 24,015.00
� : 155.00
J. tiinn. U.C. Tu
• = 2,245.00
. R. Psd�tal Exciss Ta�c i Suarp
L. Stat• Cublin; Tax =
M. Hi�esllan�ou� ExP�nis�• I �ntifr th� �aoont
and to vho� paid. •
1. Advertising = 4_06.00
Z. Utilities � _760.00
�. Maintenance � 1,494.00 .
4, Purchases s 23,527.00 7 y� ��70,�
g. Total Expsnsss
ro�rer, i �
s � 114,224.00
10. N�t Iaeo�� - 11a� � aiau� liu 9
' = j�� ��D
ll. Chsckbook balaae• b�Ylonini o p�riod
12. Total of lin� 10 sad 11 :
•• 17. Totsl coatribution� (fro� at ah�d voek�h��c)
= 82.506.00
14. Checkbook balanes snd ot rsp rtin` p��iod - = 32,935.4g
llne l2 less llns l3
. - � UNIFORM CHARITABIE GAMBIING rINA1VCIAL REP4Rt /Vr.�_ �c�t�
� ' LAWFUL PURPOSE CON RIBUTIONS - WORKSHEcT (�-
Line #13 - Total Lawful Purpose Con ributions. S
List below all thecks r+ritten rom gambling funds which are
charitable lawful purpose cont ibutions. The total dollar
amounts of these checks must tch the amount claimed in
line �13. Use additional shee s as necessary.
� CHECK # DATE � PAYEE CHECK AMOUN PURPOSE
-
1. 2162 3/13 PHALEN ARENA 6,450.00 ICE TIME
2. 2163 3/16 C.A.I.C. 144.00 PROGRAM PRINTING
3. 2164 3/19 EVERGREEN MOTEL 744.89 ROOMS FOR TEAM ATTENDING
ROSEAU TOURNAMENT
4.
5. 2165 3/21 MAPLE LEAF TRAVEL .r 28,116.00 PAYMENT ON TRIP TO JAPAN
6. 2182 4/7 CITY OF ST. PAUL 1,621.10 CITY YOUTH FUND
7. 2192 4/19 JOHNSON HIGH SCHOOL BASE ALL 150.00 BATS & BALLS FOR ATHLETIC PROGRAM
8. 2203 4/27 MID—AMERICA 5,000.00 MEALS, ROOMS, AND INTER—CITY
TRANSPORTATION FOR TRIP TO JAPAN
9' 2204 4/27 STRAUSS SKATES 5,732.79 HOCKEY EQUIPMENT
10. 2215 5/16 THE TROPHY CASE 2,165.07 TROPHIES FOR ALL PLAYERS
11. REF[TND FRpM ST. P
12. YOUTH FUND , ( 4,000.90).
13.
TOTAL CHECK l�pUNT S 46,122.95
NOTE: These expenditures will be prov ded to Council Members at your Council hearing.
Be sure that your financial rep rt is complete and accurate.
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' ` UNIFORM CNARITABLc MBLING �I�ANC IAL REPORT ��/G� —l�I'��
� � LA�FUL PURPOSE CONT IBUTIONS - WORKSHEET
Line #13 - Total Lawful Purpose Con ibutions. S
List below ail checks written om gambling funds which are
charitable lawful purpose cont 'butions. The total dollar
amounts of these checks must m ch the amount claimed in
line �13. Use additional shee s as necessary.
' CHECK # DATE � PAYEE CHECK AMOUN PURPOSE
-
1. 2015 10/3 CITY OF ST. PAUL 603.52 CITY YOUTH FUND
2. 2045 11/2 CITY OF ST. PAUL 948.82 CITY YOUTH FUND
3. 2046 11/7 STRAUSS SKATES 6,711.45 HOCKEY EQUIPMENT
4. 2063 12/5 CITY OF ST. PAUL 1,338.88 YOUTH FUND
5. 2076 12/14 IRS 12,564.00 990—T TAXES
6, 2128 1/30 CITY OF ST. PAUL 1,466.70 CITY YOUTH FUND
7. 2105 1/6 SPIRIT COACHES 930.00 TRANSPORTATION TO CROOKSTON
TOURNAMENT
8.
9. 2113 1/17 TOWN & COUNTRY BAN 9,180.00 990-T ESTIMATED TAX PAYMENT
10. 2134 2/17 CITY OF ST. PAUL 1�239.00 CITY YOUTH FUND
11. 2155 3/31 CITY OF ST. PAUL 1,140.80 CITY YOUTH FUND
12. 2160 3/10 ST. PAUL MINUTFMEN 160.00 . PROGRAM PRINTING
13. 2161 3/10 MAROON & GOLD HOC Y 100.00 PROGRAM PRZNTING
TOTAL CHECK AhbUNT S 36,383.17
NOTE: These expenditures r+ill be prov ded to Council Members at your Council hearing.
Be sure that your financial rep rt is complete and accurate.
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