89-1660 WHITE - C�TV GLERK
PINK - FINANCE CO11I1CII /
CANARV - DEPARTMENT GITY OF AINT PAUL /Q
BLUE - MAVOR File NO• / T� -
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ouncil esolution (���'�;
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application (ID # 0730) for a State Class B Gambling
License by Minnesota 'ldlife Heritage Foundation, Inc. at
Neighborhood Bar, 230 Front Avenue, be and the same is
hereby approved
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�ng n Favor
Goswitz
Rettman B
�he1�� � gainst Y
Sonnen
Wilson
SEP `.` �9p9 Form Approved by City Attorney
Adopted by Council: Date • r���
Certified Pa: C unc' ecr r By XJ
By
A►pproved �Nav • a�e� — �E � � �9 Approved by Mayor for Submission to Council
By �� BY
�'t�1� �� 2 319�
,•- �. ��l-� �`"° �
. . .
DEPAR7M[NT/OFFICE/COUNdL DATE INITIA
Fi nance �.i cense GREEN SHEET No. 5�1 $
CONTACT PERSON 8 PHONE INITIAU DATE INITIAUDATE
DEPARTMENT DIRECTOR �GTY COUNCIL
Chri sti ne Rozek/298-5056 �� CITY ATTORNEY �CITY CLERK
MUST BE ON COUNpL AOENDA BY(DAT� ROUTNlO BUDOET DIRECTOR �FIN.8 MOT.SERVICES DIR.
9-1L�.-89 MAYON(OR AS818TAN'n
TOTAL N OF SIGNATURE PA�iEB (tXIP L ATIONS FOR 81GNATUR�
ACTION REGUEBTED:
Approval of an application for S ate Class B Gambling License.
Notification Date: 8-30-89 Hearin Date: 9-14-89
RE�MMENOA17oN8:MW�lN a Rs�ct(1� C01! li'TEE/�EARCH REPORT OPTIONAL
_PUINNINO COMMISSION -GVII 8ERVIC�COAAM18810N �YST PHONE NO.
_p8 COMMITTEE _
OOMM .
_3TAPF _
_DI8TRICT COURT _
SUPPORT8 WHICH CWNdL OBJECTIVE9
fNRIA71NCi PiiOBLEM,188UE.OPPOR7LNITY(Who�Wdet,WMn,WMn,Wh�:
Hugh C. Price on beha1f of Mi ne ota Wildlife Heritage Foundation, Inc.
requests City Council approva o their application for a State Class B
Gambling License at Neighbor oo Bar, 230 Front Avenue. Proceeds from
the pulltab sa1es will be us d or conservation education youth programs.
All fees and app1ications ha e een submitted.
ADVANTIKaE81F APPROVED:
If Council approval is give , innesota Wildlife Heritage Foundation Inc.
will operate a pulltab and/ r ipboard booth at Neighborhood Bar,
230 Front Avenue.
OISADVMRA(iE31F APPROVED:
018ADVANTAQES IF NOT APPF�VED:
Council Research Center
SEP . 11989
TOTAL AMOUNT OF THANSACTION C08T/REVENUE BUD�TED(GRCLE ONE) YES NO
FUNpINp SOURCE ACTIYITY NUMBER
flNANGAI INFORMATION:(EXPWN)
. � . ' ��_���a
DIVISION OF LICENSE AND P�:RMIT ADMItiIST TION DATE 7 ,�j/ g � / o �J � /
INTE.RDF.PARTMFNTAL REVIEW CHECKLIST Appn Pr cessed/Received by
Lic Enf Aud
Applicant �11{SD�'�t w��CL �it� �r �� Home Address ��oZ�7 �un �r V�1 ��
�-oun �on =t.nc.
Rusiness Name hp� �q r' Home Phone � asV � 9 a 3
Business Address � -� �V Type of License(s) C �G55 � C��.c`n bl�n�
Business Phone Zv� t)�,,,5-�,, t'2�
Public Hearing Date /�/ � License I.D. 1{ . � d�3C7
at 9:00 a.m. in the Council Ch mbers,
3rd floor City Hall and Courthouse State Tax I.D. 4� � 5 o��j/7a
Date Notice Sent; Dealer �1 �U I,Q�
to Applicant `��C� � T
Pederal Firearms �� N'.q
Public Ne�.iring
DATE IN PECTIUN
REVIEW VERFIED COMPUTER) CUMMENTS
A proved Not A roved
�
Bldg I & D �
tiI�
Health Divn.
; ��� �
Fire Dept. � I �
, � � i
; g/,�/� I Se"-E
Police Dept. I I
g�q oK
�
License Divn.
a� � ! a �,
City Attorney �
3c� g�, o lL
Date Recei ed:
Site Plan � �' �`
To Council Research V �� ��
Lease or Letter Date
from Landlord Iv '4
7 it .
4;;.,�;�-� ' ! ' City of aint Paul �G���(��
� ����� Department of Finance and Management Services ��
c Division of License nd Permit Registration
INFORMATION RE UIRED WITH APPLICATION FOR P RMIT TO CONDUCT PULLTAB/TIPBOARD SALES IN
SAINT PAUL (Class B Gambling License in Li uor Establishments - New Application)
1. Full and complete name of organization which is applying for license
ni�c/ 1.��`l /, � -� � ," � �o��� .
2. Does your organization meet the defin tion of a "large" organization as outlined in
the November, 1988 revision of Sectio 409.21 of the Legislative Code? ^/U
Attach to this application pertinent inancial and/or organizational information to
support your answer to this question NOTE: Only S large organizatiores will be allow-
ed to open pulltab operations under he revised city ordinance. If more than 5 organi-
zations apply, qualified applicants ill be selected randomly by the City Council.
3. Address where games will be held ��� �f'� � �"� +�-� 5'����
Number Street City Zip
4. Name of manager aigning this applic tion who will conduct, operate and manage
Gambling Games � (.-� � � C / /'/ C.� Date of Birth r� "S `� 3�
(a) Length of time manager has bee member of applicant organization ��{-�" f�' j/'E=�y�j
5. Address of Manager �/�-1 � t.� fj�� ��- L�i�-L� ��`"� � � 3 �~`
Number Street City Zip
. 6. Day, dates, and hours this applic tion is for
7. Is the applicant or organization rganized under the laws of the State of MN? _i!< S
T—
8. Date of incorporation �'
9. Date when registered with the St te of Minnesota ���c�.� t/ Z � l`T 7 � - -
10. How Iong has organization been i exisCence? � � '�%�--,�
11. How long has organization been n existence in St. Paul?
12. What is the purpose of the orga ization? �lTl� �G/✓j/`G�-ri��yl C c�i'�Lf�j
13. Officers of applicant organiza ion:
Name o b�r -� ���i TG Name � �f'�"�/ �� !/
�, �2., z � �, G�� ' l�%=c�
Address N. �c+Lb .�s�y f'vt�ddress $1; f dZ�✓ �
Title Pr �s� DOB ��j -'2'7 — Title �L, DOB /�+-Z — �:3b
Name v" � �j ' /"/c.- K Name ��Li�-�i�GS v�� J�,G�-�5i
' 7 ?7""�'¢ Ff-r�i 7`)` e.%— �/"
Address y� � �-y D�-� � Ur, L��`�y�,Address �1c%�+, /�sz ss
Title !/� �r DOB � s 3�j Title � G���, DOB �Z �� � � �
. � � + � � C��-l(�Ga
14. �ive names of officers, or any other per ons who paid for services to the
organization.
Name v 6 l'� � '� ���� �'"� Name
Address �� 2c� ��77�2 ds-s, � � Address
Title %�F--et. v ' Title
, (Attach separate heet for additionnl names.)
15. Attached hereto is a list of names and addresses of alI members of the organizatien.
16. In whose custody will organization's ecords be kept?
/ aF�='��G �-��� /vo r�����a�-� ,�.�
Name U C7 f i fG-� Address L�i� �� �il�.l
17. List all persons with the authority t sign checks for dispersal of gambling proceeds:
/ � �,
Name v- �` /'� � �- Name
vF'�:�.��
Address ���� /����!!��1��� -� � Address
Member of � Member of
DOB �r> '- �C Organization? � DOB Organization?
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
18. Have you read and do you thoroughl understand the provisions of all laws, ordinances,
and regulations governing the ope tion of Charitable Gambling games?
19. Will your organization's pulltab peration be operated/managed solely by members of
your organization? yes no � '�'�'e ``''l� �Zd-�'�
�i.Y�1�..� /!d� �°..+vip�o4�
l / /
20. Has your organization signed, or does it intend to sign, a consulting agreement or a
managerial agreement with any pe son or company to assist your organization with the
pulltab sales and/or recording k eping? yes no �'�
If answer is yes, give the name nd address of the person and/or company contracted.
Name Address
Name Address
If answer is yes, how will suc a consultant be paid? (percentage, flat fee� gambling
funds, general funds, etc.) A tach a copy of said contract to this application.
21. Operator of premises where ga es will be held:
Name 4.' v �-�j !�G �
Business Address � ZT� �/��h � �v"'�— 5� �
Home Address �� 3 � `d �� sr �?'"�
- . . ��,��
22. a) Does vour organization pay or intend to pay accounting fees out of gambling Euncls?
yes L/ no
b) If you do pay accounting fees, to w m will such fees be paid?
Name P�� �c1�C�-e�+ �/� Address
DOB Member. of Org nization? _�v
c) How are the accounting fees charg d out? (flat fee, hourl � etc.)
f 2ov��
d) What do you anticipate will be yo r average monthly deduction for accounting fees?
�g�%' �`��C
23. Amount of rent paid by applicant org nization for rent of the hall:
� Z�=C�"d � c�'r� �r-�,t/G�(
24. The proceeds of the games will be d sbursed after deducting prize layout costs and
operating expenses for ttie followin purposes and uses: '
��YVc�-�( • � dE CJ-CG� / �•�
25. Has the premises where the games e to be held been certified for occupancy by the
City of Saint Paul? ��-
26. Has your organization filed feder 1 form 990—T? If answer is yes, please attach
a copy with this application. If answer is no, e' plain why:
�-- ' �1.2 .� 1.tzae 7 d'.�j .. ,
� t ,. C �% t
�� ���
Any changes desired by the applicant association may be made only with the consent oE the
City Council.
. r - *
�..��-�.z,...s,�.� G��
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�L �
Organization am
� �
,
Date � , BY�
M ge c g me
�
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, ,
�_ �` � - ."
Organization President or CEO
_ .�. .. gQ 7.�
- Cit of Saint Paul
_ Department of Fina e and Management Services �� //-��
License nd Permit Division (p
03 City Halt
St. Paul, Mi nesota 55102-29&5056
APP�ICA ON FOR UCENSE
CASH CHECK CLASS NO. • w Renew •
C� 0 � 0 . : .
Date ��� 19�
Code No. � Tttte of License From . v ""� 19�Ta ! ���� 191ci
'� .�s'' �r � �
� ,� .
AppUcan mpany Name
100 9 �/
100 Business Name
• 100 p��� %'�� �• C'!J
B�siness Address Ph/°n�e No.
100 /^I ��J �Gr-L�--zL�
/���2,� �/.1���_.r�-� �d�%? • �;_�/�,!
100 Mail to Address , Phone No.
100 �. (�/��_!C_�J �.
Ma er/Owner•Name
' - 100 __��_� ,�, . I��"'
100 AtanaperlGwner•Home Address Phone No.
4098 Appiication Fee •
2. 50
Received the Sum of 100 �/��jGy� �jyt . � ����
02. p'��j ManagedOwner•City,State 3 Zip Code�
100 Total 100
/���/� C' ��
License InspeCto� By: Sig�ature o1 Appiicant
Bond• �
Company Name Policy No. Expiration Date
Insurance:
r
Company Name Poticy No. Expiration Date
Minnesota State Identification No Esa r Social Security No.
Vehlcle Information:
Serlal Number Plale Number
Other:
THIS IS a RECEIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your appllcati n for Iicense will either be granted or rejected subject to the p�ovisions of the toning
ordlnance and completlon oF the fnspections by the ealth, Ffre,Zoniny andlor License Inspectora.
$15.00 CHA GE FOR ALL RETURNED CHECKS
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