89-1727 fE - CITV CLERK
- FINANCE GITY O SAINT PAUL Council ?r/'� ^�
..RV - DEPARTMENT j 7-� �/ �
��UE - MAVOF File NO• u «
Counc 'l Resolution ���s�
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Presented By
Referred To Committee: Date �
Out of Committee By Date
RESOLVED: That application ( #97746) for a State Class B Gambling
License by Hayden eights Booster Club at Sherwood Lounge,
1418 White Bear Av nue, be and the same is hereby approved/
dew�e�l.,
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
��g [ Favor
—6vewit�
Rettman 4 B
Scheibel __ g8i(1 S t y
Sonnen
Wilson ,
SEP 2 6 '�� Form Appr ved by City Attor y
Adopted by Council: Date
Certified Pa s Counc.il e BY �• ����
By
Approved � avo : te _ � � � p89 p►pproved by Mayor for Submission to Council
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B ` ` — _ , Y
ppg�� 0 C T 7 1989
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DEPARTM[NT/OFFlf�JCOUNpL OA INI TED
Fi nance/�i cense GREEN SHEET No. 5013
OONTACT PER80N d PNONE INITIAU DATE INITIAUDATE
�DEPARTMENT DIRECTOq �GTY OOUNGL
Chri sti ne Rozek 298-5056 � Q��1�NEY [3�cm c�
MUST BE ON O�JNCIL AOENDA BY(OAT� �BUOOET OIRECTOR �FIN.6 MOT.SERVICES DIR.
9-26-89 �MAV�i(�i ASSISTAN'T) � •nt�n�i� R
TOTAL#�OF SKiNATURE PAQES ( P L LOCATIONS FOR SIGNATURE�
ACTION REQUESTED:
Approval of an application or a State Class B Gambling License.
Notification Date: 9-8-89 Hearin Date:
�oo��a►rwws:�ov►w.w«As�e«(�► � riEPONT a+T�oN�u.
_PUWNINO t�MMMSBION _CIVIL BERVIC�COMMIS810N Y PNONE NO.
_CIB COAAAAII'�EE _
BTAFF _ '
_WSIAIC'T OOURT _
SUPPORTS YIR�ICH OOUNpL OBJECTIVE9
INITIATIN(i PROBLEM.�SIIE�OPPORTUNITY(Who�N�h��WM��Wl�x�� ).
Lester R. Hansen on behalf of Hayden Heights Booster Club requests
City Council approval of t ei application for a State Class B Gambling
License at Sherwood Lounge, 1 18 White Bear Avenue. Proceeds from the
pulltab sales will be used to support youth activities at the Hayden Hghts. Playgrou d.
All fees and applications ha been submitted.
ADVANTAOE8 IF APPROVED:
If Council approval is gi en Hayden Heights Booster Club will operate
a pulltab/tipboard booth t herwood' Lounge', 1418 White Bear Avenue.
ois�wvurrno�s iF�o: '
SEP�l�1�8.9
CITY CLERK �
ois�wv�wr�s iF NoT aaPnovea
�Qa�;��,, �����rch Center
Sti' 1°�'��89
TOTAL AMOUNT OF TRANBACTION = l�T/RHVENUE BUDQETED(GRq.E DNE) YES NO
FUNDING SOURC.E ACTIYITY NUMBER
F�NANGAL INFORMATION:(EXPLAIN)
. . . �8�-i���
DIVISZON OF LICENSE AND P�:RMIT ADMI ISTRATION DATE � � � / � 9 ��
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn rocessed/Received by
Lic Enf Aud
L P S`�e K- iZ � �Q n S F/1
Applicant �Qt.�Ci21'� �l�j�'1,'17 �DS�! '�.C> Home Address ��J(pZ� � • -tt�c,��
Rusiness Name Q, S ((,�JQL� �OU n � Home Phone � � ' —o�9�
Business Address J�'Il$ (,J�t�� �Je ✓ �U'L Type of License(s) C1�55 ,�' �-l�rnbl'�
Business Phone ��U .5� �P�
Public Hearing Date 2(O D License I.D. 4{ `7 7 7 � �
at 9:00 a.m. in the Counci Ch be s,
3rd floor City Hall and Courthouse State Tax I.D. �l C S �7/J�
llate Nutice Sent; Dealer 4� �� �
to Applicant —�'
Pederal Fi.rearms �6 ���
Public Hearing
DATE A�SPECTIUN
REVIEW VERFIE (COMPUTER) CUMMENTS
A roved Not A roved
�
Bldg I & D �
NI� ,
Health Divn. '
�
+ NA
�
Fire Dept. � �
� �IA I
�
� $�� � �� 5 e r�
Police Dept.
$ � p lL.
License Divn. ,
� I� � ' �/L
City Attorney �
� �Z � 0 �
Date Recei d:
Site Plan �Q- Q '3 Q�
To Council Research � 0
Lease or Letter � ate
from Landlord
. • � ' Cit of Saint Paul � �•��� �
Department of Fi ance and Management Services
Division of Lic nse and Permit Registration
INFORMATION RE UIRED WITH APPLICATION F R PERMIT TO CONDUCT PULLTAB/TZPBOARD SALES IN
SAINT PAUL (Class B Gambling License Liquor Establishments - New Application)
1. Full and complete name of organiz tion which is applqing for license
� � � � '- � o ' C-%u
2. Does your organization meet the d finition of a "large" organization as outlined in
the November, 1988 revision of Se tion 409.21 of the Legislative Code? �
Attach to this application pertin nt financial and/or organizational information to
support your answer to this ques on. NOTE: Only 5 large organizations will be allow-
ed to open pulltab operations un r the revised city ordinance. If more than 5 organi-
zations apply, qualified applica ts will be selected randomly by the City Council.
3. Address where games will be held � / �� GJ�f�/,� ��/�(" ,�(� ,j��,QG(L. SS//�
Number Street City Zip
4. Name of manager signin� this app ication who will conduct, operate and manage
Gambling Games ,(.�s ;�_.� ,r�'^ }��.`i��y�. E.� Date of Birth ��`
`� 3' �- r��.,-�
(a) Length of time manager has een member of applicant organization _��7 '�r S
5. Address of Manager a,rsrg',� � o�T— g� _ s i P�vt�. r��,� ` SS�/ �r
Nu�uer 5treet C�_, Zip
6. Day, dates, and hours this appl cation is for �f/�f�`'� �/4"�
7. Is the applicant or organizati organized under the laws of the State of MN? , �� 5
8. Date of incorporation
9. Date when registered with the tate of Minnesota � `- � �� 7 �
10. How long has organization been in existence? �CJ��,5
11. How long has organization bee in existence in St. Paul? Sn,�E /�s �b�v.�--
IZ. What is the purpose cf the or anization? ��O�� /�G f/ (// �/t s
13. Officers of applicant organiz tion:
Name �r' U/Ci k.� Name ��� /',�y} l�L(.� G�
Address / �/ � £ Z f� v Address r�7y � /�/''�/K.� %�o✓
�
Title ��j� � DOB �-/ Title s,��. DOB S"�C'J '.�/
Name /`� ` �!� Name /7/�/t/�(/ �G�1/J'I/�f
Address � �/ � (,� T�i v.^rv Address �f'/�^/5 /�'C/ .SS�J`
Title ��s DOB ' `�'�,6 Title � 'G��" DOB
- . � _ . � �' �t-��a�
14. Give names of officers, or any ot er persons who paid for services to the .
organization.
Name Name
Address � • Address
, Title Title
(Attach sep rate sheet for additional names.)
15. Attached hereto is a list of nam s and addresses of all members of the organization.
16. In whose custody will organizati n's records be kept?
Name ��i'���l4 /C ��'"' Address .��� � ���'Cl4h,'�
17. List all persons with the autho ty to sign checks for dispersal of gambling proceeds:
Name `i�fC►�i�l{-$ � G � L"� Name /��/�/n l/ , Y'/�/f'I/`� /
,� .
Address �`� l���''/ti` f/���� (� �-� Address �✓t�/�-/�j ;� ��
Member of Member of
DOB �� I Organization _7� DOB Organization? '�/�J
�
Name v,4/'' /� Name �P S-� r- 1�• �U r�S P�)
Address/f� �¢// ���¢ L- Address ��1� O � (-�p y-�
c Member of Member of
DOB O 3�� `� 7 Organizatio ? �//�`yS DOB %� 3� Organization? �j/!�S
T— •T—
/
18. Save you read and do you thoro ghly understand the provisions of all Iaws, ordinances,
and regulations governing the peration of Charitable Gambling games? �
19. Will your organization's pullt b operation be operated/managed solely by members of
your organization? yes ' no
Z0. Has your organization signed, r does it intend to sign, a consulting agreement or a
managerial agreement with any erson or company to assist your organization with the
pulltab sales and/or recordin keeping? yes �- no
If answer is yes, give the n e and address of the person and/or company contracted.
Name %�/'/' ��� i �� G f� Address �S�C� [,✓/�i f� �jLF+�/' /�-V
Name Address
If answer is yes, how will su h a consultant be paid? (percentage, flat fee, gambling
- funds, general funds, etc.) ttach a copy of said contract to this application.
21. Operator of premises where g es will be held:
Name �a-c�/
Business Address L l LtJf�f�i� ���``' /��
Home Address j T� � � TU
. . . c�" gq- ��a7
22. a) Does qour organization pay or intend to pay accounting fees out of gambling funds?
yes �"� no
b) If you do pay accounting fee , to whom will such fees be paid?
Name �j �� ��� Address
. DOB Member of Organization?
c) How are the accounting fees charged out? (flat fee, hourly, etc.)
- S a-7� � Z o
d) What do you anticipate will be your average monthly deduction for accounting fees?
S`%
23. Amount of rent paid by applica organization for rent of the hall:
��� =-
24. The proceeds of the games will be disbursed after deducting prize layout costs and
operating expenses for the fol owing purposes and uses:
�'"��.�
25. Has the premises where the gam s are to be held been certified for occupancy by the
City of Saint Paul?
26. Has your organization filed f eral form 990-T? � If answer is yes, please attach
a copy with this application. If answer is no, explain why:
7 �D
Any changes desired by the applica t association may be made only with the consent of the
City Council.
/��r-vct" �
Organ zat n Name
Date Z� ,j � �
By:
Manager in charge of game
Or a 'zation resid n or CEO
. . . q7��-;�
• � City of Sai�t Paul
Department of Finance and Management Services r+� Q,(,'�/�� �
Lic nse a�d Permit Division `�� / !
203 City Hail
St. P ul, Minnesota 55102•29&5056
APPL CATION FOR LICENSE
CASH CHECK CIASS NO. New Renew
00 � aa _ , p�
_ oa�e a ' is.�
Code No. , Title of License From � 19�To u �� 19 /CJ
.� , �S • � :
1 �,�=r?-G�
,� 't ���� Applfcan pany Name �
100 /i
i�
100 Busfness Name �6 ;
v
�oo /�/�C������������ •�
Business Address Pho�n do.
�oo � ��/`
/9(�O a ���!���,' U9'�=�9�
100 Mail to Address ��� Phone No.
�00 %.� t�7GL.i' � � ��-�-2-y�L_�
Manager/Owner•Name
100
100 AlanagerlGwner•Home Address Phone No.
4098 Application Fee 2. 50
Received the Sum of 100
a. ManageriOwner•City,State 6 Zip Code
100 Total 100�
License Inspector By: Signature ol Applicant
Bond:
Company Name Policy No. Expiratio�Date
Insurance:
, Company Name PoHcy No. Expiration Date
Minnesota State Identificatfon No. E.s o2 7� Social Security No.
Vehicle Information:
Serial Number Plate Number
Other:
THIS I A RECEIPT FOR APPUCATION
THIS IS NOT A LICENSE TO OPERATE.Your applicat n for license wili either be granted or reiected subject to the p�ovisions of the zoning.
ordinanCe and completion of the inspections by the eaith, Fire,Zoning andlor License Inspectors.
$15.00 CHA GE FOR ALL RETURNED CHECKS
..
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TO B COMPLETED BY
ORGANIZATION PRES DENT AND GAMBLING MANAGER
I understand and will uphold Sa'nt Paul Ordinance 409, Sections 409.21
and 409.22 rela.ting to pulltab and tipboards in bars.
Further, I understand that my arbar must meet city standards; that 10%
of the net profit from pulltab sales must be returned to the City-Wide
Youth Fund on a monthly basis; that monthly financial statements must be
filed with the City; and that 1% of net proceeds must remain in St. Paul
or be used to support St. Paul residents.
/ .
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Signature - ger
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��Signat e - Organization P dent
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' rg i tion me
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-�-cr�
amb ing Location
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Da e
Please retain the attached ordinance for your records.