89-1488 WHITE - G�TY CLERK
PINK - FINANCE G I TY OF A I NT PA IT L Council
CANARV - DEPARTMENT .�.
BLUE - MAVOR File NO.
ounci Resolution �����
Presented By
Refer ed To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #1 476) for renewal of a State Class B
. Gambling License by Bru ettes Youth Boxing Assoc. at Lentsch's,
1091 Rice Street, be an the same is hereby approved
with the following stip lations:
1) Salary overpayments must be repaid to the gambling fund.
2) A report of hours w rked and wages paid per employee must
be submitted on a m nthly basis.
3) Organization will c mply with all City Ordinances limiting
workers ' salaries.
4) The organization ca not operate pulltab sales until a
clearance letter is obtained from the State Gaming Division
indicating that pay acks have been made to the gambling fund
to replace unaccept ble expense expenditures.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�ng [n Favor
coswitz
Rettman D B
Scheibel A gai n s t Y
Sonnen
Wilson
A�' � 7 �� For ro d by C' orn
Adopted by Council: Date
Certified Pa s d y Cou cil S reta �
By
�
t�pprove �41 vor: Date Approved by Mayor for Submission to Council
By
PU�U�D �;'�� 2 6 19�9
� � ��d�-i��
DEPARTMENTlOFFICE/COUNGI D TE I TIA ����
. Fi nance/�i cense ' GREEN SHEET No. �N
CONTACT PER80N 3 P110NE pEp/�pT►AENT DIRECTOR �CITY COUNCIL
Chri sti ne Rozek/298-5056 � g CITY ATTORNEY �CITV CLERK
MUST BE ON COUNCIL Af3ENDA BY(DATE) TI �BUDOET DIRECTOR �FIN.6 MOT.BERVICE3 DIR.
8-17-89 �MAYOR(ORASSIBT� �] ('ni�nril R
TOTAL#OF SIGNATURE PAGE$ (C IP L LOCATIONS FOR SIGNATUR�
ACTION HEQUESTED:
Approval of an application �fo renewal of a State Class B Gambling License.
�
Notification 8-4-89 ! Hearin Date: 8-17-89
RECONAMENDATIONS:Approve(A)a Reject(R) NC COMMITTEE/RESEARCH REPORT OPTIONAL
AN Y PMONE 1�.
_PLANNINO COMMISSION _CIVIL SERVICE COMMISSION
_CIB COMMITTEE _ ��
—STAFF _ CO ME . .
�
—DISTRICT COURT _
,
SUPPORTS WHICH COUNCIL OBJECTIVE7 I
i
INITIATINCi PR08LEM,ISSUE,OPPOFtTUNiTY(Who,Whst,Whsn,Whsro,Why I
Donald T. Hayden on behalf f runette's Youth Boxing Association requests
City Council approval of th�ir application for renewal of a State Class B
Gambling License at Lentsch'�s, 1091 Rice Street. Proceeds from the pulltab
sales will be used to promo�e ateur boxing. All fees and applications have
been submitted. I
,
ADVANTAGES IF APPROVED: �
NOTE: Because of salary ove�pa ents and unacceptable expense deductions,
the License Division ec mmends approval of this license with the
following stipulation�:
�
1) SaTary overpaymen�s ust be repaid to the gambling fund.
2) A report of hours wo ked and wages paid per employee must
be submitted on a mo thly basis.
o�s,,ov�wrnaes�FnPPROVeo: rgani za i on wi co p y wi t a Ci ty Ordi nances imi ti ng
. workers' salaries.�
4) The organization qan t operate pulltab sales until a
c1earance letter ils o tained from the State Gaming Division
indicating that pa�ba ks have been made to the gambling fund
to replace unaccep ab e expense expenditures.
I
i
DISADVANTAOES IF NOT APPROVED:
I
�
� ��$ui:c►1 Rese�Ych Center
f�l�G � "i��sJ
i
TOTAL AMOUNT OF TRANSACTION � � COST/REVENUE BUDQETED(CIRCLE ON� YES NO
,
FUNDINO SOURCE ACTIVITY NUMBER
FINANdAL INFORMATION:(EXPLAII�
�
�
�
i l
�
+�i. � �
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE(iREEN SHEET INSTRUCTIONAL ��
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO.298-4225).
ROUTINQ ORDER:
Below are preferred routings for the flve most frequent types of dxuments:
CONTRACT3 (assumes authorized COUNCIL RESOLUTION (Amend, Bdgts./ �
' budget exists) Accept. Grants)
1. Outaide Agency 1. DepartmeM DireCtor
2: I�tiaNhg Depertment 2. Budget Director '
3. City Attorney 3. Cirty Attomey
4. MsyOr 4. Msyor/AesiStsM
5. Fnance�Mgmt Svcs. Director 5. City Council
6. Fnance�uMing 6. �:�hief AccouMant, Fin 8�Mgmt Svcs.
��,
ADMINISTRATIVE ORDER' (Budget COUNCIL SOLUTION (sll others)
Revfsion) � and ORDINANCE ,
1. M r 1. InitiatingDe�tme M Director
2. De�pertrnent�/�ccountant 2. Ciy Attorney \
3. Depertment Director 3. Mayor/AssisEant '�
5. (,'ity�Clerk�� 4. Gty Council
6. Chief aocountant.Fin &Mgmt Svca - �
ADMINISTFi�tTIVE ORDERS •.`(all others) � . � � �
�
1. Initiatlng Depar�ment ` . . �
2. City Attoriley , ,
3. MayoNAseistant .
4. City Gerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#�of pages on wh�h sfgnatures are required and p ��lip
each of these�
ACTION REGIUE3TED
DescMbie what the pro)ect/request aeeks to accomplish in either cfxonologi- :
cal order or order of importance,whichever is naet appropriate for the
issue. Do not write c:omplete aentences.Begin each item In your list with
a verb.
RECOMMENDATIONS
Complete If the iss�e in�question has been preaeMed beMre any body, public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVEI
Indfcate which Councfl obJective(s)your projecUrequest supports by listing �
the key word(s)(HOUSIN(i, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET,SEWER SEPARATION).(SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
COUNGL COMMITTEEIRESEARCH REPORT-OPTIONAL AS REOUESTED BY COUNCIL
INITIATINO PROBLEM, ISSUE,OPPORTUNIIY
Explain the situatian or conditions that created a need for your project
or requeat.
ADVANTAGES IF APPROVED
.Indicate whether this ia simpy an annual budget procedure required by law/
cherter or whether there are apeciNc wa in which the Gty of Saint Paul �
and its c�izens will benefit from this pro�ict/action. •
DISADVANTACiES IF APPROVED
What negative eftects or major changes to exieting or past processes migM
this projecUrequ�t produce if it is passed(e.g.,traffic delays, noise,
tax increases or aseeasments)?To Whom?When?For how long?
DISADVANTACiES IF NOT APPROVED
What will be the negative consequencsa if the promiaed acUon is not
approved?Inabflfty to deliver service?ConUnued high traffic, noise,
accideM rate? Loss of revenue?
FINANCIAL IMPACT
ARhouph you must tailor the information you provide here to the issue you
are addreesing, in general you muat answer tw�o questions: How much is it
�oiiny to cost?Who is going to pay4
� � � �����
� rn �� � 5
DiVISION OF LICENSE AND P�;RMIT ADMINISTRAT ON DATE "` °�� �� / �
INTERDF.PARTMF.NTAL REVIEW t:HECKLIST Appn Pro essed/Received by
Lic Enf Aud
iI � "' , t �
Applicant �2U�'lQ�b4cS\'O(,1v�1 [�� Home Address a3�5 �Jov�.brc[�i:�e ��Z
Ausiness Name � n �schs Home Phone � 0� J ����
Business Address ��G� �(,� �� Type of License(s) �!"l.e,G�J ��SS
Business Phone „ejj C � ��� LI .�
Public Hearing Date D 1'1 g� License I.D. 4� ����v
at 9:00 a.m. in the Counci Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� �l�''
llate Notice Sent; Dealer �� �'�
to Applicant �'"��q I
Pederal P3_rearms �� u A
Public Hearing
DATE TNSPECTI N
REVIEW VERFIED (COMP ER) COMMENTS
A roved Not proved
�
Bldg I & D I �
IJ �-
Health Divn. '
,,,��- ,
�
Fire Dept. i �`� �
� ( �
, ��`� �
Yolice Dept. �p
b a 5 � �— 1�- ro�� L,�7��,5 ��-��--
� �n In� evr,,,rnccn�ca c1.
License Divn. � � � '
� � �� e,e �.�.e. �� d<<k-E-,n 5
-�to►-r�
`� � �. �b�.��s ha�� �
r.� s �� � .
City Attorney �
� �' ��
Date Received:
Site Plan IU �
To Council P.esearch
Lease ar Letter at
f rom Landlord (D �-1
- � � _,���'
City of �nt Paul �� �
.
• � Department of Finance ad Maaagement Services
Division of License d Permit Registration ,
INFORMATION RE UIRED WITH APPLICATION FOR PE IT TO SELL PUL�.TABS b TIPBOARDS IN SAI�1T PAUL
(Class B Cambling License in Liquor Establis eats - Renew)
1. Full and complete name of orgaaizatioa hich is applying for license
r� v+� � n �n K� ` o c i i o � .
2. Address where games will be held �� "l'� ,s J� �j s/�
, Nu ber Street City Zip
3. Name of manager signing �this applicatio who will conduct, operate aad manage
Gainb ling Games Date of Birth s'�G'..�L/
(a) Length of time manager has been mem er of applicant organization y yY5
4. Addzess of Manager 0 ,��,�/-z �. ro� S��O
Number Street City Zip
S. Day� dates, and hours this application s for y` � ' gy '--' $ -3 � � Cj j�
6. Is the applicant or organization organi ed under the laws of the State of i�J? � 5
7. Date of incorporation ' �`
8. Date whea registered with the State of iaaesota �p � � � ` g�
9. How long Iias organizatioa beea ia exist nce? ��Tyr 5 �� �
10. How long has organization been in exist nce in St. Paul? ,��� S
11. What is the purpose of the organizatio . �o f�tr o v�rt D f�C' �wt C��,c� f
. K
12. Officers of applicant organization:
Name r�`' r Name n_ b�e r � D r �t 4c �P� �
Address �� ' C d W�O ✓�e Address g�� �D vw D /� �"e .
Title prps i c(�en� � DOB ' Title .� DOB �1(�' ��
Name K � Y Name
Address S� �I✓voU i�t' 1" � � Address
Title DOB ' Title D08 �
13. Give names of officers, or any other p rsons who at^e pai�d for services t0 the
organization.
Name Name
Address Address
Ti[le Title
(Attach separate heec for additional names.) �
�
. . . . ��-�y��
.
14. •Attached hereto is a list of names and ad resses of all members of the organization.
15. In whose custo y will organization's reco ds be kept? ,p (
ft�ob�e *� �r►.� �rttr $'D� COw�a �V�' St ("a �
Name (�p, ; ( �� k,�.��-�} � Address �3�.5 In/ooc.�b r►c��� Jeo S r vi�l�
16. List all persons with the authority to si n checks for dispersal of gambling proceeds:
`� ,
Name j�r i a� IJ r v� a. ,��r Name 1SD__!Q �r� � r H K � �"�' �
Address ��`7 Lm �v�0 �-v-c Address ,�� 7 COH�d �✓�P
Member of Member of
DOB �a G ` ��� Organization? �� DOB `7-(p-S(� Organization? �S
Name Name -
�►ddress Address
Member of Membe�r of
DOB Organization? DOB Organization?
17. Have you read and do you thoroughly unde stand the provisions of all laws ordinances,
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 the preceding calendar
year which has been signed, prepared, a verified by
f� 0 ✓-e �5 Sb/0
Address
who is the � � of the applicant organization.
Name
19. Will your organization's pulltab opesat on be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or doe� i intend to sign, a consulting agreement or a
managerial agreement with aay person� or company to assist your organization with the
pulltab sales and/or recording keepijng? yes � no �
Ir answer is yes, give the name and add ess of the person and/or company contracted.
Name - Address
i`a�°e Address
If answer is yes. how will such a cans ltant be paid? (percentage, flat fee, gambliag
:unds, general funds, etc.) Attach a opy of said contract to this application.
21. Operator of premises where games will e held:
Naaie � C
Business Address C i C '� � r � Y � � I ��/ �
Home Address r��� � r � `
. . ���-���
22. a) Do�s your organization pay or intend t pay accounting fees out of gambling funds?
yes �_ no
�
b; If you do pay accouating fees, to who will such fees be paid?
Name `
I . . ��iC Y ✓ i C i■' S ddress �n O k r k/o�
DOB Member of Organ zation? �_ � �
c) How are the accounting fees charged ut? (flat fee, hourly, etc.)
d) What do you anticipate will be your verage monthly deduction for accounting fees?
.s°� .
23. Amount of rent paid by applicant organiz tion for rent of the hall:
�
24. The proceeds of the games will be disbur ed after deducting prize layout costs and
operating expenses for the following pur oses and uses:
• � , � n
i � f !' w�o �' r o i
'r � r K✓ �o ►k
25. Has .the premises where the games are to be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization filed. federal fo 990—T? If answer is yes, please attach
a copy with this application. If answe is no, explain why:
� � � s 9
Any changes desired by the applicant associa ion may be made only with the consent of the
City Council.
`
l7� •c �rs d � f� B �'K sSK
Orgaaization Name
vate _ll� ��— ?S � By; � ,
nager in charge of game
� �
' Organization resident or CEO
� � � /� 4�7�
� �. City of aint Paui
• , Department of Finance nd Management Services ��/� ,,�)
License and ermit Division �� d���
203 ty Hali
St. Paul, Minnes ta 55102•29&5056
APPLICATtO FOR LICENSE
CASH CHECK CIASS NO. New Renew
a � � � Date �O a 1 19�' /
�
CoCe No. � Title of License s �
From � a� 1�!To , /D -�� 19 , �
�, �� � 3 y � �
��:'i— ; � �� ;� - ��Q .�,ni,,,�- 4� 5 � ,
-� i oo � �'u n � �� Uou��� L{�xJ,,y ,iJ:�c �..�
�; :_�,t.,.<.;' K,J i'.:.: ,.j� APPIICandCompany Name �----
00 ; � � � •� f-/f��-�\•
L.:= `s( i � � �/'�.�
�
00 BuSfnessName - `__
•l �' � ' ...��/ �
00 �" y I /C,t�z, ^i
Business Address Phone No.
• 00
_ .�--------��. -
00 t / MailtoAddress! PhoneNo.
------�" � �\
100 !�U�� �;�L� !Z.�' ( i �
ManapeNOwner•Name
100 �
. � �� 5 �;.,'J uU:1 !,r.. ,;,;'�,
100 AlanagerlGwner•Home Address � Phone No.
4098 Applicatfon Fee 2 50 i t
AeCeived t�e Sum of 100 �`'1C��J�I r�/ ��± Y1'� /'J
5�, `j ManagerlOwner•City,State 3 Zip Code
100 Total 100
�, ,4 • �. }
^ '�'� �/�/� %� /, �1 i
�
� � �/,•` I� ��� � �� i
License Inspector By: � • Signature ol Applicanl
Bond:
Company Name Policy No. Expiratioe Oate
Insurance:
� Company Name Policy No. Expiration Oate
Minnesota State Identification No. Social Security No.
Vehicle information:
Serfal Number Plate NumDer
�tft@f:
THIS IS A RECEI T FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your application for liCens will either be granted or rejected subject to the provisions of the zoning
ordinance and completfon of the inspections by the Heafth, Fire, oning and/or License Inspectors.
�(.t,c� f� _ !r o �(�u-�
,L,.,rn,�.
$15.00 CHARGE FOR L RETURNED CHECKS
v��t ,���G ��-�9 :�' �' � '�
. Cicy oE S int Paul P�Y� l /���� �y0 0
Dapartasnc of Finane� ad Maaa�smsnc S�tvie�s �
' �► Divlsion ot Licsa�� Yst�►ic Admiaistracion
UNIFORlI CIiAAITABLE LINC FINANCIAL REPORT •
' Data !l � ��` O `
i. Naos oi Orgsaisatioa � s 5 h
2. Addrss� vhsn Charitsbl� Caablia; 1• e uetsd /0�� /[ !�Y ,S�' �ir� � {'l� lt
� 3. R�pose lot pssiod covsria� � � l9� ehsou�h ,S- � 19� •
6. ?otal aumbsr ot day� playsd
� v0
S. Cro�� r�eeipta for abov� pasiod = ��, ,�_
6. Crosi priss payoucs for abov� pa=lod (i cluds eaab shoct) i 1 7��, 7 �3�
7. Net r�esipc• - lia� S aiau� lin� 6 i `�s 3 7.�
8. Exp�ni�� incurs�d !a eonductln` and oP� acin` �os:
A. Grois �a�si paid. Actsch vosksc 11 t vicR l' �" �-O
aam��. addrsusa. �ro�s vatu� ausp r of hour� i �(! � 3 7�
vorkad� and aaouat paid pst hous.
8. Rsnt foc � wssks i � �
C. Lleens• fs�. 3 ��/. D7
D. Insurancs i � � C�� �4
E. Bond i ���/ Y �
• T. Dishonocad ch�cks aot sseorartd i
G. Aecouncin� Facpeass i (/ �(J �
H. Faploy�sa l.I.C.A. i _V r�7o(� S
I. Pullcab ?as P�id co D�pares�at oi vsau� i .
J. ilian. U.C. ru i
[. 1�daral Exeiss Ta: i Staap i
L. Stau Caablia� 'fa�c i �/ . l �77. �O
M. Mise�llaasoua Facpsaass. Id�ntit� b� a�ount
aad to rhos p�id.
1.I-ec�KYeur �iS� i �` �•G�
� 2./�d V�c.��'i 5 1 h9 ' ' = Q � s'y
. 3, Narwcgt 13aM K 1�it� � � .� �
` Par r++<Kf" C�r p�ux�'y i
Cart�r�
9. 'fotal Fapan��• SO'rAL i � � ��
10. N�c Iaeo�� • lia� 7 sinu� lins 9 � � c�� � � � . �2
11. Ch�ckbook bala�c• b��inaini oi p�siod � i �q^y 7 s�� a �
12. Total of lia� 10 aad il i �s� . � �. ��
" 13. Tocal eoacriDutiona (fso� attscAsd vo bA�st) i 1,7���J .. �y�
16. Ch�ckbook balsnes and of rsportia� ps iod - �� � ry�
llas l2 l�as 11R� 13 s Yv'�, r -
� I
� " UNIFORM CHARITABLE Gr1M IN& r'I`IANCIAL REPORT �y��
LAWFUL PURPOSE CONTRI6 IONS • WORKSNEET C��
. � �
Line �13 - Total Lawfut Purpose Contrib tions. S 00� °�
�
List below all checks written from gambling funds which are
charitable lawful purpose contribu ions. The total dollar
amounts of these checks must match the amount claimed in
line �13. Use additional sheets a necessary. - .
' CHECK +� DATE � PAYEE CHECK AMOUN PURPOSE
1. �_� Jtiv��. �9r f�P r �►. �M��I�rkr !2 p�$� TD Dp ar°!fe�X�M� G�'1h
�X I M�
2. ���2 �"�� Y ► Ctfr St 1�aK � a�S'�/�.�� ,Dokq�;oK
3. _ �hiy GWl �4 $ S ���sg� .� g �� x��5 ��w�
a. /s'GS .4�9 1 c ��1�r 5� �hh� �a�4. y3 �9o►.qfio � �
5. �4k� G w�.4 tS S ��,3��1.�3 �3 d�c �N5 G y►�
6. �!r y� � � ,ot � G� fy St ?�h� l r�� l��d "D }��„aJ�toK
7. S�pT l� itit � 1B S 1��`�07, �t� k�i� X �h� (�J�N'► ,
8. /G 3 1 p� t 3i Grfr �f +°A►. l
/ypg. rti I�o ►. a�hto H
9. /.�S I 0 .t 3 C� iM � � S � /0� D00 �aX � n9 �y "�
10. �Gs�� ilCt �g �rNN� 1 ��C 00� in7 '� I lO � `� D �� Qa �I /'-t 'CS
Se f t �3�,I� �'r�►..
11. r(� � 4 Oc'f" 2� ,Ea 5 f C e a 5`� �a��a+�f� ,SSO '° W��S S 7e c n (�1.5,.�
12. / Q I ,A �h c `� //�.,
�(0 �✓ Y �O� � t7 !�'1 'r {! � . /� DO 0 r v v ��1� � k-/ t%�wl
��
13. �/g� S- 5�' Pa K I Gc I�Y r� ' �,o .
/l�SD l�lov�`5 _ Sp0 Go�c��N G(ov,r
To� � na w��k1"
TOTAL CHECK AhpU T S
NOTE: These expenditures will be provided a Council Members at your Council hearing.
Be sure that your financial report i complete and accurate.
. _ ' ,, 3 � ..
"" ' : � o y • ,� � •=
� ' r � �
,. '� � � � » a � .. � w � ��
�������/�f • i w • 1�
tl�W�.""" � I • � i ` q�' .
l. , � � � •� • � • O �I
�� ii ! i � O � Z � �. i i � � O>
3 \�` A � w i. s = ` w �� � _ � s = r•
s s
Z .� T ! � � e + � s = i �.�si
� � � M �'� ^ � � v • � � Y ��
y • � � �
y� y� � �y i) � • ' w ~ �,, i � � � � � � i � y a . .
� • � � � � �. � OA
� 3 C�i •1 !( � � ` � � : O � d � � �7
���m r� �I w • � i �r�ir�r � � � f f •�v�r � � ! •
o� D : � � � � � ' ��b � � • � ��
9>y� .• : a t � � 'e � s ��
_.,, � � + � c� �
� < Zr~n s • •� s �, C � s � •
�
°o .:r^7c � j � • � • • � s
� w w
ir " �' • � s �
_y � � � � � as' � ��
.`� � '� � ° ' �' � � >
� � � �. -3. J .
vw�`�`�• � • °
,�`^"' :1 � s I 1� ,� �
� i I :1 � I
� y • (
uLAYIFULMPU POSE CUNTR�IBU IONSrI�V ORKSHEETpORT / �,�;1���
,
. . . (,�
Line �13 • Total Lawful Purpose Contribu ions. S � D0� °9
List below all checks written from amblinq funds which are
charitable tawful purpose contribut ons. The total dollar
amounts of these checks must match he amount claimed in
line #13. Use additional sheets as necessary. �
' CHE_ DATE ' PAYEE CHECK AMOUN PURPOSE
1. l��I ( No�/ z� ,Crfy Sf �qti ( /y�12, s0 �Do � � ��ok
2. /G by Itlo ✓ ! G �vi Ka. L y h h �D00, � 5c�o�ars�►�� Ce���,�� �ki��o ti
,
3. ./�o �1`7 �.�c ,� G wt .4 $ 5 �/p 00 �° Bo n t�� �-x H't .
4. 170'� l��c � (�G F � �"�o � �ll�l�/ �arfY /4� 0►� x VIAaS I"n� � .
5. �� /$ D�� IS' �r►rt�c w. iu ��� /
os.� pou � �� dn
6. -� �p QwG �� �C�BY�D� p� k ��c ��rKfrr ���� ,� f �ol� �YOK� �O �A�I 0 �t
� V
1. �-7`7D ��c 2�1 Ci '�� sf l��h ( ���Da .�r �oKaf i o � �
8. (1 SD �7'�h 3 � v►1 A 16 5 ' l/d 00 "D l�a X r'N� G�r wt.
9. C7✓`�. l r' Q °-� �; r �a r ,c Wt i 55 T'r-�K
J'q n � Dw�r�a Trk v �P � a � ��,rti»'� .
10. l gp l fA K �� C i-F y st PA� ` 2 3 S(o:fG' r(/l� ky�i e 11
��. 1`? � � ��b � GwcA �s � ���00. �'' 8�� ,, h� ���,-.
�2. lq�� F�b� (:�+� 5�- ��kl �yr� �$ flo ��� � oh
� 1�0�� y�%' Gykn �hSkrrR 1C�
�3. f�0 3 l,�b i 3 � iM � $ S '' s"3"� .
TOTAL CHECK AhOUN SS ,S� oY
,
NOTE: These expenditures will be provided t Council Members at your Council hearing.
Be sure that your financial report is camplete and accurate.
-��
-� v : r o : •"• v : � 3 � = - _
w + -
,. � • e s • � � _ : a ea
� I � w .=i A ` I ,,j ; y O r •�i .
�
�
� � �
� i i +�I � ? _ ! i i 1 � O !
� A � A i� ! � � � ' � � � _ ' � �
� � � t = O � '� a N A ��
� i M A � r � .� � Y 1 �
y � ! � O � f 1 � + � � � ,
�.1 = '� t w " � � I w � y a
a � � � � � � � � > >A
1 • ` e � �7
�1 �I w � � � � � r�rr ; !
. r ; i �r�r�r � i � r � �
1 � • s w s • � �
. � � w � ,� .� r • w ♦
. � i i t + � e � i � o
= � � s � � � •
� J I • � � ' � � �
•
• � � � �
} w f � _� �
; � i : :: � _ �
,
� � -
. .
� -
1 � 'al J :
. I .1 a I
� � I �
I �
LA1iFULMPU POSEAC6NTR�IBU IONSr I�WOR SH REPORT ��;1t�d'd
EET C�
_ , . . . . .
Line �13 • Total Lawful Purpose Cantribu ions. .S �7�, DD�°`�
list below all checks written from ambling funds which are
charitable lawful purpose contribut ons. The total dollar
amounts of these checks must match he amount claimed in
line #13. Use additional sheets as necessary. , : .
' CHE,CK # DATE ' PAYEE CHECK AMOUN PURPOSE
l. /$�� ���0 17 w�T5S �w► �ri1�CYS5 ��Q,� IMi 5S /�wt l�ri v� cY55
� R�eq�t �}
}�qO Y�t rl I
2. /�1`� Y�w.rC ti ( � j�•t� � S /!. D 0 D�
, ,$d x i h5 Gy,n
3• ,� � �7 VMtf�,�re k� ��� I rG� C fl A'Y i �l r 5 �D �. �f( i r� Ckar i�! r s
4. j �.5�+ W�.�+rC�t jq 1` PctK( Ge 313 `� �B 1i�/ �I 4 h
$ 1�,�,, Gioo�s
5. /�dl�G M,arc �2 I.t p p�r wt��wYs7"
6. /4�55� Gol YN Gio�.�'s l� �� � �o �a�'io�,
YYtctr c��3 (y j,�� P�5
1. rsa� A ri' W l� � I ✓�avY � IDor�9�ioh .
7 a . p , � 3 (v wt ,1� t� 5 �/�,�'00 f�o��� K�C (�y h�
8. /�7a ��P'', ( �{ Sr Pa�l C�olorYN G(ov,cs 7 ,,�,'/r� paKQ�)sti
9. j $7� �P�f � S l�r< �'•r.� ►. t�/q��Pa9YaK�" 3,�� iD4kyfl.ou
�o. ���o �Pri I � p�h NRy��� �y�D.� ��dw�y y m � � ,�o h��f�ah
,
�1. � Sy� /�Prj � �9 G � s� i6s � g�o °'� S�cK,��s aaxrx� �y�'I
l2. (�'�l � �prt I d St Pak � Go ��tnG�Oyr`S �0 "d T ck,'� �oNK�14h
l3. l� f(� ��C �S' � � � �s yao0 �° Il�x.h ih� �rrqG� h'1i ��
_ Fe �' �m!�� �� �y�
TOTAL CHECK AhpUN S �a S ,�
NOTE: These expenditures will be provided t Council Members at your Council hearing.
Be sure that your financial report is complete and accurate.
r
.r � • r A w w y i T � � � i = .
? � � � � ! �
r� � � o � _ � � ��
• : .� .� 1� • i : � � r �-
. � • • .. � � . o �
: a i = = os
. .� � • O �
r � • �
3 � w � ! � � w ' � � � � . 3 f
• � � Z = A � • � r � � 1
' ' � i r A�' ■ � � � � �
� A N
� -� : i � ; ♦ � � � : 3 I � ~ � �i �
+� �( � � � s � � ,�,� � . s � n
° � �
. s � •
. r � w � � i �r�rV + A � i 7 `1rv � � s .
s ! • •f s w a • • �
: � w � • *
. • • � �� � � � w �
� . a � �
: s � � ' s � � +
• • � I � ( � � ( � � s
� • � ;
w
! � � , � s� � �
� � i � : � = =
" � = � �
.
, � �, ,; �
• I J .
}� i I
I �
1