88-406 WHITE - CITY Cl_ERK
PINK - FINANCE COUflCll
BLUERV -MAVORTMENT GITY O SAINT PAUL File NO. ��r �� -
Counc 'l esolution
. ` ��
Presented By �
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. # 9243) for the renewal of a State Class A
Gambling License applied for by the Church of St. Peter Claver at
1060 University Avenue, e and the same is hereby approved/clw�e�.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
Ba�
�� In Fav r
6e�iEz O
Rettman
�— �_ Agains BY
Sonnen
Wilson
Adopted by Council: Date
1 iHR 2 2 ��8 Form Appr e by City At ney
Cerlified Pas e oun�Se ar By
gy.
A pr by Mavor: 2 �F Appro by Mayor for Submission to Council
B BY
PUB�iSNED r'�t'R 2 88
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Finai� & Mnc�r�t. 298-5056 � � «r►��,�, . ` . : .
R�n�aal applicaticxi fc�r a �tate of ' C1.ass A Q�iaci�able Ga�b1� Ia.oe�.
NdPTFI�ICN LY�i3�: 3/9/88 �s 3/22/88
•t�Pl�r W«�M.ec fR1) cou�- I�oRT: . ``
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mwNO co�w��ssa� �so exa scHOO�eawo �j i.��? 7
sr� c�r�n oo�r�aN ��s�s �wro.�n* r�rv To carr�r
_ _ron�ooL rrw. _�oe�tac�ooeo*
°�rwcr� *oca�nru .
sirnoArs wra�couwe�oe,�cnvEv
Council t�esearch CEnter.
MAR 151988
..�►►..�«��,�,�.n,�.�,�.�.�:
Ms. Graoe Kie].?�asa, on.behalf of the o£ st. Pe�ter claver, reque�ts Q�n�il �va�
.c3f t�heir r� a�g3:icati.o� �or a �tate Mi�nesota Cl�aritable C�l�ing Lic�se. -T'he �';
� � � �' ���Y �i'� . t,he hours c�f 7:�0 p.m. and 1i:30 p.m. .at '
1�6U Univ+ersity Avenue: Praceeds g�o ta sist the operafi3c�n of St. Feter Claver P�i�. - '
_: �ua,wc���owee�r..�a�+uaw:R..w�.�: . •. . _ . ,
A�1 reguired appiicatiazs arid fees haste siakmit�eci::. :If Oo�ancil appro�yal is g�ant,ed,
the � of St. Peter Claver. whiah.has been in exist� for 17 Years, wi�l t�e a�,l�wed
,
. ,
. to c�tinue tt�eir �so�ship. _.
�lMM1�t YNim��ncF te WhomY
If Cauicil appirooval is riat given, the ch of St. Peter Claver w�11 be foroed tro _
clisaoaztinue their spc��sor.stLi,p.
��u►n� � . so�s .
wsroRar�errs: .
� �eoiu.aw�s: . _
. ��-��
. � � � �
UIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE 3 / �`� / °1�'''`�'� 0 Y
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn Proc ssed/Received by
Lic Enf Aud
Applicant �1�C$. ��e1 ba5 Home Address gg� 4rq rpQ �.
Rusiness Name �� r' Home Phone w L
�a►q��l�1.
GO�Vt r' �,o ct�.t C 1 k.b
Business Address �-�j Type of License(s)
� 5��,�e. c1ass � �ia�,bt�� -�►�.v�f
Business Phone L�
Public Hearing Date � �� g License I.D. 41 � q a 43
at 9:00 a.m. in the Council Chambers � � ^
3rd floor City Hall and Courthouse State Tax I.D. 4� ��
llate Notice Se ;.J �� � `'✓ Dealer 4�
to Applicant . � �
rederal Fi_rearms 4� �
Public He�iring
DATE INS ECTION
REVI�,W VERFIED ( OMPUTER) CUrII�IENTS
A roved ot A roved
�
Bldg I & D � I^ �
*�t
Health Divn. '
_ �
N��► �
�
Fire Dept. � �
� U I� �
Yolice Dept. �� I '� � �
License Divn. ,
I
f
� �
City Attorney �
i
Date Received:
Site Plan N �/
To Council Research �Q I gO
eas or Letter 1t ,- (��) Date
rom Landlord � 'd�`"[��
•1� � �� �O�
� � Charitable Gambling Control Board
� `�.���'�•:3 Rm N-475 Griggs-Midway Bldg. For eoard Use Ony
1821 University Ave. Paid Amt:
- St. Paul, MN 551043383 Check No.
• ':......''� (612) 642-0555 Date:
GAMBUNG L! ENSE RENEWAL APPLICATION
UCENSE NUMBER: '�"�'b �-'•�� /EFF. D TE: '�'�!u1ifl% /AMOUNT OF FEE: siUU. `
1.Applicant-Legal Name of Organization 2. Street Address
�iiUR(�i OF 5'+ Y�R wiVE� St�C'�! C�L'B �T �+A�;� 3'5 N t�xfnrei
3.City, State,Zip 4. Counry 5. Business Phone
St �au1. �! �sit�4 �aasev ��2 �-�oa
6. Name of Chief Executive Officer 7. Business Phone
��ura Cari.�n ''- ��j�
Ci. �3
8. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phon� R
/� l
.C7'.� . / lr ' / � ) 5�.�t :1 Ji t
10. Name of Gambling Manager 11. Bond Number 12. Business Phone
cvei�rs �rrissett? sb42%alti
13. Name of Establishment Where Gambling Will Take Place 14.Counry 15. No.of Active Members
V�d ��t :, �t raei �>i/t' : G:arr/".:,� -f�F - t �ar�ev �J
16. Lessor Name � 17. Monthly Rent:
V��i ::art. ryar :�,;t :, y7, i s� ,i d.�lc.- �� �r- /r ��s/,r� �" .5�/�• „�
18. If Bingo wiil be conducted with this license, please specify day and times of Bingo.
� Days Times Da s Times Da� Times
�' ,� '"l��- ).' �
19. Has license ever been: ❑ Revoked Date: � ❑ Suspended Date: � ❑ Denied Date: d
20. Have internal controls been submitted previously? �LYes ❑ No(If"No,"attach copy)
21. Has current lease been filed with the board? ❑ Yes BCNo(If"No,"attach copy)
.._.� r
22.Has current sketch been filed with the board? �GSfes ❑ No(If°No,"attach copy)
,.. _ ...,. . . ; . , . . • . ..�...,., . ,.. .. -,,r .�..
GAMBLIN SITE AUTHORIZATION ., . _ .,.
By my signature below, local law enforcement officers or agents of he Board are hereby authorized to enter upon the site,at any time, gambling is
being conducted,to observe the gambling and to enforce the law f r any unauthorized game or practice. •
BANK RE ORDS AUTHORIZATION
By my signature below,the Board is hereby authorized to inspect t e bank records of the General Gambling Bank Account whenever necessary to
fulfill requirements of current gambling rules and law.
OATH
I hereby declare that
1. I have read this application and all information submitted to the oard;
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 operation of all ctivities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota r pecting gambling and rules of the board and agree, if licensed,to abide by those
laws and rules, including amPndments thereto.
23.Official Legal Name of Organization Signature(Chie Executive Officer) Date Title
_�� �
/� �. ...' �'� ':, '-/�° d' �...�
/ �I T+9ti�C i;_�.x..i_.at_�
�. �G��K� I �vE �//4 JI �Ai/ '��/�'-.1..��L 'Y`' ri (..[�'sf�' -�^' .
.'.
ACKNOWLEDGEMENT OF NOTICE BY LOCAL GOVERNING BODY �
I hereby acknowiedge receipt of a copy of this application. By ackno ledging receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling Control Board and if appro by the Board,will become effective 30 days from the date of receipt(qoted
below), unless a resolution of the local governing body is passed wh h specifically disallows such activity and a copy of that resolution�is received by "
the Charitable Gambling Control Board within 30 days of the below oted date.
24. City/Counry Name(Local Governing Body) Township: If site is located within a township,please complete items 24
=� ...„.� . �� and 25:
Signature of Person Receiving Application: 25. Signature of Person Receiving Application
�� _ •✓
Title Date Received(this date begins 30 day peri Title:
.. ��,,.;. �:� -- �; �a
Name 3f Person Delivering Application to Local Governing Body: Township Name
�. � � !� �
.
CG�00022-01 (5/87); White Copy-Board Canary-Applicant Pink-Local Goveming Body
' City of Saint Paul /.�fy.{�/A
. Department of inance and Management Services �� UO �����
. Lice se and Permit Division / n� , /3
� 203 City Hall ���� y
St. Pa I, Minnesota 55702-298-5056
APPU ATION FOR LICENSE
CASH CNECK CLASS O. New Renew
a o � oo �:d � � �
Date 19�' �
Code No. Title of license From °� `�� 1�y To a "` �� 19�r
o�3�f� �t•�I.� L..1 G�s � ' n
� �, . ,ao� �.��,�� .���, �.� ��• ��� CIG ���-
�C4 m�I� ��� ��P,:-E . rP�. � r l. 5 APPtiea�UCo�npany N -
u 100 ljC�G!a.1 �.��.( r;. o� � �G�, l
lV�v (il.it ,.�
! '�-r/ � �_i
100 Bualness Name
��
100 � � • ✓`} ���
Business Addroas Phorn Na
100
100 Maii to Adtlress Phone No.
I �� C~ �r`� r�, l/� ?1 ��� ��-
ManaQenOwnsr•Nam� y,�y - �:L�-�-
100
` � � /` �/2.
� � L�q !�GYI �rOC�
100 blanagerlGwner•Home Addreaa Phone No.
4098 AppliC8tiOn Fee � �
Received the Sum of 100 ��l� ,� ��,Q��y� S,S%1 'J
�v� �J ManagedOweer-C1ty,Slate 6 Zip Code
t00 ota� 100
� � � /`
� /'��Z t.r, , r"t,.lia�-� . � �i�. ��J,�f�,..��
Ucense Inspector By: � � Si�9eture of Applicant
Bond•
Compa�y Name Policy No. Expiration Date
Insurance•
Company Name Policy No. • Expiratlon Date
Minnesota State Identificatfon No. Social Security No.
Vehicle Information:
Serial Number Iste Numbsr _
Other.
THIS IS A R E1PT FOR APPUCATION
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
ordlnanCe and completion of the inspeciions by the Health, ire,Zoning and/or license inspectora.
$15.00 CNARGE F ALL RETURNED CNECKS
.�'`
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�t°� � C��J3 � ��
�1 �� ���N
' • City of Saint Paul � �I��
Deparcment oE Fin nce and Managemenc Services !�^
- Division of Lice se and Yermit Registration
INFORMATION RE UIRED WITH APFLICATION FO PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT PAUL
1. Full and complete name of organizat on which is applying for license
T
�- � i.r .�-
2. Address where games will be held i�1e 6 % - � - u ' . c' '. f�u� d d/oy
vumber Streec City Zip
3. Name of manager signing this applic tion c�ho will conduct, operate and manage
Gambling Games �=��T .�� Date of Birth J�'-�p- a2 d
(a) Length of time manager has been ember o= appl!cant organization �J F/G�,�S'
4. Address of Manager �• �- �x ��09 y � .S3-jo j
Number S reec Cicy Zip
S. Day, dates, and hours this applicati n is for • '�-/%�j� .i� .
y-/- 8 3-.3�-
6. Is the applicant or organization org nized under the laws o: t;�e State ot �i? ��
7. Date of incorporati�n - - �
8. Date when registered with the State f Minnesota � -� ��
9. How long has organization been in ex scence? �� �/��,�,5
•—�
10. How long has organization been in es stence in St. Pau.L? /J ;/��,«
11. What is the purpose of the organizat on?� 'AsSis� `/�f//l,uG:.rs/�i �:✓j��
.' — � � S
12. Officers of applicant organization
Name � s �1ame G.e�4cf 1C�c/6�3 SA.
Address ��1 ,f, Address �'�'�y C�,r.�,��,�+o� ,L/ �,�,
Title �.�tSi�lE.li L� DOB . Tit?e�EG• -T,cEJ�IS DOB � � .�?���
Name Name
Address 3ddress
Title DOB Title �OB
13. Give names of officers, or any ot:�er ersons ano paid ror services to tae organization.
Name �� � vame
Address �,ddress
Title Ticie
(Attach separate snee� `.^,- acd'_=:or.s: ::a_es. '
14. Actached hereto is a list of names and addresses oE all members of the organizaci'.or..
15. In whose custody will organization's records be kept?
Name ���i�u /�- /�I e,�.�..ss.=��t Address 7t/�/3' � G.����.� �E�.z°_-
16. Persons who will be conducting, assisting in conducting, or operating the games:
Name uc�i,V /J')p,�,r�_S_Sr��. Date of Birth g--,�a���
Address __�t��� �. G� e�,v zj-Eyd
Name of Spouse �"�,��� .,,1. Date of Birth �l y ,1 L_
Dates when such person will conduct, assist, or operate c�{_ /_ �,� — l�_��_dr'�
Name ,�f�A, � Date of Birth � -�r,/- aG
Add r e s s ���j� �'��,�� �,(� ,��
Name or Spouse ,v 7'�, ,sst Date of Birth J�'-/�-�3
Dates when such person wi11 concuct, ass�st, or operate //-/g-�'�"— y-/`fj�'
17. Have you read and do ;�ou thoraughly understand the provisions of aIl laws, ordinances,
and regulations �overning the operat:on of Charitable GambLing �,ames? Y�=�
18. Attached hereto on the ior� �ur::ished bv the City o� St. Paul is a Financial Report
whic:� itDmizes ai1 rece�gcs, eYpenses, and disoursemeats o= the applican[ organization
as we?1 as aii organ=zat_ons crao have receitred �unds tor the oreceding calendar year
whfch has beea s:�ned, prepared, and ve:if�ed �y ���1,,,; �������y
vame
��',�f ��A�b.�u�� � ,r„_/.J� �� .�-��� L.���-
�adress
who is the ��s,,�� /1�y,,���� of the applicant Organization.
� vame ot Pff�ice
19. Operator of premises where Aames :�il? be held:
Name ���.fi�.�d .S11�d.�r �N /_y�.�//r^.1/�'
Bu�siness Address ,�'�3� `�. �y��,� ei� /4�/� ,,�„��.. ��j
Home Address _�^�� �S,• r,r�,���� �d�/��
20. Amount of rent oaid bp aop�=csnc Organi;.acion ror rent o= che hall; specify amount
paid per 4-hour se�sion j_��, �
� • .
" . �� 'v�
21. The praceeds oi the games will be isbursed after deducting prize layout costs and
operating expenses for the followi purposes and uses:
- d � � / .v .vGe=
1�G C �.r/zl„f
i � �
-/ — ' L c � d7
22. Has the premises where the games ar to be held been certified for occupancy by the
City of Saint Paul? �
23. Has your organization riled iederal form 990—T? �Q If answer is yes, please attach
a copy with this applicacion. If a swer is no, explain why:
! Fi —
Any changes desired 'oy the applicanc �ss ciat'on may be made only crith the consent of the
City Council.
�
Organ zacion
Date ` ' p �
� /� � By:
�Ianager charge of game
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C S " y � !9 O R
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��v�sion r �ticense and ?erait Administ;acio�
• UNIFORH C ARLTABLE CAl18LINC FINANCIAI. REPORT � ��'�o�
. Dace ��/.�•�iI
� 1. Name oE Ocgani:.ation -
� � �`<s� /.t!G.
2. Addresa vhere Charitable Ca ling is canducted /L�l Q ������. <` ✓. A��.
/�
3. Aeport Eor period covering - t9 through /�-��. ���'','
4. Total number of days played �"
5. Croa� recelpca for above per od � __������
6. Crosn prizs payoucs Eor abov perlod ; i y�, 9�y
1. Nec r�ceipca - Line 5 minua 1ne 6 f �� ��G
/
8. Expenaes ineuc.-ed in canducc ng and opecating gamo;
�1. Cross vages psid. Atcac vorker lisc aith
name�, adlress aod groas vages. S �,_3��S-
8. Renc fo� � creeks ; --� �';
� C. Llcense Fae �z�'�! � /�tC ; �
D. Insurancs �-f,(fdC%�/�'! �✓S C'���•
s ��'d
E. Bond i�9
S
F. Dishonored checks no� rec vered � ��S
G. Employers F.I,C.A. ; ��/
H. Sales Tax ; �,� J
4�
I. H1nn. U.C. Tax $ /�� '
! J. Fed�ral U.C. Tax �
�
K. Niscallaneoas Expansea, dsncify ths amount
and �a �ham paid.
�/yldi°/�1 �i.//s� $�
� n,t. 3 7�r�n►e.vd�'/��•� T,�
,B. 1✓A�'hH,dso.� %,5�. �` 07�..?/
\C'�R e�s) 2._1.vs f;/ /�i�//N L� $ 7�
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� St.�.�ayl$�u� is.'3. Ds�lu uC C'fie�� ; ��
( 7:T N.5 t.v ?�, •-� ��5C• 5����i�s S
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D
� 9. Tocal Expense: _�,t-AL f �' ���
�� l0. Net Income - Iine 7 ainus line 9
S — �_ � ��
11. Checkboak balance beginning of perlod s �Q� �
�
� t2. Total of 11ns 10 aod 11 S __ _S�L 7 �_
13. 2oca1 eoncributions froa line 1 ! 5�.,�`Sd'ZJ
14. Checkbook halanee end oE repor ing period -
line iZ lese Iine 13 - S /� /�,�,
I15. SpeciEq use made of amount on irte 11:
!
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COMP.rz�r: rn� kevexse srr,e
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r. ' ' vame tJk.0�/l�i.d�//� uame �/
Addreea '3 � `e d Address
Date Rec'd "��� Dace Rec'd L - l /�- jr
Purpose y,�d � . �d s�• /e-t-pSf�iose
Slgnatur�'fAyF,G t � t' ds��c.gnacure
of Reclplenc f 6[ A/SFS , o[ Aecipienc
Amoun� S �✓,+ ' C�y� •"� ��s�
Amounc
Name Naa�e J
Address Addresc
Qace Aec'd Dac• Elst'd /_ �'�f /C '�f
-�._�_
Purposc� Purpose
Signacure Signacure
of Recipienc of Reclplent
Amounc �J� .�� Amount �� �� v��
Name Name
Address Addrese
Dace Rec'd y 7 Date Rec'd
�.,7-� j.J- S
Purpose Purpoae
� Signacure Signature
of Recipient of Recipient
• Amounc 11�'J •"� Amount �TS"//7'� �s y�'
� Name Name
Address Address -
Dace Aec'd - Date Aee'd
9- s /-�'
' Pu:poae Purpoae
Slgnacure Signacure
of Recipienc of Recipient
Amouac �1'+� '� Amcunt ��� �� ��,.r-�
i
17. Total Diabursemencs
i
� TfiIS AEPORT !t115T BE FILLED•IN 0!�:L.�Y TO QUALIFY APPLICATION i0R CHARITA$LE GAH3LZNC
LICENSE.
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4��.�.=,e. ,� � CITY OF SAINT PAUL
. : ��
DEP RTMENT OF FINANCE AND MANAGEMENT SERVICES
+ ��� e� DIVISION OF LICENSE AND PERMIT ADMINISTRATION
�'��, ,��� Room 203, Citv Hall
Saint Paul,.Min�esota 55102
George Latimer Q,,.,���p
Mayor C,I`�� /
3/7/88 ,
To: Virginia Baisley
From: Chri sti ne RozekC�
Re: Record Check
In connection with an application to renew a State Class A Gambling License
by the St. Peter Claver Social Club at 1060 University Avenue, a record
check is requested on the foll ing:
Evelyn Morrissette Laura Carlson
2443 E. Larpenteur #209 1343 Gentry
N. St. Paul
Birthdate: 9/20/20 Birthdate: 12/27/57
Grace Kielbasa
3889 Cranbrook Dr.
White Bear Lake
Birthdate: 6/24/26
CR/car
� � �OG '7�'f�
. �•, .�.••�.. CITY OF SAINT PAUL
'' = DEPA TMENT OF FINANCE AND ,MANAGEMENT SERVICES
• y�
% '��� � DIVISION OF LICENSE AND PERMIT ADMINISTRATION
. �
°' ,��� Room 203. City Hal)
Saint Paul,Minnesota 551Q2
George Latimer
Mayor
March 8, I988
Grace Rielbasa (Church of S . Peter Claver)
3889 Cranbrook Drive
White Bear, MN 55110
Dear Ms. Kielbasa:
Your application for a Stat Charitable Gambling License has been
received in this office.
A hearing on your applicati n for Class A Gambling ID #(s) 69243 will be
held before the St. Paul Ci y Couacil on March 22, 1988 at 9:00 A.M. ,
Third Floor of the City and County Caurt House. This date may be
changed without the License & Permit Division's consent and/or
kaowledge. Therefore, it i suggested that you call the Citp Clerk's
Office at 298-4231 to confi this hearing date.
You are hereby notified tha your attendance is required at this
meeting. Failure to appear maq result in denial of your application.
Ve truly yours�, �
� � } "
�,;� � .. _ f ` - :.�:^i�""`.r'.`"
;T�seph F. Carchedi
License Inspector
JFC/Ik