88-407 WF�ITE - CITY CIERK
PINK - FINANCE ,('j I TY O SA I NT PA U L Council (�
CANARV - DEPARTMENT /{
BLUE - MAVOR File NO. �v � -
-�'� Cou l solutio
�
Presented By
Referred To Committee: Date
Out of Committee ' Date
RESOLVED: That Application (I.D. #13794) for the renewal of a State Class A
Gambling License appli d for by Prosperity Heights Booster Club at
1494 North Dale Street e and the same is hereby approved/�.�
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
�i�ren�
�� [n Fav r
- - �-��
Re�r Q+� __ Agains BY
Sonnen
Wilson
MAR 2 2 198 Form Appr ed y City Atto ey
Adopted by Council: Date
Certefied P• - �ba uncil e BY
By �' _
A►ppro y IVlavor: Da e _ 2 �F � Approved ayor for Submission to ouncil
By
Pt���.�SNED rti i'�t� ;i t �� �
.
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;:.� F, e��:;. �,� ,m �„�� ���'��E1� No.04��9�97 .
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.��,��.�#YL7fiS:7� .. . . � . . . F� �+__-FlMIiCE 6 MMfMflBAB�It SERYICES OfECTOR- . J . .0!!V p.EPo( .
� -
Fit�noe & l�mt. �98-5ti55 � �n� 2 Ovu�ei:1 �ear�
l�er�wa]. appli.cation fo�r a State of C1ass A Ch�itabie C�qbli,ng L�,a�e.
, I�IFIC�f'I'Z�d-I�TE: 3�8/88 1�A�E: 3/22/88
ll+�lllac:UDVro+M��N« , ' (H1) #6ront: '`'
n.iwww oaMrseio�+ a��oo►�assara o��x� o�►�E aw.rsr w�oHE
�IR13 CdMN881oN . . 18D!2a BCMOOL eOARD. . '.( -,-.� . � . � �� . . . .
. . STIIfF� , �. _ � qWi'IER COMMIB810M .. .AS IS �ADDL fIFO.ADO� _F�Af D'L�� _ . 11pDEp• � .
� DIBTRCTCOIINCL. . *� . . . . � - - � . .
TION: . . � . .
°"�""�"�"°°�'"�' Courtcfl Research Cen#er
. ,
�AR 15�
_
�cw,s.uE.or��o.v��w,.R,,a�,wn,►,►: ,
1�. Jaaiuelirie Ja�, on behalf of the ?r�perity f�eiglits Boos�er C1�ub, req�s Oa�i.�.
a�ap�va]. af th�ir r�]- apFlication< f a State af i�fi.iu�racxta Ct�ari� Gaatrta.r�g Liv�e.
� �siron� are held.on 2"hur�iy af betw�een �he`haurs flf I:00 p.�t. a�d 5s�3 p.m. ° �
`=at`i+�94 NorEh D�a].e Street. Pr�Ceeds` ar u.�ed t�a��lp p�rovide activ�.t�.es �or th�-�th of
the oo�nunity. .
.N�1�7101f.tCoMU9�n.Ip..;�awenp�.c A.M,Nq: : , ,
A}.l. '�Qt� ��9.Cd�jA[IS � f�=1'IaVC'. b8211 SL1hCl�'t't'+�. ` T� Q0�,1 �'O'V$� 18 �'ffii���
't�l� Pi�'lt�i" ��q�1�8 HC�O�t'LL'..C1L$5� C�1 ha$ b�E."Tl �Il ElC�.S�CE fOI' 29 yE�'8� 'W�11 b�
3�:�.f� � aC3[!'��.1'11]�'`fi3]e].r 8p0�0Y'S�.p. ,
�'i�whNw na To whora?. -
, .
If Oauncil app�+c�val is not given, the ity Heightss Booster C].ub will be forc�d to
di�oontinue tl�eir spoc�sorship.
� . �,�+�+�,�: �os c�
wsran�rs: . . �
_. �.��u.aaxs:
���-��
. DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE �`�"7'w / �"'["�V
� INTERDFPARTMFNTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant Q, e�lM�(,J !1 Q� Home Address ���� �,b,�rT''Z �a(1�
Rusiness Name Q t^ !�'G�. �'L'� Home Phone � 3 g- �9 a a.
Business Address O 1�}° µ �� �a,� Type of License(s) �a M b�1 h G�
Business Phone �'-� S-I�,`�Q,,.��Qgg A �►1 v [S"�• ��.'�,
Public Hearing Date 3 �- � License I.D. 4F � 3�9 �
at 9:00 a.m. in the Council Chambers /
3rd floor City Hall and Courtho se State Tax I.D. 4� N/ A»
llate Notice Sen � '�� � Dealer �{ � � �
to Applicant • ' r �;'�� � �
rederal Firearms 4� N �'
Public Hearing
DATE IIvS ECTIUN
REVIEW VERFIED ( OMPUTER) COMMENTS
A roved ot A roved
�
Bldg I & D N'� I
Health Divn. �
; � lp� ,
�
Fire Dept. � A �
� �' <<�` �
Police Dept. <��( �� �o
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License Divn. �
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City Attorney �
�
Date Received:
Site Plan N n G
To Council Research J �C O�
Lease Letter Date
rom Landlord -Q,S
� ��-�° 7
1 b��'f �
� .,<-�=-��.. Charitable Gambling Control Board
a i ,I�' Rm N-475 Griggs-Midway Bldg. For Board Use Only
• 1821 University Ave. Paid Amt:
- - � St. Paul, MN 551043383 Check No.
"r�°•'`�� (612) 642-0555 Date:
GAMBLING LI NSE RENEWAL APPLICATION
LICENSE NUMBER: ;}-UQ6;1�`173 I EFF. D TE: �)4f 1U/$7 /AMOUNT OF FEE: �i[10.W
1.Applicant-Legal Name of Organization 2. Street Address
BUOSTE7 CLUB AROSPE�ITY riT5 Cottaue Ave and �(ennard
3. City, State,Zip 4.Counry 5. Business Phone
St Paul. �AI 551�6 l:LASS 'A' LIC"ch5c o12 774-3453
6. Name of Chief Executive Officer , 7. Business P�one �
°'.�:;�It-ensiew l._:�9 L E z-.J; `� ' 7 y,
8. Name of Treasurer or Person Who Accounts for Revenues 9. Business PFrone ti
1 G/ � ` , zj )
10. Name of Gambiing Manager 11. Bond Number 12. Business Phone
Jacnuelir�e 3ansen �14;;,6i l i ' ��
13. Name of Establishment Where Gambling Will Take Place 14.Counry 15. No.of Active Members
;dea 1 Na i i St aau 1 �atosev �'�
16. Lessor Name • - 17. Monthly F�ent: ,
ideai Hali 3i��
18. If Bingo will be conducted with this license,please specify da and times of Bingo.
Days Times D s Times Days Times
`�i '� /- i
�-19. Has license ever been: � Revoked Date: ❑ Suspended Date: ❑ Denied Date:
20. Have internal controls been submitted previously? �Yes ❑ No(If"No,"attach copy)
21. Has current lease been filed with the board? ❑ Yes �No(If"No,"attach copy)
22. Has current sketch b�nfiled with the board2i ;�,,., : ' I�Yes. ❑.No pf."No,"attach coPY): � - -- -
,
- " � GAMBU G SITE AUTHORIZATION
By my signature belc�lecal law enforcemeM officers or agents o the Board are hereby authorized to enter upon the site,at any time,gambling is
being conducted,to observe the gambling and to enforce the Iaw r any unauthorized game or practice.
BANK Fi ORDS AUTHORIZATION
By my signature below,the Board is hereby authorized to inspect he 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 Board;
�i. 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. 1 assume full responsibility for the fair and lawful operation of al activities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota specting gambling and rules of the board and agree, if licensed,to abide by those
laws and rules, including ame�dments thereto:. ' . - - ' ' ' "
23. Official Legal Name of Organization Signature(Chi f Executive Officer) Date Title _
,+' . '' '".j 1 i' . . �J•
1 „/ � ' � '�� 7� + �i[r'��.KI�..✓�
t � . . .N� f,t,%l�l,nr� .._ . . _
� ACKNOWLEDGEMENT O NOTICE BY LOCAL GOVERNING BODY -
I hereby acknowledge receipt of a copy of this application. By ackn wledging receipt, I admit having been served with notice that this application will
be reviewed by the Charitable Gambling CoMrol Board and if appr ved by the Board,will become effective 30 days from the date of receipt( oted
below), unless a resolution of the local goveming body is passed ich specifically disallows such activity and a copy of that resolution.is rec�ived by
the Charitable Gambling Control Board within 30 days of the below noted date.
24. CirylCounty Name�(Local.Governirg Body) Township: If site is located within a township, please complete items 24
;� � � � i:'.;._ `�.�.c �.c and 25:
Signature of P�rson Receiving Application: 25: Signature of Person Receiving Application
, _ ,
\ ', ' r.
Title Date ReceiJed(this date begins 30 day peri d) Title:
� ' �_ ;� L � �-� - 4 -
� Name f Person Delivering Application to Local Governing Body: Township Name
• _.-
� �,,. ' � -
,�_`.. ,
C(9-00022-Ot (5/8�i' White Copy-Board Canary-Applicant Pink-Local Governing Body
° City of Saint Paul ' � � � y
� Department of inance and Management Services
Lice se and Permit Division ,8,- D����
203 City Hall� (��`�— �o
� SL Pa I, Minnesota 55102•298-5056
APPU ATION FOR LICENSE
CASH CHECK CLASS NO. New Renew
a � -�- n o ..
� _ � � ;�.
Oate °` °� 19 '�
Y�� � - �,.
Code No. Title of License From � 19=To '` - � 4 19 � 1
0�7 .�-H'�y;J1 �1�..1 Q�� ;'1- ' � '-i i, ��� -�
,00 '1'�rJ � �,� u.:� . �,- �o:�s-�- '�1 z�
�� n
'"'i� \ � ,'��.• �1� AppllcantlCompany�lame
100 _.
1 y�4' ��� �-�s� ,:.-,4�-Y
100 8uaineas Name
100 � �'�
'�� ��I `��,�
• Buaineas Address Phone Na
100
100 Mail to Addreas Phons No.
i
100 G� C� UP_ �tvl � C.._. �t ;� �.G ;�
,
ManapedOwner•Nams
,o0 7j � —
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��1U�j �Ghv=z �_ou� ,?_.�
100 AlanaqerfGwner•Home Addresa Phone No.
4098 Application Fee 2, 50
Received the Sum of i00 �• �Q-� � � ,�r1 �S�� '�J
S(�U•V V ManapeNOwner•City,State 3 Zip Cade
100 otal 100
�
• � � �
J c� r� ;� �/. -_�..:.._ .._� .� �� ;;�.- � .�
Ucense Inspector By: / ; Signature oVAppiieane
Bond•
Company Name Policy No. Expiratlon Dats
insurance:
Company Name Policy No. ExpiraUOn Oate
Minnesota State Identification No. Social Security No.
Vehicle Information:
Serial Number Plate NumbM
Other.
THIS IS A R CEIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE.Your appiication for I cense wili either be granted or rejected subject to the provisions of the zoning
o�tlinanCe and completion ot the inspections by the Health, ire,Zo�ing and/or License Inspectors.
$15.00 CHARGE F R ALL RETURNED CHECKS
,1 ��?C,�"�
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�"� ; _�_ �� �
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3-�(-�� �-
' Cit of Saint Paul G !`
. Department oE Fin nce and Management Services � �s �TO�
.�
- � Division of Lice se and Yermit Regiscracion
INFORr'.ATION REOUIRED WITH APPLICATION FO PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAINT 'PAUL
1. Full and complete name of organizat 'on which is applying for license
PROSPER TY
2. Address where games will be held
Yumber Streec City Zip
3. Name of manager signing this applic tion who will conduct, operate and manage
Gambling Games .Tacqueline L. Jans Date of Birth 1��7
(a) Length of time manager has been member o= applicant organization 12 Years
4. Address of Manager 1949 Ebert Court, St. Paul MN 5511
Number Streec City Zip
5. Day, dates, and hours this applicat 'on is for Thursdav. 1-5 n.m. 4-y-�s1 - 4-8-88
6. Is the applicant or organization org nized under the laws o= the State of �I? Ye3
7. Date of incorporati�n Aug. 1 58
8. Date when registered with the State t Minnesota Sept. 1958
9. How long has organization been in es stence? 29 years
10. How long has organization been in ex stence in St. Paul? 29 years
11. What is the purpose of the organizat on? To provide activities for the youth of the
coa�nunity, such as, athletics ar ies field t
12. Officers of applicant organization
Name D� Lewis ��e Michel Chisrotta
Address 138 W Address 1566 E. Clear
Title President DOB Tit1e Treasurer DOB 2-14-42
Name Name
Address :�ddress
Title DOB Title DOB
13. Give names of officers, or any ot:�er ersons •ano paid Lor ser�ices to cne organizat:on.
Name None Vame
Address �ddress
Title ?'�c?e
(Attach separate snae� `^: addi::or.s_ ���es. '.
14. Actached hereto is a list of names and addresses of all members of the organizdcion.
15. In whose custody will organization's records be kept? • .
Name _ Jacqueliae Jansen Address 1949 Ebertz Court
16. Persons who will be conducting, assisting in conducting, or operating the games:
Name Jacqueline L. Jansea Date of Birth 1-4-47
Address 1949 Ebertz Court, St. Paul•
Name of Spouse Gerald D. Jaasen Date of Birth 5-14-42
Dates when such person will conduct, assist, or operate All
Name Date of Birth
Address
Name-of Spouse - - Date of Birth
Dates when sucn person wi11 con�uct, ass=st, or operate
17. Have you read and do vou chor�ughly unde:stand the provisions of all laws, ordinances,
and regulatior,s oo�rerning the operat:on ot Char�tab?e Gambling games? Yes
18. Atta�hed hereto on the form �ur^ished bv the City oi St. Paul is a Financial Report
which itemizes a1.1 rece=pcs, e:cpenses, and disbursemencs of che applicant organization
-as well as a1I ozganizat�ons who nave rece_ved �unds tor t:�e oreced'_ag calendar year
whfch has been s�gned, prepared, and �*eri��ed T�y � Jacqueline Jaasea
Name
1949 Ebertz Court, St. Paul
aadress
who is the ManBger of the applicant Organization.
Yame �t Office
19. Operator of premises where �ames wil� be held:
Name Joseph Perkovich
Business Address 1494 N. Dale
Home Address 297 Maria
20. Amount of rent paid by appl�cant Organi�acion tor reac oz the hall; specffy amount
pafd per 4-hour se�sion $175.00
, , � ���°7
21. , The proceeds or the �ames will be isbursed after deducting prize layout costs and
operating expenses for the followi g purposes and uses:
All roceeds are iven directl Pros erit t3ooster Club to be used at Prosperity
playground f or various youth and ommunit activities.
22, Has the pre�ises where the games a 2 to be held been certified for occupancy by the
City of Sainc Paul? Yes
23. Has your organfzation tiled tedera form 990—T? N� If answer is yes, please atcach
a copy with this appiicacion. IP nswer is no, explain why:
Due by May 1, 1988
Any changes desired bv tne applicant �ss ciacion may be made only with the consent of the
City Council.
Pro s! eritv Ron4ter Club
Organizat�on
Date d7-07 ��,� By: � _
nager in charge , game
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- " D�parc�enc E F!nance and Managemenc Sec•�;ces ��
� Division oE L.tcense and Permit Administracion
UNIFaRN CH ITABLE GAHBLINC FINANCIAL REPOR'I
' • Da C e-.tz2--,�.z.:d J
1. Name of Organizacion
2. Address vhere Charitable Gamb ing is conducted /j��i�J /� A��
_�_
; 3. Report Eor period covering 19� through ��-3j l9�
4. Total number of days played
5. Croas receipts for above perio ; '�y �/�y
6. Cro�s prize payoucs for above eriod s ��' �j�
7. Net reeeipts - line 5 mtnus 11 e 6 ; �.��
,Z�
8. Expenses incurred in conductin and operacing gam�:
A. Gross vages peid. Attach orker liat with
namaa, address aad groae v ges. i !��11�
B. Renc for �� veeks i y�3�
—�_�
C. Llcanse fee S�%A TF G fT�/ � ��
D. Insurance ; �ryD
E. Bond s �
F. Dishonored checks noc reco red � ��
G. Employer� F.I.C.A. _ /,,?—
L�
N. Salea Tax ; --��;'`
7
- I. Hinn. U.C. Tax � �`
�
J. Federal U.C. Tax ; /��
.
K. Hiseellaneous Espenees. Id acify cha amount
and Co vhom paid.
1.S!F i��siG✓>cd j /�dl
2. 9 .��A.��.�t C���° ' : ��7�
3. ;
4. ;
9. 'focal Expensei TOTAL ; � f�f��
.
10. Net Incoma - line 7 minua line f �� gs�
11. Checkbook balance beginning of p riod S J ,�A f�
`^"��=--
12. Total of line 10 a�d il s �� � , y
ir���•_-
13. Tots2 contributions froa lins l7 s �;/��
S
14. Checkbaok balance end of reporti g period -
line 12 leas line 13 f _�� �, '
15. Speeify use made of amount on li e 13:
/�/ � a - - ,� -
d y� '�o � f/
,5 .
COMPI.1 TG Tt1E REVERSE SJf:E
.5. ,, :�urse.^..e.^._s ..-01 __......,_ :n _Lne .Z:
Name��J�p����J�s�S�a �Ji,�,� Name
Addresn �j7� � ,y�/A Address
�f/ ������ds Dace Rec'd /-1 -�'1 Date Rec'd ' ,
`?-� 10 ��90_ �, .
�O Purpose jf�,Ut� AG�i�I/�'i�4 Purpose
Gd je /��/���ignacure Signacure
of Recipienc/}� E G'f��„p�j _�1�� of Recipienc
,C�o�St�� C/�� -
EAS.. Amounc+�/l$�. '� Amount `�
/y1i1(� Gh.aPE�t�, -7.� � r,/7��.ie
Name Name
Address Addreas
Dace Rec'd /- ,� Date Rec'd � --� �'lJ��
Purpose Purposa
Signacure Signacure
of Recipient of Recipient
• Amoun t 7 i S L� . •rU ---'l�sc--`zL_/ b �l y.�I-�
Amounc
Name Name
Addresa Addresa
Dace Rec'd �- �� Date Rec'd �J_ Q
/� '_ .�/
Purpoae Purpoae
Signacure Slgnature
oE Reeipienc of Recipienc
Amount �� Amount ��y js'3'y ��
i
Nama Name
Addreas Addrese •
Date Rec'd _ 3- (� Date Rec'd
-- �- y ,,_3 v .
� Purpoae Purpose
Slgnacure Signature
of Recipient of Recipient
aa�
Auount .S d�' Amcunc �/ �l, �'� .: �',f}� '��
, 1,
17. Total Dlaburaements _ � � �__�
THIS REPORT MJS? BE FILLED•IN COl�LETEI,Y TO QUALIFY APpLICATION FOR CHARITABLE GAHBLINC
LICENSE.
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_����*• �.. C1TY OF SAINT PAUL
.�;' '� DEPA TMENT OF FINANCE AND MANAGEMENT SERVICES
�; �ii ;
,,. „ DIVISION OF LICENSE AND PERMIT ADMINISTRATION
' ,�.. Room 203, City Hall
Saint Paul,Minnesota 55102
Geo�e Latimer
Mayor
March 8, 1988
Jacqueli.ne Jansen (Prosperi y Heights Booster Club)
1949 Ebertz Court
St. Paul, MN 55119
Dear Ms. Jansen:
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 46(s) 13794 will be.
held before the St. Paul Ci y Council on March 22, 1988 at 9:00 A.M. ,
Third Floor of the Citq and County Court House. This date maq be
changed without the License & Permit Division`s consent and/or
kaowledge. Therefore, it i suggested that you call the City Clerk's
Office at 298-4231 to confi this heari.ng date.
You are hereby notified tha your attendance is required at this
meeting. Failure to appear y result i.n denial of your application.
Dery trulq your$..1 ,
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J �e�s�i-F� Carchedi ~
License Inspector
JFC/Ik
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�._.,, C1TY OF SAINT PAUL
' �'�' ' DEP RTMENT OF FINANCE AND MANAGEMENT SERVICES
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; �� DIVISION OF LlCENSE AND PERMIT ADMINISTRATION
° ,��� Room 203. City Hall
Sainc Paul,Minnesota 55102
George Latimer
Mayor
3/7/88
To: Virginia Baisley
From: Christine Rozek �
Re: Record Check
In connection with the renewal of a State Class A Gambling License by
the Prosperity Booster Club at 1494 North Dale Street, a record check is
requested on the following:
Jacqueline L. Jansen Dan Lewis
1949 Ebertz Court 1389 Winchell
St. Paul
Birthdate: 1/4/47 Birthdate: 2/20/50
Michel Chiapetta
1566 E. Clear
St. Paul
Birthdate: 2/14/42
CR/car