89-1657 WMITE - C�TV CIERK
PINK - FINANCE G I TY O F SA I NT PA U L Council
CANARV - DEPARTMENT
BLUE - MAVOR File NO. ��
Co ncil solution �
�
Presented By
Th
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #5921 ) for a State Class B Gambling
Cicense by Church of the H ly Spirit at Keenan'S 620 Club
Dahl 's, 620 W. 7th Street, be and the same is hereby approved/
�ewi-ec#-
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�� [n Favor
Gosw;tz
Rettman � B
Scheibel Against Y
Sonnen
Wilson
�Lr 1 1� �$�. Form Approved by City Attorney
Adopted by Council: Date
Certified Yas- d by Council S ta By �v �
By
Approve by M or: e SEP 1.5�Q$,� Approved by Mayor for Submission to Council
C\�� � By
PliBltStEb S EP 2 31989
,. . . . ����y7
DIVISION OF LICENSE AND P�RMIT ADMItiISTRATI N DATE 71�g/�`I / � � g
INT�RDF.PARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
ChurcF. u.dd►�.ss:
Applicant �uyCh D� �-}� �0��{ Sp�r�� Home Arldress SI 3 �, AI b�r'� �{
T
Rusines� Name �p�nG'nS ��� C�u � Home Phone � �j �' ,3353
Business Address �v�0 C,� �� a� Type of License(s) ��2 �'l15S ,f3
Business Phone ��irn bI�� L��Y� S�
Public Hearing Date � �� g License I.D. �� �y�l�
at 9:00 a.m, in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4t N1�
llate Notice Sent; Dealer �� ���
to Applicant -j0-�y
Pederal Firearms �6 l� �'
Public Hearing
DATE INSPECTIUN
REVTEW VERFIED (COMPUTE ) CUMMENTS
A roved Not A oved
�
Bldg I & D �
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Health Divn. u�
A'
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Fire Dept. � � �
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Police Dept. � ��k ���3 ��
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License Divn. ` .rftha�zm�h�' u�✓��'�
�LCj��'� ! � ,�, OK -�r'orn ��� �i�D✓h P�
City Attorney ����� �
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Date Received:
Site Plan N � F �j
To Council Research � 3! � 1
Lease or Letter D te
from Landlord �V
. ,• . � • -- City o! iat Paul /�o ` � /���
�� • Dspartasnt of Finaacs 1�lanagsmsnt S�rvicsa �� �
Divi�ion of Licsaas Psrait 8s�i�tsation
• ,
INFORMATION R.E IIIRED WITH APPLICATION FOR P T TO CONDIICT PULLTAB/TIPBOARD SALES IN
SAINT PAUL (Claaa B Gembling License fn Liq r Eatablishmeat� - New Application)
1. 8u11 aad coapists nams of oYgaaization ich i• applyin� !or licsa�s
�� S i ,
2. Dos� your organization ��t ths dsfi ti a o� • "lar�s" orgaaization aa outl nsd in
th� Novsmbar, 1988 r�vision of Sactioa 4 9.21 of ths Lagi�lativa Cods?
Attach to this application pertineat fin cial aad/or orgaaizatioaal iaformatioa to
support your aaswar to thia qusation. N : Onlq 5 large organizatioaa vill bs allow-
ed to opsa pulltab operatioa� uader the evieed citq ordinance. If more thaa 5 orgaai-
zations apply, qualified applicaata �rill bs sal�ctsd randomly by ths City Council.
3. Addresa whero gaa►as will be held '�''' • � !L� �
N er � Strs�t City Zip
4. Nam� of manager signing this application who wi11 conduct. oparate and maaaga
Gambliag Games �. � �. Date of� Birth � ' �7--�,(
,
(a) Lsngth of tima manag4r has bean memb r of applicant organization � u►� �
S. Addrass of Maaagsr (o ,3 � � • �• � —
Numbar treet City Zip
6. Day, datsa, sad hour• this applicatioa i for � 2 �U(9 - .'c2��1'�
7. Is ths applicant or orgaaizatioa organiz d under the 1 a of the St a of �? �
8. Dat• of iacorporation J ?,Z 1 9
9. Date whea rsgisterad �rith ths State of nnasota /I't.✓�c�n 2 1 � l S 3 �'
10. $ow long haa or�anization b�sn in �xi�ta a? S Z
11. Boa loa� ha• orgaaization b��a in axi�t� a in St. Paul? _�2. ,
12. What io ths purposs of th� orgsnization? � �
13. Officars of applicant orgaaization:
�.ms = -�"_Nr,r�[�'2 g... � JU�C/� /�'IO.L/soyV
Addrs�• �i�� S. AL�2T ��'. �ddsa�a �i91�1� '
Titla Pet'3'�� DOB 3-I 7'37 Titls S�r,��'Ti�x y �� 3�?/'�/
N�. .J�fGK ivNAL�Y �S
Addrss• 5�0�? llddsssa
Titls �P�i�!!ll.�4L �8 �-�/�-�.� Titls DOS
. • . � � � - , = --/��7
. . �/'�1
14. Giv� nams• ot offic�r�, or aay othar p�r oas Who paid tor a�rvic�• to ths
orgaaiZation.
Namt Jdk:�N� Nas
. .
Addrsaa � llddrsa�
Titls 1Ytls
' Attu�y �aparats ah t for additional aames.
15. Attuhad h�r�to i• a liat ot nam�s and resass of all oambsra of tbs organization.
16. Zu vhoas custody will organisation'a r�c ds bs kapt?
Nsa� �ti� %!.'oNR/,/�4t� Addrsas �i� �. A��'�- :��-
17. Liat all per�oas with ths authority to s chacka for dispareal of gambling procasds:
Name F './1 i�iyl f/�/VS' v�� Nam� .�fl'f,ll� BAR��f'
Address ii.T S, A���/'j ��� Addrsas /��,; .�i`'�E%�d'�%�UO P��-
Member of Member of
DOB ��T a-3� Organization? 5 ;fE�'� DOB A-f 7- !(3 Organization? �,
pv
Nams �;Z-� F'��E�qu AN Nana _
Addr�as 5�'�1� Addsss�
Membar of M�bar of
DOB � "' - � Or�saization4 � yu�°I9 DOB Or�anization?
18. Havs you rsad aad do you thorou�hly und�r taad tbs provisions of all taira,. ordituncs�.
and rs�ulatioaa �ovsrniag ths opsratioa o Charitabl• Gambling ga�s4 �r'ES
19. Will your organization's pulltab opsratio bs oparated/mana�ed aolely by memb4rs of
' your or�aniaatioa? yss ao , X
20. Has qour organizatioa sigasd. or do�a it ntsnd to siga, a consulting agreemsnt or a
managerial agresmant with any person or c anq to �aasist your orgaaization With tha
pulltab sal�s aad/or rscording kaepiag? yss ,� no X
If aaswer is qes, giv4 the nams aad addre s of tha person aad/or co�panq contracted.
Name Addr�ss �
Naas Addre�s
If answer is ysa, ho� will auch a can4ult t bs paid? (psrcantaga, flat fsa, gaabling
fuads, ganezal fuad�, etc.) Attach a cop of said coatrsct to this application.
21. Opsrator of premisea ahare games vill bs ald:
i ,
Nass
Busin�s• Addr�aa 20 S�• ��X �'� . �IUS-
Soms A�ddr:ss J.3 2 Sf- . � �
: - _- . . � � . � � ������7
22. a) Dos� your or�aaisation pay •os{iat�ud t pay accouaCin� tss• out ot �asblin� lund�?
• ysa X'� ' ao ..
__.. .
b) If you do pay accounting f�ss, to �tb vi.11 sucb !��• bs paid?
� St!/f� �'�
• �aaa�s h��R /I'IRf�J�6E1�1�/��'l s�sa , ?3G� /�Ti�7 ,�8 L UD. �g/M� /l��,=��5�
DOB ��A ,_ 1��bas of Or� tioat �
c) Hov ars th� accountia� la�s chas��d t? � ilat fas hoarly. atc.)
d) What do you anticipat• vill be your erags sonthly dsductioa for accountia� fesa?
� SO --'
23. Amount of raat paid by applicaat organiz ioa for rsat of ttu hall:
�',��.�� ,�/L�E �k
24. The proceeds of the games will be disbur d after deducting prize layout costs and
operating eapenses for the following pur asa and uses:
5�.�/Cy�l k'��1�'PS
25. Haa th4 pr�mi4aa �ars ths gamas ars to h�ld bsea csrtifi�d fos occupancy bq the
City of Saint Paul? ��.�
26. Has your or�anisatioa filad f�d�ral fora 990—T? NO If aaswr is yss. pl�as� attach
a copy Wi.t� this applicstioa. If answsr is ao� ezplain whq:
Aay chaags• dssirsd by the applicant sssociat oa may be mads oaly �ith ths consant o! ths
City Couacil.
�✓�,Gei'� o{ �i `� Hd�Y S�l.c�'l
.��9� �� Organizstioa aa�
�Y"--' Z'.
Dats �.-J-�9 By: ��N� DAi/IQ '�'��
Mana�ar ia char�s of game
�-.�.�- !� ��--''`.�' -
fR7riYE'/' 77� f�'1s�%!c%��
� . Or�aaisatioa PYSaidsat or
.�,.:........... ... ���,._. .y�..�•.;. �. -..•`�.r.7�,: .••�A- .. -.-. . -r+�-.,�1 . ..y�`- ..-�.�'�-'•" . , - r"-"��� _'_'."".-..�.�_
� •� ' � ' .��a����
- • City of aint Paul /���
Department of Finance nd Management Services ��
License and ermit Division
203 C y Halt
St. Paul, Minneso a 55102•29&5058
APPLICATION FOR LICENSE
CASH CHECK CIASS NO. New Renew
0 0 0 _ �� .
Date 19�
Code No. ; Title of License � Q�
From a _1g�fo �°�� 19-/V
`� C��n � � , . •
���� � (' f
, o v C ()-�t' I �r i�
. JQ Q,1 ApplicanUCompany Name
, o Q�' !1 Peh�r� 5 �0�0 ���c,�
i Buslness Name
1 0 �po�� GU. ��L,l�i �. Odt �
Business Address Phone No.
1 0 l
u' �C L� � � l'� y 1
1 0 ;'�=tvtaii to Add=e j� Phone No. .
i r i
1 0 ``t" l .�i r✓� �C
Manafler/Owner•Name L •�:
� �3
5 �a . � br � �� �
� �
1 0 Alanager/Gwner•Home Address Pho�e No.
4098 Application Fee "
2.
Recelved the Sum of 1 �� �a(� ( � � ����(��
3 Jrp7•02 ManagedOwner-City.State.8 Zip Code
100 Total 1 ,� ; �=d" I'f�., P r
. 1 �• �y�
LiCenS@ InSpBCtor �1 v By: �� Signature of Applicant �
Bond• '
Company Name Policy No. Ezpiration Oate
Insurance:
Company Name Polfcy No. Expiration Date .
Mfnnesota State Identification No. Social Security No. �� ' ,
Vehicle Information: �
Serial Number Plate Number
Oth@f:
. THIS IS A RECEIPT OR APPCICATION
THIS IS NOT A UCENSE TO OPERATE.Your application for Iicense wii either be granted or rejected subject to the provisions of the zonfng�
ordlnance and completfon of the inspections by the Health, Fire,Zoni g andlor License inspectors.
$15.00 CHARGE FOR ALL ETURNED CHECKS
� �-a-� c�, 7, /
� _ ^ _ - , � . ���--1���
TO BE COMPL TED BY �
. ORGANIZATION PRESIDENT 0 GAMBLING MANAGER
I understand and will uphold Saint Pau Ordinance 409, Sections 409.21
and 409.22 relating to putltabs and ti boards in bars.
Further, I understand that my �arbar m st meet city standards; that lOx
of the net profit from pulltab sales m st be returned to the City-Wide
Youth Fund on a monthly basis; that mo thly flnancial statements must be
filed with the City; and that 51X of n t proceeds must remain in St. Paul
or be used to support St. Paul residen s.
�,
r
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� �i�J,n1P
nature - anager
V
� � �-�_
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gnature - rgan zat on res ent
�Ildl� ' DF 7 � �d�.Y 5t'I�IT' �
rgan za on ame
ee v�a S 2d GP-(--
m ng ocat on
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Date
Please retain the attach ordinance for your records.
� -; .