88-124 WHITE - CITV CLERK
PINK - FINAN E COUnCII
CANARV - DEPA TMENT G I TY OF SA I NT PAU L /� ,�
BLUE - MAVO Flle � NO. � '
Counci Resolution ���
Presented By � - '
Refe red To Committee: Date
Out f Committee By Date
RESO VED: That Application (I.D. # 9655) fox a One Day Gambling Permit
(Paddlewheels, Tipboaxds, and Pulltabs) applied for by St. Casimer
Church at 930 E. Gerani m on January 30, 1988, between the hours
of 4:00 P.M, and 8:00 P.M. be and the same is hereby approved.
COUNC MEMBERS Requested by Department of:
Yeas Nays
'mond
� in Fa or
swstz �
ttman
be1�� _ Again t BY
nnen
�Ison pp
JAN z�J 00 Form Approve by City ?Ittorney
Adopted h Council: Date
Certified asse .' Secr ry By
g}, '
Approved y Mavor. Date —�-'� - �� `� Z �ove b Mayor for S�ubmission to Council
By "'"�—." � By
PIIBI.ISHED r=�=��? � 1988
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. {�.F• ���.�. .. . � .DAT!NiIM DA7Y . .. . M���� �� � � ,�R/. �V����� �� �.
T�.�.. ��y� �L�.�,,..� . . . � OEPANI'MEN[OIRECiCR � IMYOR�(OR ABBISTMiT) -. .
. . yy,.� -� :P.�VGYi isV.�+a � - � �N � FWANCE�#INWIOB�IBff�BBIVICES DIRECI'OW - CRV CLERK �� . .
. � ' � � � � ACE N0. ' � N� .� � . � . � .. . �
Z�98-5056 o�o�w:> ��
, �nt c�es_ . —
�.crn�?�ow�r
t3ne Day . Per�ni.t.
t�ev�.t�t a�(R>) c� �:
�anc� ctii�sERV�c.�oN w�w o�rE arr ,v�rsr v►�No. :
mw�o �aaa scHOO�eawo � )t g � t +?S�f't� �
sr� ca+�a�s�or� � �e�s '�DO�+.�o.�ooeu* _ �.°�T _�e�ac�MOSo
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D�aTRtCr *oa+u►� .
,' s��oars wriar+ oe�cnJe� �
f�f1A7A10 MN11E�O/P011iUt�ft'Y(vY1a,whet,wha►.Where.VYhY)c
Mr. Stin�oai, an beh�alf of St. Cas 's Church at 930 East G�x taia, x�st�s �prwal
of ' applicatiaai for a Or�e Day Gaamb Pex�u�t.. It:.wil]. be-u�ed. voa�junctia3-with
t�e. �s annual booya.
.IYI�At101! `��R�)� _ > , .
If the is given. th� church wi 1 be a11c��d t4 �uct a �.tab].e Gaa�b�ling sessi.�
:the h�rs o� 4:a0 p,m. �nd 8:00 p.m. oa� J�nu�a,y 30, 1988.
, : � 'N11+M�.aiu!To°Wlwm): . . , .. :. - ;
' If the al'is rr�t gi.ven. th�e will nQt be ailo�a�ed t�o any Q�arit�.� `
activi.t�ies.
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Msronr . _
t�rui rewea: � __ :
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DIVIS ON OF LICENSE AND PERMIT ADMINIS RATION DATE IZ(a�1y� / �Z� '3�7 �4"�
INTER F.PARTMF.NTAL REVIEW CHECKLIST Appn Prbcessed/Received by
Lic Enf Aud
Appli ant �, .�S i m�Y \:.tr 11.�.rc_Yl Home Address ��� '� � �,Yc.�� �
Busin ss Name G, Home Phone '�''� � , �—�(Q S
Busin ss Address 3(� � . � ; Type of License(s) ����.� �p,rrn,�.
Busin ss Phone �1 -��I'� � l�Olg� ��' �p(X�� • n°� ,` Il����
Publi Hearing Date . � � � � License I.D. 4� (QC������
at 9: 0 a.m. in the uncil Chambers,
3rd f oor City Hall and Courthouse State Tax I.D. �t �(�
llate Tutice Sen�; �, � � Dealer �P ��,�} '
to A plican S � �
Federal Fj_rearms 4� � ��
Publ'c Hearing
DATE INSP 'CTION
REVIEW VERFIED (C MPUTER) CQMMENTS
A roved N t A roved
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B1 g I & D y� I � i ;
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He lth Divn. ' '
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Fi e Dept. I (
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Yo ice Dept. I
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Li ense Divn. �
1zI� I o �
C'ty Attorney �
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i
Date Received: �
I
Sit Plan �'
To Council Research;
Lea e or Letter �, Date
fro Landlord �Z 2 '
�
. . . . . . . �.. . . . . ...- . . . . - ._ . .... . .. . .� ,.. .Y: ". � _. ..... ... .. . . . . .
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Offieers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
� � �. �� � �_ �, ��. ��y �-�-��y t/
" �rr"st�.TA��T OF FT1_'� ;C�., �.[:TD t�1�;�;�C:..:��:T S:.:?VIC,^-.S
" " DIVISiQ;I 0� LICr'�1 �, x:TD P�'?�T :s�MLdISTa.A��1 ,�
I2�OR''A CN �C,UI?� '•lIT? Ar��.;��.TIGPJ �0 �:t,.""ST TO CC?d7UC'" Gx:•��`;G L�JSI01" I:d ST. ?AITL
. Z. .. :: e o� Orgar�ization - � �lm � C .�
, � �.,�..�.
2. � ' ss where C�g,anization's regula mest�gs ars held ���Er' ;��_���/L`
T
3. D and ti�e of �eetin€s � S �3�tJ ��' Ql.c.. :.
1�.. dress Hhere GambZint� Session �rill he held �3c� E . (9-�-�-�2l� .0�G�f�
�. I aap�.icant owner of propert� wher Gambli� Session will be halc?,�_'�es "o
b. I� leased, who is awner of pro�ert wrere GambZin€ Sessi�n sri.Il he heid?
7. I Ieased, attac:� letter of nerr�is ion to conduct Gaz�blir.� Sess�.on, s_gaed by lessor.
8. N of officer �aIa.nr arn�lication F �� /�cr � O �
9. A ess of of�icer ma.iang az�oLcat on �3�L C �y}�Jl U!�J'f Date of birth
1o.. 11 e of manager who wiL conduct G bling Session ��O H ll� %/N SO�
L. dress of nar.ager J � �SOl� �ate of birth -� 7-36
I2. connection with �rhat event is t -�s Gambling Sessioa beir:g he�.d?
0 iS f�
13. F at tvpe of ganbLng devics(s) rri. be used? Paddlewr�el X 'y3.pboard Jr P.a._f`1e
IL. ` ag, dates a.nd. hours t�:.s applicat'on is for anc't number of sessions.
ay(�i:� B �L�� �ates �- 3�1 �Iours -�-- � prI"I�rlo. of Sessions �
15. 1i?.i �r;zes ee paic �n �on�p or � rc:�.andise? /,'�B,CJ�
I6. s ths a�pLcant association or� 'zed under �he laws of �he State oi :�iir.nesota? ��
I7. �ow long has Cr�aaization been i.a e�dstence? �� �"y�1�5
I8. �'Y�at is the pvraose oi tt:e Orga.ni ation? ,�f c.Z� G2d�s " i N C�,U,CJ�lO<�
.-I ,���-rr�-N C' �� c _rtl /eu �rti' ;�b �;��-T�
19.. Of�icers of the Organization
ilame-Ti}�.le 4ddress Date oi bix�h
�!� ��'1 I�?.C��J2.- �?�c/ R�:�3¢ � �72.I�.U�ll 1�. ����3 b
�
�L�?N.�d�AJE C�.�/�'�OCiQt- - kS '� l 16 ��I��l7G ���3�3�
� �
,+�,u t�/lr� P��2k�N ._ 772Gts _ C, � 1 N �(,/k�� .�Z
�
� � . � � . ������
� 20. G� na�.es oi oi°icers or any otr.er ersor.s paid �or se�ces to the Or�-a.�-ii.zatior..
� ' ;Iame-Title �ddress �ate o* ��-t2:
21. In w�ose custad� will. records of azization's Gamblin� Session� te kept?
_ .j e ^. S, USd� Address 7 '�'� � . �Gf✓SO�
�
22. At ach a copy of �our Qrga.ni.zation' �aesabersr.:�p roster and date each me�nber joi.ned.
23. At ach t:^.e Ga�bling Session �anare `s bond.
ZL. � �ac:� a copy oi the Denar��.ment of the Treasu.-�, Interaal �evenue Service "Returr. of
ani zation :�cer.roi �rom Inc one ^_' ", Form 990. (Cha�ter Lla.�L. (1).)
25. ..A tach a ccp� of Det�a.�i:.ient of the ^reasur?, In�eraal °evenue �elrv�ce, ''='Ye:rmt OrPan-
i ation 5usiness Income Tax", Form 9°OT. (CPapter 1�1°.01� (2).i
26. a tach the annua? report requ�red f c!�aritahle or�anizst�ons byr ;•iir�esota Statutes,
S cti�n 30°.�3. (Chapter 1�19.0l� ( ). }
27. :: ve �ou read ar_d do �ou thorou�hl unders�ar.d the prov:sions o�' all la�rs, ordinanc�s
d regulations goverIIZI1� the oper tioa af Gamblin� Sessions? ;_T��
2�. cnanses desired b� �he appLc �t association may be made or�7.y T��th �r.e consent o�
t License Coirmiit�ee. �
�
29. a.n� person(s ) partici�ating ' the operation of any oi t�':e �€aribLin� sessior.s cov-
e ed by this Lcense ever been cor �cted of a felony �n tY:e Sta�te oi �li�nesota or in
other Statie or ��ederal Court? Yes N��_. I� answer is "yes", provi.de
es, add�esses and birth-dates.
� S C` S/�'// � �/��.CtE
Orga.nization
n � � ��'/ /� !�?
rp ,
(Offic�r-Title
P
�
(�ian `er in c!:arge o� C lin� Session
State of 14irs�esota) .
jSS
Count of ?.astsey )
�
�v�� � and ��
R�
being duly sworn sa� ihat ��: f a°e t:�e pet�t�on in the above a�plication; that t::e? aane
read „he foregoing pet�tion ar.d Tmow ` e contents t:�ereof; tihat the same is true of t::e_r
ot�rr± _ ,rled�:e.
� + �• ?•,, �llice Ii. Jan.sen
ubsI� ribed ana sworz ,.o before r�e t..i � ,
01 IL �a.� OS (��..1�,.(�yyy�t/ �� O ( �+��:i R.:;: INNES^v?P
t,%' �� NOTARYPUBI.IG-M
. . � � � �'<�ti`^� ..._. . � .
h WASHIfvGTON COUNTY
MY COMM�Sg��N EXPIRES APR 28• 19�2
. �i0't t�Ab1.iC� l:OUA � irL1.Z1A SOt•8
:•� c �mission Pxpi:�s ;
�
3ui1 ' �eparv:�eat �pproved iSaD�Z'OVBd b� ii
�ire Denart;aent .��proved 'sa��raved _^y �,
Poi� e Depart.�enL Approved isa�roved �y_�i„ _
�
d
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���a� �
,Minnesota Cha�itable Gambling Control Board LAWFUL(3AMBLING EXEMPTION
Room N475 Griggs-Midway Building FOR BOARD USE ONLY
�,},: � 1821 University Avenue
- - - = St.Paul,MN 55104-3383
�"'��`�� (612)642-0555
�;
�,>: ..
�� INSTRUCTI NS: ?._ Submit request for exemption at east 30 days prior to the occasion.
£ x-: �: 2. When completing form,do not c mplete shaded areas until after the aG+tivity.
..�" 3. Give the gold copy to the City or ounty. Send the remaining copies to the Board.The copies will be
`���` returned with an exemption nu ber added to the form. When your activity is concluded; complete
`'`"` PLEASE TY E the financial information, sign an date the form, and retum to the Board within 30 days. ,
'� Organization Na e Number of Members License Number lif currently or previously .
LF".'; St. Cas�mir Church � �Qp licensedlandlorpermitnumber. �C&203j4�;� "
`'•.;Address . _ - . Ci y State Zip County �
934 E. Geran i uEn S t: Pau i Ptta 5510Ei itamsey
, „,Chief Executive fficer's Name Phone Manager's Name Phone Number
_ - F�.Tom Meyer �6i 2 � 77t+-0 G� Jonn St i nson �612� 774-$9�2
Type of Organiz tion . If Other Nonprofit Organization ICheck One and 8ttach proof of nonprofit statusl.
;-'` ❑ Fraterna O Veterans ❑ IRS Designation
; .� Religion ❑ Other Nonprofit Organization ❑ Incorporate with Sec�etary of State
�Attach pro f of three years existence. ❑ Affiliate of Parent Nonprofit Organization
• ,�,::-
„ Name of Premis s Where Activity Will Occur , Datelsl of Activity,drawinglsl
St. Casinir Hall
;;, ' Premises Addre s City State Zip,. County
)30 t. Geraniur.� �t. Paul i1�! �:,1(?fi i ams�y Jan. �0, 1�°3
. �. ,,._ , � ,
,,. :. _ ��. . u ,:.
,� �"se��nd° � �fa�$`'�
,._ - . . � ��
� � � Ga e Yes �No � � � , � �� �
.� � - ��,
' .
�- _ ..:,
Bingo ;�
: Raffles � .�.��� -�;,� �,��
� �. n
��. . ..�. ,e
� . A. .���.< �. ��.- ��� � � ,,.,
� Paddlewh els �� � � �����
� � �; :� ���' �.
- � �� � � ' ' �
Tipboards ;( � '� r'� �#;�#�� �����"�:;� :�,�� �__. ��, �
, ,
��<, �.� �_ . �. _ �,� n e
, ,_
� .�� s,fi'`=�r � a✓ :,�t� :��'�, .`, � a •�` '�� `���,r,""„�"`���z. r ;° �
Pull-Tabs ; s�- � � �� � �`4 °
`, ,���, �� :;� .:a
Use of Profit
Nelp support educational acti ities o` paris�� scf;ool
` , r. , ._ �x_._ ,� ,,� �a,��.,.s�,�.: �� �DisVfbutcir sF:�cenae No.
� �� • . . �
� � �> r x
� °,�k� ��`�'������� .:n�������;�'"�ae�,�. ' �'a' - �,'�;i..� s���" '` .�� �`s"#'� ;�
�,�r. I affirm al information submitted to the Board is true, accor- .'T r r��c�a ""' ����` � � '���F�!�
" �. �� �'�, �� c�
,.. ate,and mplet . �� �
,� . ,� . - -
� - � �� /� �3
5 � '
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: Chief Executi e Officer Signature Date y ;,, -° d�'"
. �-.`. _, .._
ACKNOWLEDGEMENT O NOTICE BY LOCAL GOVERNING BODY
I hereby cknowledge receipt of a copy of this applica ion. By acknowledging receipt,I admit having been served with notice
j r;�.af4.; that this pplication will be reviewed by the Charitab e Gambling Control Board and will beaome effective 30 days from the
; _�'`r date of r ceipt(noted below)by the City or County, nless a resolution of the local governing body is passed which specifi-
ay cally dis Ilows such activity and a copy of that reso ution is received by the Charitable Galmbling Control Board within 30
''��`=` days of t e below noted date.
<<":;;; CITY OR COUNTY TO I NSHIP
�'���' ` Na�pf 1 Govg[�ing B dY City or�unty � - Towns hip Name(Must be no ti fie d w hen oun ty is t h e a p p r o v i n g bo d y)
i �� �i -!Et(. _ 1
{�'''`'
��`'�'� Si n reof rson ReceiGi Applic�tio � -;� Signature of Person Receiving Applicati n
r� � 9 i : ,r �T/ • + 4'
i y,T �.-r r'' �`�y�:i1✓j� j.} .J'P,�-, . . c� �
` "T,n, �P ec R��ea Title Date
' s =' � �°:r5e.. P.r�°r' -71 .
,
� CG-0�J020- 1(6/87) White—Board Canary—Board retums to Organizatipn to complete shaded areas.
• Rnk—Organization Gold—City or County
�. _. —