89-1907 WHITE - C�TV CI.ERK
PINK - FINANCE G I TY O SA I NT PA U L Council /� f/�
CANARV - DEPARTMENT 7� /yO�
BLUE - MAVOR File NO. � �
� C ;;nc 'l Resolution ��;
Presented By
Referre Committee: Date
Out of Committee By Date
RESOLVED: That application (ID #16013) for a State Class B Gambling
ticense by Epilepsy oundation of Minnesota at the Clover Club,
501 W. University Av nue, be and the same is hereby approved/
-���
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
Lo� In Fav r
Goswitz
Rettman J
s�6e;ne1 _ Agains BY
Sonnen
Wilson
OCT � 9198 Form Approved by City Attorney
Adopted by Council: Date -
Certified Passe � o cil Se ry � BY �+ �� �
,�
B�, �v�-----
dlpproved b 'Navor. D ��+� � � � Approved by Mayor Eor Submission to Council
,
By v V--�_ .r By
ppg�t� o C T 2 S 19 9
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DEPARTM[NT/OFFICEICOUNCIL DA INI TED
Fi nance/I.i certse GREEN SHEET No. �J��k4 A�
OONTACT PERSON 3 PF10NE �DEPARTMENT DIRECTOR CITV COUNqL
Chri sti ne Rozek/298-5056 �CITY ATTOFiNEY �cm c�c
MU8T BE ON COUNCII AOENDA BY(D/1T� �BUOOET DIRECTOR �FlN.8 MOT.SERVICES DIR.
10-19-89 ❑AAAYOR�"��T""T� �21_._C�o�u,p.ci 1
TOTAL A►OF 81ONATURE PAGES (CU A LOCATION8 FOR 81GNATUR�
ACTION REOUEB'fED: .
Approval of an application f r State Class B Gambling License.
Notification Date: 9-13-89 Hearin Date: 10-19-89
�Na►�s:�w c�a�c�� t�voErr o�
_PLANNINO OOMb118810N _pVIL 8ERVI�COMMISSION Y8T PNONE NO.
_q8 OOMMfTTEE _
—�� — � E : REC
_asrAicr couAr �
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x�rcu►n��,�ssue.oP�tuNm�wno,wna�.wn.n,wn.r..w►M: �,��
Marlin Possehl on behalf of h Eiplepsy Foundation of Minnesota requests
City Council approval of the r pplication for a State Class B Gambling
License at the Clover Club, 0 W. University Avenue. Proceeds from the
pulltab sales wil1 be used t sist people affected by eiplepsy and
provide public education, in o ation and referrals. All fees and
applications have been submi t .
ADVANTAOES IF APPROVED:
If Council approval is given plepsy Foundation of Minnesota will operate
a pulltab booth at the Clove ub, 501 W. University Avenue.
�
;
�SADVANTAOES IF APPROVED:
i �9 ,��;� -s;,� ��nter
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:) "L'�� �, �l �i��J�
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DIBADVANTACiE3 IF NOT APPROVED:
I
I
. I
TOTAL AMOUNT OF TRANSACTION CWT/F�VENUE ONDOBTED(CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMlER
FlNANGAL INFORMATION:(EXPWI�
I
� ..
� �NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE QRE 3HEET IN3TRUCTIONAL
MANUAI AVAILABLE IN THE PUACHASINi3 OFFICE(P , E NO.298-4�225).
ROUTINa ORDER:
Below ere preferred rouUr�ps for the�ive most frequern typea of .
CONITRACTS . (aswrt�es authorizsd COUNGL SOLUTION (Amend, Bdgts./
budge�t sxists) Accept.(3reMs)
1. Outside A�ency 1. Director
2. InitiaUnp Department 2. Budpet nctor
3. ay n�com.y 3. Gty
4. Mayor 4. Mayor/
5. Finarx��Mpmt 3vca. DUector 5. �ty tx�l
6. Ffnar�ce AcoouMing 8. CMsf . Fln d�Mgmt Svca.
ADMINI8TRATIVE ORDER (Budget OOUNpI U7lON (all oiMra)
Hevision) and ORDINANCE
1. Activity Manap� 1. Inidtll D�Amsnt Directo�
2: . Depertmont M.couMeuft �� ��
3. DepaRment Director .�
4. Budpst Director
S. City Cle�lc
8. Chief Ac�untaM, Fln�Mgmt Svcs. .
ADMINISTRATIVE ORDERS (all dhera)'
�
1. Inhfatinp De�rtnwnt .
2. Gty Attomsy
3. MayoNAsMetent
4. qty Gerk
TOTAL NUMBER OF 8KiNATURE PA(iES
indk:ats the A�of pp�wt which sipnatures u�raquired uM i
each of these�
ACTION REOUE8TED
Dsscr�s what tbs projecfhpusq asska to eccomplish in either ch M
cal ordsr or ordsr of importance,wMt�wer b most appropriate tor he
lesue. Do not write complsts aente�. Begin eed�itsm in�rour 1 with
a vsrb.
RECOMMENDATIONS
Compiats N ths iswe in qusstia�hes bNn prs�eMad bNoro airy � publ�
or private.
$UPPORTS WHICH COUNqL OBJECTIVE?
Indicate wh�h Coundl objsctNr�(s)You�P►ojwtlro4u�BupP� ��D
ths key word(s)(HOUSINO, RECREATION, NEKiHBORHOCID8, E IC DEVELOPMENT,
BUDC3ET, SEWER SEPARATION).(8EE COMPLETE LIST IN IN UCTIONAL MANUAI.)
OOUNCIL COMMITTEE/RESEARCH REPORT-OPTIONAL AS RE ESTED BY COUNqL
INII'IATINO PROBLEM,13SUE,OPPORTUNITY
Explain ths situatlon or caMfdons thet crearted a need for your p
or request.
ADVANTACiES IF APPROVED
indicate whsther this is simply an annual budpN proc�dure requir by law/
charter or arhether thers en epsciflc in wh�h ths City of Sai Paul
end Ita citizens will bsneflt fran this p�/action.
DISADVANTACiES IF APPROVED
Whet negatiYe eifects or major chan�es to oxisting or past p might
thfs proJectlroqu�t produc�if ft is passed(s.p.,tratNc dNeys� noi � .
tax increas�or aeeeartienb)?To Whom�Whsn?For how bng?
DI3ADVANTA(3ES IF NOT APPROVED
UVhat will bs ths nsgetdve conssquencsa if ths promiaed aetion is
approved?Inebility to dslivsr ss�?CoMinusd hi�h traifiC, nolse
accident rats?Loss of revenus4
FlNANqAL IMPACT .
Although you must Udbr tha informetfon you provlde here to the i e you
are a�ressinp, in�ral y�ou must answer two questi�s: How m ch is it
going to cost?Who ia�inp to pay4
� � � � � � ��'-iqa?
UIVISION OF LICENSE ANI) P�:RMIT ADMIN STRATION DATE � � U / / g � � /
INTERDF.PARTMFNTAL KEVIEW CHECKLIST Appn ocessed/Rec ive by
,�/� Q er/� �v S$eh � Lic Enf Aud
/ I
Applicant �n,(���„ �ound..,�a» b-� �� Home Address �07 0� �►i�'hS�v' ��
-�-�r
Rusiness Name l� p e r'' C�(,�� Home Phone l0�� �`��O�r
Business Address SU �.O Y1tv� S�"�� Type of License(s) (.: IQSS � '
Business Phone C1�� ��r ►'� C.� LI C Q n S�
�
Public Hearing Date �� �q g License I.D. �� '(p0 � 3
at 9:00 a.m. in the Council ham ers,
3rd floor City Hall and Courthouse State Tax I.D. �� C 5 a�.��D�
llate Nutice Sent; Dealer 4� � �Pr
to Applicant — .��
rederal Firearms �� /J��'
Pub.lic He�.�ring
DATE II�SP 'CTIUN
REVIEW VERFIED (C MPUTER) CUMMENTS
A roved N t A roved
�
Bldg I & D +
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Health Divn. !
; ���.
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Fire Dept. i �
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! ��i , g� �
Police Dept. ' I
� � � g� ��
License Divn. (�' �
13 I� I �/�
City Attorney �
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Date Received:
Site Plan �J f} �y
To Council Research �� ��—a �
Lease or Letter Date
from Landlord N e4
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�'`�.L�,'�' ,.'� ,� .,.. . . Cit of Saint Paul ,�j
`�'F Department of Fi ance and Management Services ��' ` "1���
� " Divieion of Lic nse and Permit Registration
INFORMATION RE UIR�D WITH APPLICATLON F R PERMIT TO CONDUCT PULLTAB/TIPBOARD SALES IN
SAINT PAUL (Clasa B Gambling License i Liquor Establishments - New Application)
1. Full and complete name of organiza ion which is applying for license
� � P c. o��o� o� �,,��c�.s�
2. Does your organization meet the de inition of a "large" organization as outline��i,nw.��
the November, 1988 revision of Sec ion 409.21 of the Legislative Code4 � r.s�o..S
Attach to this application pertine t financial and/or organizational informati n to
support your anawer to this questi . NOTE: Only 5 large organi2ations will be allow-
ed to open pulltab operations under the revised city ordinance. If more than 5 organi-
zations apply, qualified applicants will be selected randomly by the City Council.
3. Addrese where gamea will be held 5�� uKiVE�S� �. �T�/9��- 55��.�
Number Street City Zip
4. Name of manager eigning this applic tion who will conduct, operate and manage
Gambling Games ��fZC-11� 1� S�tf'L_ Date of Birth ��` � �' 'C )
(a) Length of time manager hae been member of applicant organization !� � ��S
5. Address of Manager `'�U.3 �� /��. 1�a. � N'LS. ���7
Number Street City Zip
. ' 6. Daq, dates. and hours this applicat on is for �� "' SA1. /��4� � "' �•�0 �'�-
7. Is the apQlicant or organization or anized under the laws of the State of MNZ ��S
k8. Date of incorporation � �C 4�
.�9. bate when registered with the State of Minnesota ��+��7'�C.'l� `� (�j 7
�10. How long has organization been in e istence? �Z `1�72,5
11. How long has organization been in e istence in St. Paul? �J� `�" �� ,
12. What is the purpoae of the organiza ion? � QSgi S'�" `►7�Qn� �e.���'� f��+ eAl'`"��
czw[t (�OJKXL �M li�. ' , eAeF�''J��M �'t
13. Officers of applicant organization:
Name l,! G�RGLN Name �N�.Z �(C-(�56�
Addrees .,� W��t.�, (.,h�1( t��f Address ���( �, II�Sr, a�`«.'�T� 55�J
Title {�(Z�,S', DOB � Title ��C U08 3 �`� �
Name �t.Ln 0`� Name �..� � Gj-��-'JU`�
Addresa C,.t�, c.t). 55�-Sr.-� 3�z /`►P . 55`�1°J Addr�ss �c►�l -1�! I��,c.GR/�DE , n�l
Title �R�.� nos / Title t�ict {��2.�5 nos a
�-7'! �Q ymond
� � - .� . � � - �-��-��o�
;�� 14. Give r�ames of officers, or any oth r persons who paid for services to the
organization.
Name I�f°�RC,In( pO�S��f"L Name
Addresa G�.�, I�S 'T V'�L Address
Ti t le �,.p�p�',.t�,�� �( i.+e,�C�' Ti t le
(Attach separ te sheet for additional names.)
15. Attached hereto is a list of names and addresses of all members of the organization.
16. In whose custody will organization s records be kept?
Name � (�� POSS Address (,"j2, � ��SF� �
17. List all persons with the authorit to sign checks for dispersal of gambling proceeds:
. Name �„��( S 5�(_,_ Name ,� LKK� ��.(I�[ S
Address `f0� Q��-� �'� � S. Address C•� � ��''��� �, ST�L
Member of Member of;
bOB � - ,'�� -4.� Organization? j, DOB Organization? ZS
Name (c..L� /y�, CJ Name
Address L-(- ur•C (.,,A�`lZ r(0[1T�1- Address
Member of �,,/ Member vf
DOB ��/�G Organization? 1 � bOB Organization?
18. Have you read and do you thoroughl understand the provisions of all laws, ordinances�
and regulations governing the oper ion of Charitable Gambling games? ���_
19. Will your organization`s pulltab op ration be operated/mana ed solely by members of
your organization? yes no
20. Nas your vrganization signed, or do s it intend to sign, a consulting agreement or a
managerial agreement with any perso or company to assist your organization with the
pulltab sales and/or recording kee ng? yes no �
If answer is yes, give the name and address of the person and/or company contracted.
Name Address
Name Address
If answer, is yes, how will such a c nsultant be paid2 (percentage, flat fee, gambling
funds, general funds, etc.) Attac a copy of said contract to this application.
21. Operator of premisea where games w 11 be held:
Name �(..�.�i4 °/L ��,((..p
Business Address 5� ( / 'J��d
Nome Address � 6GtJeJ1� �� d
. . ; � � � � - ��-�q07
-� 22. a) Uoes vour organization pay or i t nd to pay accounting fees out of gambling furids?
yes. no
b) If you do Pay accounting fees, o whom will such fees be paid?
Name Address
DOB Member of Organization?
c) How are the accounting fees ch rged out? (flat fee, hourly, etc.)
d) What do you anticipate will be your average monthly deduction for accounting fees?
23. Amount of rent paid by applicant o anization for rent of the hall:
. � � ..� f"�a�
24. The proceeds of the games will be d sbursed after deducting prize layout costs and
operating expenaes for the followin purposes and uses: '
�.l � C. �A-(_ �� P�1 C� ()'F
� �"'(. u. S t'�
25. Has the premises where the games ar to be held been certified for occupancy by tl�e
City of Saint Paul�
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.
�P t c.�S`I `�w�c��►�cml a�f' �.
Organization Name
bate �i " � D —� By:
Manager n charge of garne
� „ +
Organization Pres nt or CEO
. _ , � . ��0/3
_ • ' City of Saint Paul
� Department of F nance and Management Services
� Licen e and Permit Division ���C—/-�J�2
203 City Hall
St. Pau Minnesota 55102-298-5056
APPLIC TION FOR LICENSE
CASH CHECK CLASS N . New Renew
0 0 i � �
Date —� 19�.
Code No. Title of License From l �� 19o�To ���� 19�
,�
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<� � � / �� � � ���/,/�� /y
�� i ` , �y/��C-R��� , l 1.�'/< �
�' �C � � ,00
j,',�� ���� Appli nUCo pany Name
100
�G�-�'-�'yL�-�
100 Business Name '
100 ��� c/�'�/lL�� �'4-�-;����
Business Address Phone o.
� ,/
100 � % v T —.
, �
G -y� ��,� ��� a! ,i ' �d �
100 Mail to Address Phone No.
� � //�
100 �?��,,�(/ ��?-��L_.�'
ManagerJOwner•Name
100
100 Alanager/Gwner-Home Address Phone No.
4098 Apptication Fee 2, 50
Rey�efved the Sum of � � 10,0�
�i ��l ,(�G{� p�� a. .�G.r� ManagerlOwner•City,Slate&Zip Code
.
100 T tal 100
_ `-� .
LiCense InSpeCtor By: Signature of Applicant
V
Bond:
Company Name Policy No. Expiratio�Oate
Insurance:
Company Name Policy No. Expiralion Date .
Minnesota State Identification No. E�-� ��� Social Security No.
Vehicle Information:
Serlal Number Plate Number
Other:
THIS IS A R EIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your application for I ense will either be granted or rejected subject to the provisions of the zoning
ordinanCe and completion of the inspections by the Health, ire,Zoning andlor License Inspectors.
$15.00 CHARGE F R ALL RETURNED CHECKS
..�iG�.o`�e� 9-7�'9 .� �� /