88-204 WH17E - CITV CLERK
PINK - FINANCE COLLIICII �J/
CANARV - DEPARTMENT GITY OF SAIN PAUL ��� Q((��
BLUE - MAVOR File NO.
� Cou cil Res lution
. ?�3
Presented By �'G'�' ��
Referred To Committee: Date
Out of Committ e By Date
RESOLVED: That Application (I.D. #16873) r a State Class A Gambling
License applied for by Holy Chil hood Church Women's Club
at 408 Main Street be and the s e is hereby approved.
(Former location 57 W. 7th Stre t)
COUNCIL MEMBERS equested by Department of:
Yeas N s
Dimond
Lo� In Favor
Goswitz
�he� Q' _ Against BY
Sonnen
1A�'
Adopted by Council: Date
FEB 1 1 1988 Form Appro e by City torne
Certified Pa_• ��o ncil S tar By
By
Approv y Mavor: at _ � FE� � r I��� Approve Mayor f r Submission to Council
y BY
PU9LiStiEO `_.�a�_` " �r 19 �
?aa oAre wruteo o� ca� � 0� ��
` J� aa��.� ' - - Gi A��' �f�E�` No: 0 0 0 9�`3
. . �T - _ . � DEPARTMENi DIRECTOR � .. � MMYOR�(OR ASBISTI�M)� � ..
C:�'1�"f.3t].Yl� RDZPaC �FOR �a�n�rr a�o�cmn �cmr a�
ra' ROtJTfNG �r a�c'roR 2 �(�T1Cj.�. ��'CIl
Fir�a�oe & � . 29�8-5f356 or+�ea:
. crrv nrro�r+�v . ^ , ,
Applicatic�ri far ch�r�e of laoatiori for a State Minnescc�t�. C:�i#�b1.e G�nbl.�;n,y Lice�s+e
C]:a,�s A (Bingc�. Raffl�., P,ae3dl:ewheels. T az�d �;lt'�hs?.'.__ . ,
�. .. ,, .. . �. . � . . _ _ . . t , . . . _ � .. . � . � . � . : .
A�c�r �s �o ssr ��t n� 2/1/�s � � � w�, � 2/�./ae.
n�oy►�+o�+s:c�av►�•u►► ��m� ' ��+ .
vur�wx�6o�resaH cnrw sE�oa��ori o��w a, our �w.rsr q+o�ra.
mwxs� �so ers sc►ao��
X er,� crwx�R co�w�aa - co�:��s�s _,wotpa�o.�* _��o.�a'.� _��oe�c�"`�•
o�cr c�ca�
*ocauw+nor�:
eu�voRts w►i�oo�x�cr.oa�cnvE� -
AppLi.cati�on for o€ 1c�aticxi frcxn 57 West th Street t,a. 408 M�an Str�t �Gr a
State of ' C�Saritak�le License C s A (Bing�o, Raffles, Padd7;�eels,
Tipboax!ds. ar�d ltabs) .
��nNO w�o��.wu�. t�a v�.w�,v�.�rr.
Dorothy A. , c� beha�l� �f t�e Qiuzr.h of the I�oly G'hildt�ood Wan�n's Club, is requ�esting
�tbuncil of a .char�e o� iocatior� for C1ass A�. (Bingo, R3ffi�ss, Pad�dlewhee3:s,
Ta-Pboards, ai�1 ltabds) Char3table Gam�b].ir�g Li
�n�to��a.��.�.. ��: . � .
If ttieir a�pl� .on is apgroved, tt�y will be lo�wed to :�an�or bii�!o sessiions oai
S�s betva�en :3f? p.m: and 10:30 p.m. at �08 ' St.reet.
�:s E�rc v�,ane w�w�»: . . ,.
. ;
,.
If their appii °_�;s not"�, t}�ey wil.l fOrced to di:s�an�.ia�e char�.tab�e
gaanbling ev�ts.
�u.raw+►,�es: �s �,s �
_ _ . , _ ^ _ _ l .
;
. �
�ri.�ceoeats:
Rautine:a�rti.nis t,iv�e wnrk.
�rea,�s:
_ _ _. — _ ,
� -�
. . � � �fi��c'�
UIViSION OF L CENSE AND PERMIT ADMINISTRATION DATE I ' Z���/ 1 Z� � �
' INTERDF.PARTMFTTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant �.c.��,{ter�tllHo e Address `� �� '4-�'�
/� � , j �p� v.
Business Name w H e Phone cu,c/� S S�U
� 33-�/Qo�
Business Addr ss �Ug ���Q,�.wJ � T e of License(s) ..d�.�
, .
Business Phon � �y– �y�j5 �
Public Hearin Date a��� 1 $�S L cense I.D. 41 l�� �3
at 9:00 a.m, n the Council Chambers,
3rd floor Cit Hall and Courthouse State Tax I.D. 4C N��'
llate Notice S nt• D aler �� —
to Applicant S � � $g
r deral F3.rearms �6 '
Public Hearin
DATE IICSPECTION
REVIEW VERFIED (COMPUTER) CUMMENTS
A roved Not A ro ed
Bldg I & D �
N�A-
Health Divn '
__ ,
N�,� �
Fire Dept. i �
� �/� �
��� I
Police Dept
��24 ��
License Div . � � `��Z,o ~'1�v...�-:..L�z•-�Q — (� �� ✓
. ��s� !
City Attorn y �
I
Date Received:
Site Plan N A'
o Council Research
Lease or Lett r Date
from Landlord ��S
�f�_ �o���
��' `.
�•, mu
���?T'�� Charitable Gamblin Control Board
.;,o,� � .�, c� , 9 FOR BOARD USE ONLY
.. '�` �"��,� Room N-475 Griggs-Midway Building
- ;� 1821 University Avenue License Number
�� St. Paul, Minnesota 55104-3383
�;; -
(612) 642-0555 AMT
�.
�'1�' CHECK#
DATE
G MBLING LICENSE APPLICATION
'�, INSTRUCTIONS:
A. Type or print in in .
B. Take completed a plication to local governing body,obtain signat re and date on all copies,and leave 1 copy.Applicant keeps 1
copy and sends o iginal to the above address with a check.
C. Incomplete appli tions will be returned.
Type of Application:
f�Class A - Fee S 1 0.00(Bingo,Raffles,Paddlewheels,Tipboards,Pull-tabs)
❑Class B - Fee S O.00(Raffles,Paddlewheels,Tipboards,Pull-ta s) �a��kspayableto:
O Class C - Fee S O.00(Bingo only) N��s��e Chadtable CaambBng Control Board
❑Class D .- Fee S 5.00 IRaffles only)
❑Yes�7No 1. Is th s application for a renewal? If yes,giv ompl te license.number � - 0 - 0
❑Yes�No 2. If th is not an application for a renewal,has or aniz tion been licensed by the Board before? If yes,give base
i lice se number(middle five digits) �' ''�"' "`�f J
Yes ONo 3. Hav Internal Controls been submitted previously?I no,please attach copy.
,4. Applicant(Offici I,legal name of organizationl 5. Business Address of Organization
'��! _�f, ..(�-iI _ ,- �<i � � '�� f� .� � /_i-, � � s.;Y .�-`,�,� .. "�
� � 6.;s City,State,Zip � '� �- . `-% 7. County , �� 8. Business Phone Number
� r - �_� _ ., � j%` , _:.f� ( "::'..�l-;;4� -;��� ';1_c,'"—
� 9. Type of organiza ion: ❑Fraternal ❑Veterans aReligious Other nonprofit" � " �
- 'If organization is "other nonprofiY'organization,answer questions 1 through 13.If not,go to question 14."Other nonprofiY'organizatio�s
� must document it tax-exempt status.
_ ❑Yes❑No 10. Is rganization incor o�ated as a nonprofit organiz tion?If yes,give number assigned to Articles or page and
� b k number: Attach copy f certificate.
DYes ONo 11. A articles filed with the Secretary of State?
ti,.
❑Yes�No 12. A articles filed with the County?
❑Yes�No 13. Is rganization exempt from Minnesota or Federal i come tax?If yes,please attach letter from IRS or Department of
R venue declaring exemption or copy of 990 or 9 OT.
�Yes�No 14. H s license ever been denied,suspended or revok d?If yes,check all that a ly:
❑ enied ❑Suspended �Revoked Giv date: - -
15. Number of activ members 16. Number of years in exist nce Note: tf less than four years,attach
evidence of three years
" ��� .�,-`�% existence. �..---
'�
1 Z� Name of Chief ecutive Officer 1 . Name of treasurer or person who accounts for other revenues
�f' �--~l� - %.�r • ' j', '"ofthe organization.�
� - �� �
��. 'x�� ;; - ,._ �L-r_ �i��� ;�=...�-... . � ,� - '� _ / ,. _ , _ j
Title Title
�_..__
, -- , ^, .
: _. ,
, ,•��• j, _... .� .%..� ._ .� -.__ .��•.
Business Phon Number Business Phone Number
. , ( // .. � .���° �' C ,��,
�,� %i��� L� ;�``==- .�� _,r, `�! � r�, /�-) _ /J
19. Name of establi hment where gambling will be � 2 . Street address(not P.O.Box Number)
� � conducted
� - �7', �„"'� �-:a. .,;:=..�...�.e!�f-�. :%-.�¢c- / �J <�
��' 21. City,Stste,2ip �� / 2 . County(where gambling premises is located)
` �' ! _ �
•_�/� .-/�� � . �' ' `+ "��G.-G.� �.Z- �'�N-�,i .
CG-0001-02 18/86) White Copy-Board Canary-Applicant Pink-Local Governing Body
� . __ , „ . ���o�/
; . .
� GambAing License Ap lication Page 2
, Type of Application: ❑Class A ❑Class B ❑Class C Class D
�es�No 23. Is ga bling premises located within city limits?
, :r,�C�IYes�No 24. Are a I gambling activities conducted at the premises isted in #19 of this application? If not,complete a separate
� ' appli ation for each premises(except raffles)as a sep rate license is required for each premises.
��'� ❑Yes o 25. Does organization own the gambling premises?If no, ttach copy of the lease with terms of at least one year.
"xr (�es�No 26. Does he organization lease ihe entire premises?If no, ttach a sketch of 27. Amount of Monthl Rent ,
the p emises indicating what portion is be jng leased. lease and sket' ^ �, $ ��i � �
is no required for Class D applications. •;,,�,. ��:— ,�.��.- � � ..�,
�Yes 0 No 28. Do y. u plan on conducting bingo with this license?If es!�give`d`ays and#imes of bingo occasions:.,��; ' �,�y��,�
oaya ,/ /. � ,3'imes ,:��u—= � �
�. �.
�' =t p` - - .� !. " .=� / . , _.
, y
/
Yes�No 29. Has t e S 10,000 fidelity bond required by Minnesota tatutes 349.20 been obtained?Attach copy of bond.
30. Insurance Compa Name ._�-�`` 31. Bond Number _ -
�..,� _ /�,., ..�f: �.: j` J f-.� �
, ,
j� . . : .
, _.- . _ : . ,
^ 32. Lessor Name�� , 33. Address 34. �ity,•State,Zip�% , �
. i�t;-,:' .:_ ., :✓r .,..-�, .�.:--.,�� .,` :::,...:, ,- - c�%.:c..-�L—� '/,' - -'/'a
r 35. Gambling.Manage (�lame s/�' �' 36. Address �;_ •37. City,State,Zip,� -• . ,
��_ ./ � . 'J . �` "Y:J � ` .! i ' . , .� .. �,,.
38. Gambling.Manage Business Phone 39. Date gambling manag r became '
� � �' _ '• _� member of organizati n: . �',
� /,,�;► . ._ _ �"`-T-1
- � ,
GAMBLING SITE AUT ORIZATION
By my signature belo ,local taw enforcement officers or agents o the Board are hereby authorized to enter upon the site,
at any time, gamblin is being conducted, to observe the gambli g and to enforce the law for any unauthorized game or
practice.
BANK RECORDS AUT ORIZATION
_ .By my signature belo ,the Board is hereby authorized to inspect e bank records of the General Gambling Bank Account
whenever necessary o fulfill requirements of current gambling r les and law.
��.. ' OATH
-� I hereby declare that:
1. I have read this a plication and all information submitted to t e Board;
�z 2. All information s bmitted is true,accurate and complete;
3. All other require information has been fully disclosed
4. I am the chief ex cutive officer of the organization;
5. I assume full res onsibility for the fair and lawful operation o all activities to be conducted;
6. I will familia�ize yself with the laws of the State of Minnesot respecting gambling and rules of the Board and agree,
if licensed,to ab e b those laws and rules, includin amen ments thereto.
40. Official,Legal Na e of Organization � 41_ ignature(must be signed by Chief Executive Officer)
,�y
. - . % '' � �...-.(� �,° .-,� �/ ...i" "/� .;+'1, 'i� .^i' �.:-• ' .'�_� �.:, �!
Title of Signer l,,�----- � Jt" ,. Date �
. . .
� ; . <--l:�,•%- � � ..c;� U
ACKNOWLEDGEMENT OF NOTICE B LOCAL GOVERNING BODY
I hereby acknowledg receipt of a copy of this application. By a knowledging receipt, I admit having been served with
notice that this appli ation will be reviewed by the Charitable Ga bling Control Board and if approved by the board, will
become effective 30 ays from the date of receipt(noted below), nless a resolution of the local governing body is passed
which specifically di allows such activity and a copy of that res lution is received by the Charitable Gambling Control
Board within 30 da of the below noted date.
42. Name of City or C unty(Local Governing Body) If sit is located within a township,item 43 must be completed,in
i ' r �,
addi ion to the county signature.
�-. I , �:� L/
Signature pf person re iving application 43. Name of Township
`?'�.' X y i • :� C.�..._ rl.� �-�. i`-�-t^ ��.-�IP� _
,� Title � Date receive�d)(30 day period Sign ture of person receiving application
�'�' ��1j� � begins from tfiis date) /
b_y
-fi \���i)��.�.0 �s 1\ � � ' �.�1� �� .' �1� !/ .. . X � - - . ' �. . - � � . _ . .
44: Name of Person del vering application to Local Goveming Body Title •
r
CG-0001-02 18/861 White Copy-Board Canary-Applicant Pink-Local Governing Body
• � , City of Sai t Paui �����
� . Department of Finance an Management Services /� � '�3
License and Per it Division
203 City ali
St. Paul, Minnesota 5102-298•5056
APPLICATION F R LICENSE
CASH CHECK C SS NO. New Fie ew
� �: � . • � . ' P/
-f�C{i..,4. ' . C�V
�, Date �� �g 190
":�'�Code No. tle of License ^
r.
" From '—�� 19��To / J°�d 19�
" 0'�3 �.�-� '�Q ayo ,�T �97�� . ,, _
; �
d � � � � ) too j-�-C�� �i�i±{I '�� :��.l C_ ;�t r�. -
r1�i �,,., .,�..i;�,,� /l�-(f.�1 S.�/ AppliCantlCompJeny Name _
/' 100 L�{�.:v�� �> ; L( 1.�� �
_��..`.,. �t� .�"�-� _� �1 J ~� /�`? Q �� �;� �=�`
�...
100 Business Name
����1�
100 C � �-'� � � r�r-r�
Business Addreas Phon�Na
100
100 Mail to Address Phone No.
' --�
100 v o �r J r;'i ✓.� � �l ? ��•.�:- _;�• �
ManaQeNOwner-Name �' �, _
100 � -, �-.„ ,' `D�`'
' _ •� {'` � _. ,; r.
�.�.' �` �� �'�. �`� r� �E 'i`. ii�\:: '�� !
100 Ata�agedGwner•Home Address �� Phone No.
4098 Application Fee 2 gQ
� '" �;1�j
Received the Sum of 700 � ! ' �i �� �, L� � i `• `.' "
-- . ..
J L'� �= ' ManagedOwner•City,Slate&Z1p Code
100 Total t00
� . ., � ; ;l
'' , 1 � . , , �f'•—
LiCense InspectOr �--' � By: � �`� �� " � � ,Signature o!Applicant
Bond:
Company Name Policy No. Expiration Date
insurance:
Company Name Policy No. Expiration Oate
Mlnnesota State Identific tion No. ocial Security No.
Vehicle Information:
Serial Number Plate Number
Other:
THIS IS A RECEIPT F R APPUCATION
THIS IS NOT A LICEN E TO OPERATE.Your appiication for license wili e ther be granted or rejected subject to the provisions of the Zo�ing
ordinance and comple ion oi the inspections by the Health, Fire,Zonina�nd/or license Inspectors.
� �>�.�
� � � ��� �I
; $ /^ , . ,' ' �41g URNED CHECKS
. _q� (I�!{�► �
'1 •l V �
��..: . . . .. . .,t.M . .. � . ._ . � ..''1 �:. (�� �� ...
� � 1 1 L.{'(i\A
� L ' ,',/+
� � = U
����� �- ' �� ` ` �'�'
':-��p��� C�-�...��..� r-z�-��
� - - f�-���a� .
_ . .
, • • '� City of Saint aul
. Departmecit o[ Finance and M nagement Services
Division of License and Ye it Registration
INFaRMATION RE UI ED WITH APPLICATION FQR PER.*iIT T CONDUCT CHARITABLE GAM�3LING GAME IN
SAINT PAUL
R ���
� �� 1. .Full and com lete name of organization which s applying for license
� r
2. Add s wher games will be held - - �cT' og, r
Number S�cr t City Zip
3. Name of mana er sign g this application who ill conduct, operate and manage
Gambling Gam s r Da_e of Birth o�'� ��5 r
(a) Length o time manager h been member oi applicanc organization �� �
4. Address of M ager �� " � � ,, ��a(
Number Stree City / Zip
5. Day, dates, d hours this application is =or ,L%�1�u"" � — b`�C� ld�,�d •
6. Is the appli nt or organization organized un er t`�e laws o= t:�e State'of `�IN? I���,
7. Date of inco orat�on � �� (�
8. Date when re istered with the Stata oL M�:nes ta � ��
9. 1?ow long has rganization been in esistence? �
10. How long tias rganization been in eYiatence,i St. Pau;^. '
11. What is the• p rpose of the organ�zatior�? �'�-��z4��
� �_
� �
I2. ficers of piicant organization
Na�:e � � vame �G
„ � •�
Addre � � ddr2ss
+ . ��!`r��� i o
Title OB . iitle c��s�w /DOH ` ����i•
.� r , , �"�
�Name ' vame
Address �a.3 � ��. �d�ress ` �
� /
�` Title ` � DOB ��.- �� ..� Titie DOB �
13. Give names o oificers, or any ot:^.er persoas - no ?aid ror ser�ices to tze organization.
-.�� � " ,
Ivame Vame
Address ' addre�s
Title ---�z
(�:ttach se�arate saa�_ - _ ;c�-==.,..__ __-:�:. '
. , . .
a,-
(
14. Att here i�Iist E names nd addresses of: a memoers of t o ganization. 1
, �� • `c,�a��
15. In o custody wi or�a at on's ords� ke t? '
N� � Address �� � '
16. : e sons who will be c ductin �a�
g, assisting in conductin , or operatin the games:
Ivame Date of Birth �.:'�/�� ����
Address d �, � ��/O d/
i �
Name of Spouse Date of Birth � .3--- 3�
1 ���ates when such gerson wili conduct, assist, or operate �
'�/ � ��i-��� `
� � `�
� r
Name - Date of Birth ���^��cj�
Address � �� C3 �_/��
Name ot Spouse v.J/ Date of Birth � - �� �/`3 L.1
Dates wlen suc:� persor. *ai1l conduct, ass:st, or cpe-ate
G ���- i� z.�v
17. Have vou read ar.d do ;rou thoroughly unders and the prov:sions of all laws, ordinances,
and regulatior.s �ove�--i'_�; tae operat_on c: Cha�_tab_e GambL_n� €a�es?
18. ' Attached hereto oa t:�e forT �ur^isaed b,� c�e C�t� o� St. ?aul �s a .Financia_ Report
whicn �te�izes aL recei�ts, e::penses, ar.a d�sburse�e::ts a� the apnl;cant organization
25 W2,_ 35 d_� C.eSP,�ZdC'_�:iS WC1C C12TT? �?�e''T8'? _t;�1C1S i t:12 ^ur°C2GF:Clg calendar year
T
wh�c^ `:as bee^ s:s�ea, . -e�a__��, and .ar__'_ea �v
- ..- -
e
� �� � ��--���
- L
:�- ress
who is che o� �ne aoplicant Organization.
`lame o� 0�:_�e
19. Operato: o: pre�ise= a?:ere 2ames a�l? �e he�d:
O
� ry,9
Name C�, �`iESJ�OiL -
. _ �� `� � ��� �`"' �O �;
B�tsiness Address �
Home Address �p�� ���7�,. -
/� ..: `tl"�
20. Amount of rer.t paid 'oy appi.csr.c Or�ani�ac:ez tor re^c o� che �:all; specify amount
paid per 4-hou: se��:on � �cS , � � �- ;�
. �--����
•1 ,
!.
21. The proceed o� the gar�es wi11 be disbursed after deducting prize layout costs and
operating e penses for the following purpos s and uses:
�� � , �
��,
�
�, -
.
�
� _
�
.
22. s the pre ses where the g2mes are [o be held been certified for occupanc}• by the
City oE Sai t Paul? �
23. has your or ar.:zat�on rile ' cedera� �ora 990 T'. � Ii answer is yes, please attacn
a copv ith this applicat�on. I: answer is o, e:cplain why:
� C
� � �� ` -�'�--�-¢�✓
�' - / ,
Any changes desi ed � J �ae apnl�caz� 3ssociacaon a� be �ade onlr with the consent oi the
CiCy Council.
� J
/
rgan_zat:on
r � �� ,
�ate `� � , �: -- .
Mana e: in charge oi gaQe
� .� rr �_ � z t I _� n — � .. .- � c7 cn
� � �' —'—r.d,.:i� � ; � � :� rr � �. ! y u
�q I� :A r. 7 rt
��r'y y"�. \ c7 "7 _ � CC � n (9
���' - ,�" '� � —• ? r „• r' ^ �� O
�� .... � �: � �D r � C O �-n
J4^�.� '�; :o rT rr (D i-+ ^n
. . A - 'f.��•...a� � :A — `< �
"' � .. .'�' -- -n _7 3 � r :D W � G �
r. 'Z. � ,'f. — co � rr E ' 3 7
� ' �-
;,,.: � — ^ =� i� rt � Jf (�
?er � � 71 ,n � � !:. `G O
� �•"y � . . i, � � R
�T.�O' " P� �C' :� � �.1
. "' .'1:t� � .. 1 (� (A
. ,'� ,9^f'� '� ^ � ' -t 'S1
:'�.•�' I-.• � � �
'SI zJ ^I E �� �ti �/�J�J
!-� fD ! � ~ J �n � I`A I� � N
n � � I A I � .T I
� �: : T I I
c� � � � ! , � �-~ o �` - m i
� „ , � �p _ � �
�. �, � =; � � I� ,� � � I G1
� � _ _ �° "
^ i = ; '° _ � —
E r* r- �'
, I � i �- I R � :A � O ,f0
� � � y _ T � co
� A fD J 11 I!+ �
( � y � ! E ro .,�D '� pf (
9 C � .-� �
. 1 J �
Q �• � ( \�
7
�i. -
. `� ��rt pt Sain- Pau1 /v���0�
i
• � �R Departmenc of F!nance and anagemen[ 5er•:ic=s � ��
` � Division or License and ?e mit ddministratlon
4�\ UNIFOEtN CHARITABLE GAMBLIN FIiIANCIAL REPORT
� �, oe � ,z— �'"—���'?
� -'�� r
1. ` e oE Organization
.N � � O 2'- d ress vhere Charitable mbling ia conduct d � ,�,5�/p�
��� � ,tlo�' :�..s� ,19�-p`�'i��, ,
3�Q e ort Eor period coverin � e /�����- �
V� 8 19�through t9 �
��.
'.�� 4� o al number of days played
�� � 5�.r aa receipts for above period $ ��',���/��
� � 6. r s9 prize payoucs for above period ; �j
� �f
\ 7. Ne receipcs - line S minus line 6 S � Z�� s�
V
\,\ ^ .\ . Ex rnses SncurreJ in conduccir.g and op�ratin game:
� �� A. Gross vages paid. Ac�ach wurke�list ui h �_
ri1
�� namea, aJdress and groas vages, � a ����� �
� 1.,.�� ,r---
�� \ � B. Renc for � veeks + j ���,/ 9Q� �� ,
� �f�
� � � CJ�C �� "�
�. License fee
r
� D. Insurance �r� � �Y+
� \ E. Bond.� � — �, �7 '
�, -� � $ _ .
� � ' � F. Dishonored checks not recovered � ��Q�B-0
I �
' ` C. Ewployers f.I.C.A. S �Al �/J�'
� ir� ��i
` \ H. Sales Tax � ��Q� � , �
� /, .,�L.
` I. Ninn. U.C. Tax �
�
J. Federal U.C. Tax $
�� � K. Hiscellaneous Expenses. Idencify �he am unt
and to vho paid.�
� ��
�. � � ; � �,.�
Z..�'� ��$
�� �, �� ; �
( 4' ; ,���
9. Tot 1 Expenses TOTAL ;
l0. Nec Incoae - line 7 minus line 9 � ��D�
1I. Che kbook balance beginning of per:od 5 /
F �� 12. Toc 1 of line 10 aod 11 f � ��/
;� 13. To� 1 contribuctons :rom line 17 s �. �_
J
� 4. Che kbook balance end oE reporting period - • ��O �
LIn 12 less line 13 f �j�
�,C.
l5. Spe ify use made of amount on line 13:
�%L�G�`„ AO►-v • � 1
I/ � � �
G! �'�� � > ! _
�jd. v ,�� � �3— —�- �' ���
� �orri.rrr T . . �•.,�
Q 9� � �.r� .�,� �� �� 7'1�,
,r�v � a o �-- ��t�
�
.�: �'s.,�rser..encs .:oa aaounc ia l.ae 12: .
� .
�'�aine • � 7 � ame p�' ` .
� r,� �� y ;f l9
Add ess� � ; �y .ti' ess �J l�� �
�-. � -_z_
Dace c Dat Rec'd �
�� � �
, _ .. _ Purpd�e" u o
Signacu 1!Q%�� a re -
° ," , �oE Rsc� _� ecipient � �
. ount ta(i� Q��G�� Amounc ,
Name � j � Name
. Address � � d reas
Dace Rec'd Date Rec'd .
Purpcse Purpoee
Signacure Signacure
of Recipienc of Recipient
„ � AmounC Amount
Name Name
Address Address
Dace Rec'd Date Rec'd
Purpose Purpose
Signatu:e Slgnature
of Reclplent of Recipient
• Amount Amount
Name Name
Address Address -
Date Rec'd Date Rec'd
' Purpose Purpose
Sigaature Signature
of Recipienc of Recipient
Amount Amcunt
17. Toca1 Disbursements e�� 6 a.�}`�jL.�
�
TiIS RE?ORT MUST BE F}LLED••�:1 COMPLETE'i,Y TO QUALIFY APPLICATION FOR CHARITABLF GAMBLINC
LIC�NS$. _
H C �'1 f� fA ql C �1 A Cn . fn F �-1
S �o rs S O �i r+ �u ro S O .-1 r►+� tsl + �
m O � 2' �-3 � O � Z �-1 �^ \O Vi
� � �. �i t+� m .e .+� r7 cn n a
, � ^a � A ,p ,;e a ��o o •e a .i .+
� � a ��..m"���o'•, -°o C a e o .°n � "'
3 T �0.4�:.O.� �'*1 • .�+ �T�_' 2 � �o O +� 3 O >
n K ri'' w � .7.r+��, \ �' ft T !+ � �
r+ •7 �7., s�°� i.Z. !� I1�\ 0� ! 3' 7 � 2 C .�
m ;;r w' i,r'S •._z - '\'• � o '�+ r- oo z —m c
� r a. . �n nr,: *� . g �e, '`- m �n rn -' rn _
, f. �n Gr �n B ` .• rn cn w
A 2 '�",�f .�C p ,A� . i+ 7 �C O [R >Z
z n m m+„ ��-3. e►. "w 3 °f > 3� ��-1 C
• n B o n n "�'� y,` , �r. o n
y.c:�, h m
W n � L' V � ",r +t -� �Q-.' O � C 7 O C) � .
. r+ . 3 �• io - 7 �` .n 3 ' m +t O
G. �s v..rv -rb �� �- ie v v v� Oo a
q� 7 m O '. �iv�'•` 'C q d 7 3 77 . . .
; � 10 1� `,C R � .Q ,�� M V `C iT f0 � •< A
' O� W T 01 . ..O � r��`a"1 � w (� Q 01 Z � .. .
� . 1� 'J a 00 rv��.'�V.rN - �\\T f0 � » ..
. . '_ C. • Of W Y m p+'Z..
` m n a n � ._
., •t ' �' A �. � p„ ..Y_� ..a ,� � � � "` "� .
- .. ,�. . 7 . O ..... m . .� O t+l M � . ..
o E ' r+ E • 9
- � r n o � A ' C'
�o a � a c.
a uo � � ao ��
� w� m � � m
� � G . a � a J
� � ''� �
�
°� �, �
. . , , ������
4�.�.*•o, ' CITY OF SAINT PAUL
� � � DEPARTMENT F FINANCE AND MANAGEMENT SERVICES
+, ,.: � DIV SION OF LICENSE AND PERMIT ADMINISTRATION
���� Room 203,City Hall
- Saint Paul,Minnesota 55102
George Latimer
ra�yor
Janua 29, 1988
To: Vi ginia Baisley
From: hri sti ne Rozek l:q�
' Re: R ord Check
In co nection with application for a S ate Class A Gambling License by
Churc of the Holy Childhood Women's Club, at 408 Main Street, a police
recor check is requested on the follo ing people:
Janet ��I. Fairbanks Mary Ann Harokives
1527 impson Street 1137 West Iowa
St. P ul St. Paul
Birth ate: 2/22/51 Birthdate: 3/16/35
There e Picha Dorothy A. Green
1463 reda Avenue 1402 N. Albert Street
St. P ul St. Paul
Birth ate: 3/6/56 Birthdate: Z/17/35
Eilee Hagel
1379 reda Street
St. P ul
Birth ate: 2/10/39
r
A cop of the application is enclosed. _
CR/ca
, .. ����<<
.
_ `�,*, o;�, � C1TY OF SAINT PAUL
-'� '� DEPARTMENT F FINANCE AND MANAGEMENT SERVICES
��� i�ii� '�
.� ,,. DIV SION OF LICENSE AND PERMIT ADMINISTRATION
���� Room 203, City Hall
" Saint Paul,Minnesota 55102
George Latime� .
Mayor
Febru ry 1, 1988
Doro y A. Green DBA Church of Holy C ildhood Women`s Club
1402 orth Albert
St. aul, MN 55108
Dear Ms. Green:
Your application for a State Charitab e Gambling License has been
rece ved in this office.
A he ring on your application for C1 ss A Gambling ID �(s) 16873 will be
held before the St. Paul City Counci on February ll, 1988 at 9:00 A.M. ,
Thir Floor of the City and County C urt House. This date may be
chan ed without the License & Permit Division's consent and/or
know edge. Therefore, it is suggest d that you call the City Clerk's
Offi e at 298-4231 to confirm this h aring date.
You re hereby notified that your at endance is required at this
meet'ng. Failure to appear may resu t in denial of your application.
Very truly yours,
. :yr-,
; d . 1 .%� '� /i �
.,
� :'� '� -.>:_�.� .��,�,: „�.:�,;vV
� �f� ..::i
J � h F:�� Carchedi
Lic nse Inspector
JFC lk