88-347 WHITE - GITV CLERK
PINK ± FINANCE GITY OF SAINT PAiTL Council ��_ ��iii���
CANARV - OEPAR7MENT �
BLUE - MAVOR File NO. -
� , ,nci Resolution �7
Presented By
Referre o Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. # 4227) for the renewal of a Class A 5tate
Gambling License applied for by Merrick Booster Club at 1060
University Avenue be and the same is hereby approved/denied.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Dimond
�ng In Favor
Goswitz
Rettman
s�ne;be� � _ Against BY
Sonnen
Wilson {
�R — 8 I�� Form Approved by City Attorney
Adopted by Council: Date
Certified Yas e bn ncil Se r By
11
gy. �l. .
A►ppro e y 1Navor: Date _ � j � ,98 Approved by Mayor for Submission to Council
B By
PI�BUSHE� i�;r,;; 1 9 19 $
' _ Oa �T,
�.,,,,� _ �,.� �,�� GRE�N �WE�T wo. 0 0 a 9 8 0
Jc� F.'
� *� o�r�r,r o�croA �vivaa�aa�earram
Qlr].St�.t1L AssKi —Fx�a w�e�eKr sahnces owscmn 3 an ca.eac
FOR -
FinaYx� & t. 29&-5056 �a — ��`� _ � Cjour�c____�� i�eardz :
. CRY ATIOFMEY. . .
�]. 1al.catioai'fax a .State of Charitable Glass "A" G�nbling Li.c:ense. -
�� a� zErrr� s�: 2.-a2-8s Fs,�uaG : 3/s/ss . : _
�Taws: N10►�eJ.a cfl�) couHC� RvoRr: � `:
PLAWiNiC� � . . � - CIVIL SERVICE C06NA13310N DATE IN �.. . PIq1E ND. - � � �. .
� �IMlfi OOIiMM8810N . - , 19D.i#6 BCFIOOL BOARD . .. . ��.� . . . � .. ,
� :8TAFfi�. ' . - . . GIAFYIER COLIAAIS�SION . . .. . � ��� _��' '��* T_FOA�p'�ff0�� _��p• . ..
OIBTRICT COUNCR � � . . •DCPLANA . - � . � � . , � .. . � .
� � � eIJPPOfi'18 YN11CF1 COUNCR. � . � . . . . � �. . . . .. � . . � . .
Council Research Cier�te�
F�B �`i988 ,
.m►„��.�. �.�„�n�.,�,,�.�,,�.�.,��: . .
Mr. K�vin , �z behalf of ttye Boo�ter Club, req�ests Qaulc:i.1 apgraval. .of
� thei.r app�i.�a�ioel for a State af ta C�aritable Gaanb
13.r�g �. A �lass "A"
Livex�e a11 b�tti'Birhg� ar�d Pn].ltahs. : �sess�,ioc�.s are he].d on '
of� 1:00 .m. arLd`5:QO Stu�ays betw�en � I�x�rs
P p.m. at 10�0 Uni ity Av�u�. Prooe�ds are used to assist wi�h the
mentally .
:�Rki11RC�1,oN( :��_ . : ; ,
All requir a�licaf3c� aund fees hav�e st�mitted, Tf C�cii
the Merrick tex C].ub, which has bee.n endst.�ruae for 8 ��- is grant�ed,
c�orit3t`iue �
• : ��P.._ . -
Year�, wi7.1 be allc��ed
_ �PNhi�C. .nQ-Tc wrwr+�: ' � , ,
If Ocxmcil i.s not gj.v�n, the ick Booster Clt�b will Yie for+oed to disc�o��tinue
tt�eir 'p. ,
��: . _ - : r�or� . .
— — — .. _
1 .
. � ;
�roaw�s: .
�aaies: '
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TiIVISION OF LICENSE AND PERMIT ADMINI TRATION DATE �-I � "o D / �"�+Z'�04
INTERDF.PARTMFhTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant ��ut�h �Q.r'T�h�4l.( Home Address �1 a1g �`�t,f VC1.I.S ��-�+
Rusiness Name M�Y'p� O �1+.bHome Phone
Business Address �p(pp l�i,h�u trsr� Type of License(s) �j�� Vt 4iS' �
Business Phone 71Q-�' aDQ ��v� r,.�..hV��� �.
Public Hearing Date 3 g t�g License I.D. 4i � �Z�7
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4t (V ��Q
llate rutice Sen . '
`V�P�, Dealer 4� �1��'�'
to Applicant (�� $ �
Federal Fj.rearms 4t N f�.
Public Hearing
DATE I1vSP�. TION
REVIEW VERFIED (C UTER) CUMMENTS
A roved No A roved
Bldg I & D +
N I�
�
Health Divn. N�� '
!
�
i
Fire Dept. i � �� �
� �
�olice Dept. � �1G0�°�` ��'�'V' �t►��
a I 7���
License Divn. �
�
City Attorney �
�
Date Received:
Site Plan N �
To Council Research
e s or Letter n_ Date
from Landlord IC.R� 0�
� � , City f Saint Paul ��3`��
� Deparcment o[ Fina ce and Management Services
, �--' Division of Licen e and Permit Registration
INFORMATION RE UIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHAR.ITABLE GA,�IBLING GAME I*1
SAINT PAUL _
1. Full and complete name of organizati n which is applying for license
Merrick Booster Club
2. Address where games will be held � �G!0 IIniversity Avenue, St: Paul MF 55104
�umber Streec City Zip
3. Name of manager signing this applica ion who will conduct� operate and manage
Gambling Games Carl Falkowski Date of Birth 3/7/23
(a) Length of time manager has been mber of applicant organization � YeSrs
4. Address of Manager
Number Street Cit� Zip
5. Day, dates, and hours this applicatio is for Sundays year round 1:00 PM-5:00 PPi
6. Is the applicant or organization orga fzed under the laws o: the State or !Qi? Yes
7. Date of incorporation 1 6 86
8. Date when registered with the State o �Sinnesoca 1/6/86
9. How long has organization been in esi tence? g ye8rs
10. How long has organization heen in exi tence in St. PauZ? 8 pears
11. What is the purpose of the organizati n? To raise funds for evui�ent. events and
programs for mentally retarded a ults.
I2. Officers of applicant organization
Name Robert Faric "��e Loupllpr FQ�p4
Address 350 Cedar Street #555 St. Paul Address 196R .S'ki l lm9n ra �o�avil].o�—�Oii—
MN 55101 55113
Title President DOB Tit?e SecrPtaro DOB
T-
Name Ralph Stouffer Name Revin Martinesu
Address 6065 NE Mc�inle St. Fridle MN Address 1728 Gervais Avenue Ma lewood MN
55432 09
Title Treasurer DOB Title �0 DOB 4-2�-51
13. Give names of officers, or any other o rsons who paid for se:-vices to tae organi:at±on.
Name � Vame
Address Address
Title Tit?e
(Attach separate nee� `ar acdi=_or.s: ::a�es. �.
� � - � \� .. '.
� �����
_JJ.
14. Attached hereto is a list of names a d addresses of all members of che orgar;�, -
15. In whose custody will organization's records be kept�?
Name Revin Martinesu Address 1�28 Ger°ais Avenue, Maple "`
16. Persons who will be conducting, assi ting in conducting, or operating the games: ���
Name Car1 Falkowski Date of Birth 3���23
Address 364 Charles Street, St. Pa 1, MN 55103
Name of Spouse Betty Jean Falkowsk Date of Birth ��9�29 f
Dates when such person will conduct, assist, or operate All occasions
;
Name NA Date of Bi*th
Address
Name of Spouse Date of Birth
Dates when such person wi11 concuct, ss=st, or operate
17. Have you read and do ;rou thoroughiy derstand che provisions of all laws, ordinances,
and regulatior,s �ove�ing the operat= n ot Charitable Gambl:ng �ames? Yes
18. Attached hereto on the for� fur.:ished by the City o� St. Paul fs a Financial Report
which icemizes a11 receipcs, espenses, and disoursemencs oi the applicant organization
as well as aii organizatfons who have :eceit�ed `unds tor t:�e precedfng calendar year
which has been sia^.ed, pre�ared, and e:i��ed �y Revin Martineau
vame
1728 Gervais Avenue, Maplew d, MN 55109
2,ddress
who is the Chief Eaecutive Officer ` of the applicant Organization.
Yame oc Of :ce
19. Operator of premises where games :�il� be held:
Name �litary Order of the Purpl Heart Chapter #5
Business Address 208 Veterans Servi ce Building, St. Paul, � 55155
Home Address �
20. Amount of rent paid by anplicsnt Orga i�acion ror rezc o= the hall; specify amount
paid per 4-hour se�sion 135/ ession
� ���
. r '
� ne proceeds oz the games will be isbursed after deducting prize Iayout costs and
operating expenses for the followi g purposes and uses:
� To purchase equip�ent, events d programs for mentally retarded adults to
-.,:�
_ acquire vocational and communi y skills.
22. Has the premises where the games ar co be held been certified for occupancy by the
City of Saint Paul? Ye8
23. Has your organization riled iederal form 990-T? No If answer is yes, please attach
a copy with this applicacion. Ir a swar is no, explain why:
1�Ierrick Booster Club has filed 990 which is attached
Any changes desired by the a�pl:cant dss.o iat=on may be made only wich the consei�t of the
City Council.
lierrick Booster Club
_ _ . _._._,..._.
Or �zaciar,
ii',
Date 2�9�88 By• Carl Falkow ki ,���..�Gz�;�,�r�2'� �
� �fan�g '-n c ar$.e� o f g��;ru�
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..1:�.. Charitable Gambling Control Board For Board Use Only
Rm N-475 Griggs-Midway Bidg. paid Amt:
i + 1821 University Ave.
- - . St. Paul, MN 551043383 Check No..
�.....:�� (612)642-0555 � Date: a
- GAMBLING LICE SE RENEWAL APPUCATION �
LICENSE NUMBER: 17�.)i?l /EFF. DA : (?�►�01/87 /AMOUNT OF FEE: �140.i10 �
1.Applicant-Legal Name of Organization 2.Street Address ��
Herrfck Booster C ub t728 Gervais Ave
3.City,State,Zip 4.County 5. Business Phone
:�a�i�aai. �u �"4:0� ��ev 612 i7G-�c�';
6..Name of Chief Executive Officer 7. Business Phone
Revin Martineau 612 770=��b20a�
! 9. Business Phone
8. IVame of Treasurer or Person Who Accounts for Revenues
Ra1ph Stauffer b12 64; 5676
10. Name of Gambling Manager 11. Bond Number 12. Business Phone
i.a�i �7 r a i KowsK i RCB335359 612 227-4456
13. Name of Establishment Where Gambling Will Take Place 14.Counry 15. No.of A�:tive Members ',
?+�GAN ��ii 5k ?aui �7a�sse!i 5� ,.
j 16. Lessor Name 17. Monthly Rent:
� Rosi h845 aoe�ld Nar ii.+1F'�i S40
18. If Bingo will be conducted with this license,please specify day and times of Bingo.
� pays Times Da Times Days Times •
� Snndays 1:00 P'M-5:40 PM
I
I 19. Has license ever been: ❑ Revoked Date: ❑ Suspended Date: 0 Denied Date: ''�
20. Have internal controls been submitted previously? C�Yes ❑ No(If"No,"attach copy)
' 21. Has current lease been filed with the board? ❑ Yes C�No(If"No,"attach copy) �
� � ' �
:. �..:._.. .. _ , .. .. _...
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22. Has current sketch been.filed with tne:board? � • < .: ; � ..�Yes' ;0 No(If'No,"attach coPYT' . -
i ` ; GAMBU G SITE AUTHORIZATION
� By my signature below,local law enforcement officers or agents o the Board are hereby authorized to enter upon the site,at any time, gambling i
, being conducted,to observe the gambling and to enforce the law r any unauthorized game or prectice.
� BANK R ORDS AUTHORIZATION '
', By my signature below,the Board is hereby authorized to inspect e bank records of the General Gambling Bank Account whenever necessary to
fulfill requirements of current gambling rules and law. -°
OATH "� °
� 1 hereby declare that: -"
' 1. I have read this application and all information submitted to the Board;
2. All information submitted is true,accurate and complete;
3. All other required information has been fully disclosed;
4. I am the chief executive officer of the organization;
5.•I assume full responsibility for the fair and lawful operatiorrof a activities to be conducted;
6. I will familiarize myself with the Iaws of the State of Minnesota specting gambling and rules of the board and agree, if licensed,to abide by those
laws and rules,including amendments thereto. �
23.Official Legal Name of Organization Signature�Ch f Executive Officer) � Date Title
Merrick Booster Club � �, '� !� , � ----- --� Z/3/88 Chief Baecntive Officer
I ACKNOWLEDGEMENT NOTICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application.By ack owledging receipt, I admit having been served with notice that this application nn��
be reviewed by th6 Charitable Gambling Control Board and if app ved by the Board,will become effective 30 days from the date of receipt(noted�
below), unless a r6solution of the local governing body is passed hich specifically disallows such activity and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the belo noted date. �
24.City/Counry Name(Local Governing Body) Township: If site is located within a township,please complete items 2�
�-.---� ;.,_.; _ and 25:
Signature of PersOni Receiving Application: 25.Signature of Person Receiving Application
, �:
I � - i r;,4
' Title V �. ^ Date Received�this date!begins 30 day pe od)� Title:
i _ r ; -- � , �
� � Name of Person Delivering Application to�ocal Governing Body: Township Name
, e�
� 1Cevin Martinean
� CG-00022-01 (5/8� White Copy-Board Canary-Applicant Pink-Lxal Goveming Ba
i
I
ORK�NATOR� DAf! 7ED DAi!COY/lL7ED
�Joseph F. c� GREEN SHEET No. 000980
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` -Finance & N,�anzt� -_-•-:298-5056 . �;_ �o ..::,�, _ _ .-__.. . _-�- --� � _: .
:� C.oimcl.l. Research
. .]. crtr�rroa�r .. .
� SUBJECTlDESCRIPTI OF P OJECT/REGUEST:
� • _, . . _. . . ' � . :.a �.y'`'. .. _ �t . . . ` '- .c.t?�� . - . � . . . .
. .•-:. - . ..,...
Renew�l �application'for a State of __. . -CharitabSe Glass pA" Ga�nbliivg Lice�se.
_ . . _ . _ _
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� NO►I'g'IC�YCN LETI�t SflVT: 2-22-88 �. ' ';:.�,F�ARIlVG L1A2'Ec " 3/8/88
RECAMM@IDATIONS:(AOP�e(A)a AN�(Rl) COUNCI NESHARCM REPORT:
PIANNINfl COMMI8810N CMl SERVICE COMMSSION OATE IN DA7E OUT AINIYST . PlIONH NO.
ZOPNPIO l'AAAM18910N 190 825 SG1001 BOANC � .
� STARF C1111R1'ER C04YAI�ON . AS IS AODL Iti�AOOEO� REI9 70 COPIMCi' CONBTITUENT
. . � � _POR ADDi iNW.* _fEEDBACK ADOED*
018'TRICT COUNCIL . * _
TION:
SUPPORTS NMK�i COUNC�08JECiNE7 � . � ,
p�Mi1ATi1�Ui PR08lEM.IS�UB.OPPORTLN(TY(Wlw.Whet Whsn.Wlwn.1NM): ' . .
Nlr.. Kevin Ma�tillec�l r.o�1..behalf.of t17e Booster Club r l�quests Cou�.7. ap�Val Of
their renewal appiicatio�:for a.State o Mi.nnesota. .Charitable Ga�nbling License.. A�Class. "An
License allcxas both Bingo and Pu1lt.abs.: The sessians are held � S1a�days be�n tl� hours
of 1:00 p.�. and: 5:00 p.m.- at 1060 Uni ity Av�nu�e. Proceeds �e u.sed to assist with �the
ment;ally retarded�.._ �` . - _ _ ._ .
.. - ���' .: r :- . : ...F- _.- . . . _ _ _
..,
JU3i1FICA710N(Cwt/BarrAls:Adva�OM.fieNb) '" .-- - - - - -
£ .. - �
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_ � ,.v::.;��..�'4u.�.:c.�:�1:�.:..�,>::.:.;. ,,..r•.�. �ti:':�:w .,R.`.-....,�.�. -..� •;f�� . .._-,�.• .,-..•-____ ._` .,..� .L.. �-:^F y - '
;_ .. .... ���... ' ...- ' :... ..:.... � �s �vs , . ..
� . Pit�. Z'E'lqll��.dj7p1.1C3t1.�S",� �225 Y13VE SL]}=[L�.tt'.2C�. ��.�LIIlCS1:d�V3J.. 13':�3Iit�r .�'�
t� �1C�C BOOS'�2�,CI1]27�. W�7.l.Ctl,..t]dS.. 3A:E�.S�EIICe � 8 �S� W.1:�.1 }Je 3�.ZOWECI-1"A- . _ .
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� COL7T1C11 dj�]:'O�Ic'11.13 llOt C�1VEI1� �7� �C3C BOOS't2r C:I.L]27 W].0 �' �C� t'A C�].SCC81tl.11tl2
their spa�zsarship.
wt�►TrvES: . . wros c�
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N�riPnecEC�rs: .
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�ca►�rssuFS:
r:ry of Saint Paul /� �— �/'7
�3rpartment o Finance and Nanagemen[ Ser•�ices / ,�'��,37�/
'� Division oE icense and Permit Administration ��
� • UNIFORM CHAR TABLE GAMBLINC FINANCIAL REPORT
uate 1-30-88
1. Name of Organization
2. Addreaa vhere Charitable Gaabi ng is conducced 1Q60 Univ r�; t-y�Ve, St• paul
3. Report Eor period covering Jd uar 1 1987 through December 3]. l9 87
4. Total �umbar oE days played
S. Gross receipea for abave period s 194,24� .($
6. Gross prize payoucs for above p riod ; 149 , 31� .34
7. Nec receipts - 11ne 5 atnus 11n 6 S 44, �2� . 34
8. Expensea incurred ia cooducting and operating gam�:
A. Gcoss vages paid. Attach w rker liat vith •
namea, address and gro�s va es. ; 13�370 . 00
8. Rent for veeks ; _ 6 ,50� . �0
C. Lieens� faa � 5 0 0 . o 0
D. Insurance ; 739. 00
E. Bond ; l o o.o 0
F. Dishonored cheeks noc recova sd ; �6� . ��
G. Employers P.I.C.A. ; 982.52
H. sales Tax ; 6,356 .34
I. Minn. U.C. Tax s 362 . > >
J. Federal U.C. Tax i N/A
K. Hiaeellanaous Espenses. Idaa ify the aaounc
and co vhom paid.
1• Tranfer to #2 i _ 552 . 98
2• Bankcharges i 127.15
3. Supplies ; 1, 835 . 73 �
4. S
9. Tocal Expenses TOTAL ; 3i� 790 . 83
10. Nnt Income - line 7 minus line 9 S 13 .132.51
11. Checkbook balance beginning of per od f 9, 3 6 9 . 4 8
12. ?ocal of lin� 1D and 11 S 22�50�. 99
13. Total eoetributions froa lia� 17 ! 25, �57.35
14. Cheekbook balanea end of reporting period -
11ne I2 less l lne 13 f 2 ,5 5 5.3 6
15. Specify usa made of amount on line 13:
COMP1JiTS TIIE ItEVCRSE SJf?E
�
�
.�: ,.`:5ursene.^.cs .;om a.our,. .n ?:ne i2: �
�
Name Merrick Companies, Inc. Name Merrick ComAanies, Inc. • �
Addrese 1728 Gervais Ave Address 1728 Gervais Ave.
Dace Rec'd ] �_�p_p� Dace Rec'd 1 —��_R7
Purpose See Attached Purpose See Attached
Signature Signature
of Racipienc of Racipienc
nmounc $5,900 . 00 noounc $8 , 531. 00
Name Merrick Work Activity N8„�
Address 1728 Gervais Ave./ eaaress
Date Rac'd IZ-3�-87 Date Rec'd
Purpos� SE(� Attacho� Purpoaa
Signa�ure Signacure
• of Recipienc of Recipienc
� nmounc $9, 000 . 00 amount
Name EPA Audio Visual Name
Addre9s S't. Paul, Mn Addreea
Date Rec'd 1-5-87 Oate Rec'd
Purpoae See Attached Purpoee
Signacur� Signature
oE Reclpiant of Recipient
Amount $6 2 8 .3 5 Amovnt
Name Merrick Comx�an� P� Inc. Name
Address 1728 Gervais AVE. Addresa •
Date Ree'd 1-22—$'] Date Rec'd
� Purpose SE@ Attached Purpoae
Signacure Signacure
of Recipienc of Recipient
Amounc $9 9 8 . 0 0 Ameonc
17. Total Disbussemancs $2 5, 0 5 7 . 3 5
THIS REPORT HIIST BE FILLID•IN COl�.ETFLY TO QUALIFY APPLICA?ION FOR CHARITABLS CA?tBLINC
LICEHSE.
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,�M:�.,,� Minnesota Cheritable Gambling Control Board SCHEDULE C ���,,J`'7�!
a*;� �1�` 'SJ4 Summit State Bank 8uilding
310 4th Avenue South RECORD OF LAWFUL PURPOSE CONTRIBUTIONS
���- Minneapolis.MN 55415
�'.^".' . 16121341•7676 �
, Organization Name License umber Month and Year
Merrick Booster Club Inc. A-00 79- Pa e�_of._L_
Check Date Payee Description of lawful Purpose Check
Number Amount
1761 12/30/8 Merrick Companies, Inc. Financial Su ort for
Merrick Com anies Inc
a vocational training
� center for mentally
� , handicapped adults 5 , 900. 00
1762 12 30 8 Merrick W k A
Merrick Work Activity a
vocational trainin center
for mentally handica ped
adults 9 , 000 . 00
Subtotal—this page .............................................................
Complete these rows only �"� Add: Subtotalls)of the a ditional pagels)other than this page(if applicable! ..........
on the very last page of 4 9 0 0 . 0
Schedule C �"� TOTAL—Carry amou�t o tax return,PART IV,line 29 .......�....................... '
CG•00014-01(2%85) White-Board Canary- rganization
<<*�R�yw Mfnnesots Charitable Gambling Control Bwrd SCHEDULE C �„ _' ,3 7/
�'� � '904 Summit State Benk Building
���'� 3to 4th Avenue South RECORD Of LAWFUL PURPOSE CONTRtBUT10NS
�jp Mipneepolis.MN 55415
�'""" 18121341-7678
Organfzatlon Nama "�j� Ucense N mbe� Month and Year
Merri k om anies Inc. A-00 79-001 Jan 1 7 Pae of
Number Date Payee Dascription of lawful Purpose Amount
1650 1-05-87 EPA Audio Visual Seal Lamina
for Merrick Com anie , Inc To make communicati n
for use in Da Habil ' tatio Wallets for non-verbal
ro ram for 140 ment 11 ersons .
' retarded adults voca iona
and communit traini
- 1655 1-22--87 Merrick Com anies , I c. Water Cooler for client 998 00
for use in Da Habil tatio cafeteria.
- ro ram for 140 ment 11 To rovide fresh cool
retarded adults voca ional drinkin water for
and communit traini mentall retarded clients .
Subtotal—this page ............................................................. �
Complete these rows only � Add: Subtotalls)of the ad tional page(s)other than this page Itf applicable) .......... •
on the very last page of 1 , 6 2 6 .�3 5
Schedule C � TOTAI—Carry amount to ax return,PAAT IV,line 29 .............................. _. __ .
CG-00014-Oi(2/85) White-Boerd Cenary-Org nization •
. • •,,. ..............__.. .. . . ... o
� � ' � 904 Sumrnil Slsle Benk Bulldinp
� 310 41h Avenua Soutli RECORO OF LAWFUL PURPOS CON F118U110NS
• Mlnnen�olia,MN 65416 ��3C�7
�i' .
�:�'"' (0121341•7878
ae�lzetlon Nerpe ' Ucenee N mber Monlh and Year ' � �
[errick Booster Club A-001 -0 1 Pee 1 0� 6 �
Check Date Peyae Descrlptlon ol Lewiul Purpose Amaunt
Vumbe� �
i
653_ 1_22_g� IBh1 AT personal com�u Pr Ill1.
1654 for use in Da t�abili ation O en s stem
ro ram for 140 menta 1 software '
i
retarded adults vocat onal E son Printer & Table
and community trainin .
' Subp. 16 Lawful ur ose `
--� i
A. Benefitinq persons by �
i
eniiancing their opportunity }
for religious or educationat t
advancement, b relievin
or protectinq them from . �
_ �
disease, sufferin or
distress , by contributin :
to their h sical well-
beinq, �'b assis nct hem'n"
es'f'a�shin�fiemse3.ves'in" ;
�
li e_:as..wo , y�an �°use'�'u'�.''""
c t�zens�, or by increasinq �
tl�eir compre}iension of and �
devotion to the principles
upon which tliis nation was '
founded;
� I�i the United States of
America we are tau i�t that �
�
' to be a worthy and useful �
citizen one Gho�ld wc�rk
hard and pay our taxes for
the benefit of the nation
as a whole. Traditionally
mentally retarded people
have been institutionalized
in this country and have -
Subtotal—Ihle pegs ..... .....................................................
�plete lhese rows only ""� Add: Subtolel(s)of Ihe eddit nel pegels)otlier tf�an Ihle page (�1 epplicable) ..........
�e ve�y last pape ol
�dule C '�'� TOTAI—Carry emount fo ta return,PAFiT IV,Iine 29 ...............................
��..,.� �,,�e� w�,u..a�.�� C�f1�/V.�raen��tlan
�����' 904 Sumrnh Slato Bonk Bulldinp
� 3to eu�A�enue Soum RECORD OF LAWFUL PURPO E CONIF�IBU iIONS
Mlnoenqoli�,h1N 65416
�:"�'� 18121341•7878 ��
�eni:atlon Name Llcense Num er Month end Yeer '
Merrick Booster Club �1-0017 -001 1/87 Pee 2 of�—
Check Date Peyee Descriptlon ol lewlul Purpose Cfieck �
Jumber Amount
. not had the opportunity to �
' �•�ork and l�e useCul cit.'
Over ttie past twentyfive
years our nation l�as
actively sought to close
the institutions and brinq
our handica ed citizens
back into the commurrity. A
variety of services l�ave
been developed around this
populatioii including the �
development of one hundred
and seven Develo�mental
Acl�ievement Centers ( UAC)
throughout Minnesota .
Nterrick Companies ,
Incorporated is licensed
in the state of Minnesota
as a Developmental
Achievement Center by the
� Department of Human Service
Licensing Division. The
mission of P9errick Companie �
Incorporated is to rovide
� liabilitation services to
one l�undred and fort
persons witl� developmental
disabilities . The focus of
the program is to rovide
training in areas of
adaptive beliaviors
community integration skill •
Subtotel—thle page ..... .....................................................
rlete these raws only � Add:Subtotal�st of Ihe eddit onal pagels)ollier than tfii�page IIF applicable) ..........
e v�ry last page o(
fule C • "'♦ TOTAI—Cerry amount to f x relurn, F'ART IV, Iine 29 ...............................
711 01 (2�05) Whlls•Boud Cenary•Orpe Itello�
■k (+'!in�eaote CherMeble Gemblinp Co�trol Boerd $C��EV V�.E �'i
904 Summit Stete Benk Bulidi�p
�� 9to•eth I+��enue South RECORD OF LAWFUL PURPOSE C NTRIB'�f��
� Mln�eepoli�,MN 65416 .
'.�• IS1Y1341-7978
�anizetion Name llcense Num er Month snd Yeer �
Merrick Baoster Club A-0017 -001 1 87 Pae 3 ot�—
Check Dete Peyee Descrlptlon of Lewiul Pu�pose Amount
lumber
� use of ublic trans orta-
� tion, and vocational
training. To accomplish
�. this goal Merrick Com anies
Incorporated is providin
state of tlie art, best
available ractice services .
In fact, Merrick Companies ,
Incorporated is considered
one of the mos� respected
programs of its t e in the
state. Merrick Com anies
Incorporated is considered �
a model program, and many
otlier programs in the state
of Minnesota are attempting
to pattern their service
delivery af ter tl�e ro ram
options offered at Merrick
Companies , Incorporated.
In order to rovide
vocational trainin to the
persons with develo mental
disabilities at Merrick
Companies, Incorporated,
hlerrick Companies , Incor -
orated must obtain a
"Commensurate Wa e
Certificate" for t�ie United
States Department of Labor,
Employment Standards
1ldministration, Wage and
. Subtotai—thie page ........ .................................. ... .............
ilete Ihese rows only � Add: Subtota1�sJ o(the eddition 1 pagelsl other tf�an Ihis page(if epplicable) ......... .
�very last page ot
fule C � TOTAL—Carry amount to tax r turn, PART IV,line 29 ...............................
�11•Ot (2/85) Wh11s-8oard Csnery•Orp�nlisl n
Mt , Minn�sote Cheritnb�e Gnmblinp Control Baerd �t.����v�a. v
90A Summlt StMv Oenk Bulldinp
���—' :3toe�h/►�cnue 3outh . RECOfiD OF LAWFUL PURPUSE C Ntfi BUTIUf S
Minnenpolte,MN 65418 � (
li�!•.• • (8121341•7878
�enlzetlon Neme Ucanee Nu ar Month end Yeer '
Kerrick Booster Club A-00179 001 1
Pa e 4 or.�L._._
Check bete Peyee be�criptlon ol Lewiul Pu►poee Amount
lumber
. Hour Division, 30 South - -
� Dearborn Street, Room 509 ,
Cliicago, Illinois 60604 .
One of tlie many rovisions
of tliis certificate is tl�at
�]errick Compariies , Iiicor -
orated is reyuired to
keep detailed records oii
' each client it � serves in
regards to type of work
performed, piece rate of
work performed, amount of
work performed, avera e
liourly production, avera e
daily production, avera e
weekly proc]uction, arid tota
wages earned on an aiinual
basis . Tl�is reyuires tliat
tlie direct care staff at
�lerrick Companies , Incor -
orated count, recora and
. compute these wage figures
• daily . Tt�is work would
take eacli direct care staff
member approximately forty-
� Five minutes per day. '1'his
- forty-five minute figure
stiould be multiplied by
twentyfour staff inemUers
for a total of �iyliteen
l�ours per day to complete
the required F�yrol.l record
Subtotel—thie pege ....... ..................................... ...............
�lete these rvws only � Add: Subtotel�s►of tfie eddili nal pegels)olf,er Il�en Ilils pago (il applicable) .........
e very last page o( '
�ule C �"♦ TOt�1l—Carry amount fo fax relurn, I'/1R T IV,line ?9 .......... ..... . . . .... .........
D1e•01 (2�85) Whlle•Boe�d Canery-Orpenl: Uon
,. , M�nnosote Cherlleb�e Oembilnq Control Bosrd SI.IlCU V�.0 �.
� 904 Summit Stete 8enk Bulldlnp
': 310 4!h A�enue souch RECORD OF LAWFUL PURPOSE ON TF11BU il ��3
Ml�nennolla,MN 65�16
�'•• , (8121341-7918
nizstlon Neme ' lica�ss Numb r Month end Yeer '
Kerrick Booster Club A-00179 001 1 7 Pe e�.—.or�i—
heck Dete Peyee Descrlptlon of Lewiul Purpose nmount
mber
. keeping . With i.he purchas �
� of an international Busi- �
ness rlacliine ( IBM) 11`1'
computor and some special-
ized payroll software,
�lerrick Corn aiiies , iticorp-
orated is able to reduce
tl�e time it takes direct
care staff to complete
� payroll records b thirt -
five minutes per day er
staff inember, or a total
of fourteen hours er cla .
Tliese saved fourteen liours
cari now be spent in
providing additioiial lianas
on service to clients as
opposed to time speiit away
from clients to do a er-
work . Since in tlie busi-
ness Plerrick Com anies ,
Incorporated is in there
is a direct correlation of
results and suceess to tlie
amoui�t of time staff s enc]
working directly witli
clients , and since A]errick
Compariies , Incorporated
has a mission to provide
vocational training to
persons with developmerital
disabi.lities ancl since
Subtotel—Ihls pege .......... ................................................
�te tliese rows only ""� Add: Subtolells►ol the edditional egelsl oti,er tl,an ii�ls page(if eppiicable) ........ .
+ery last page of
le C � TOTA�—Cerry amount to Inx ret rn, rnnr iv, tine 29 .. ......... .. . . . . .... .... .... . .
�•Ot(2i9S1 Wl�lts•Bo�rd Cans►y•Orpenl�etlo
wk.� M�n�eaote Chs�ltbbte(iembling Control Bosrd SCHEUULE C
�!0.Summit Stete 8snk BWldinp
r310�th Avemie Sputh RECORO OF LAWfUL PURPOSE CONTF�IBUTION$
;�,� ' Mlnneepolie,MN B5416 •
�"'�'•• (e121341-7878 �'
:anlzetion Name Ucs�se Num r Month end Yesr '
Merrick Booster Club A-00179 001 1/87 Pa e._.�_ot�i_
�Check Dete Peyee Descrlptlon oi Lew(ul Purpose Amount
lumber
. person with develo mental
� disabilities need intensi�e
vocational trainin to
� ever have the abilit to
enter into the main strean
of American emplo ment,
and since employment and
ones abilit to a taxes
are measures of worthiness
in the United States of
America, Merrick Booster
Club feels it is a very
prudent and wise decision
to donate the funds
necessary to purchase the
IBr1 computor to blerrick
Companies, Incor orated.
Subtotel—thta pege ........ .................................................. $8 , 5 3 1 . 0 0
plete these rows only � Add: Subtotal(s►ot the eddition I page(s)other than this paga(if eppliceble) .........
�e very last page ot $8 , 5 31 0
dule C � TOTAL—Carry emount to tex r turn, P/1RT IV,line 29 ...............................
�014•O1 (2i85) White-Boerd Cenery•Orpenlr■�••