88-408 WMITE - CITV CLERK COURCII
PINK - FINANCE GITY OF SAINT PALTL ��—�O
CANARV - DEPARTMENT
BI.UE - MAVOR File NO•
-�Cou � ' solution
�.6
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. #6 416) for the renewal of a State Class A
Gambling License applied or by Blessed Sacrament Home F� School
Association at 1494 North Dale Street be and the same is hereby
approved/d��d,—
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
�I�++en�}
�� [n Favor
�Z ,
Reaman
�� Against BY i
Sonnen
Wilson � /.,�
MAR 2 2 198�6 Form Appr e by City Att e
Adopted by Council: Date
Certified Pass d y� ' Secr ry By
gy, �
A►ppro d y Mavor. Dat _ � av Approv d Mayor forSubmission to Council
B �
Y
P[�LISHED a�R ? t $8:
�3/3 .
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Finanoe � N�c�mt. 29�5056 oao�: — -2.-5��i1 �aeaarch
crrv*T,or�v _
R�a]_ applicatia� for a Stat�e of ' Class A Charita�le Ga�nbl�.ng Li.ve�se.
�'IC�ICi�T �IATE: 3/9/88 I�,TE: 3/22/88
��+o,►nows:c�vwor.tN o.R.1.a tw►1 cou� • .
. � .PLAMVINIi OOMMIBBION � . . GVIL 96iVICE�COMAI8810N DAIE M DA� � ANJ16Y8T � � Pl1pE NO.� . .
� � aDINNfi COA�tA18810N � ISD 62b SCF1001.BOARD � I r .��� . . � � . , _
.. - . -8TN7 ' . . . piAR1lR OOAMAI8,RqN � . AS IS � ADD'L MIFO..AEip6D* RfiTU TO Opff/1�T. . . � � . .
. - . . __ .. - _.fiOR AOD'L Nf0 _PE�i@lA�CIC I10tl�•
.. OIBTHICf COUNCIL � * .� . � . . . �
��,�� °�" Coun`cfi �_e rcF �ente
r
� fr1AR I 51988
.�►��.�.����,�.,�.+�,�►: .
t�r. Gerala Jans�. �.behalf of tt�e at sa�ra�ment H�me and.school As�oc�.at�.a�, requests
Ocxu�ci� ap�val r�f their r� app�.ica oa� fo�r a Stafi� of A�f�ta Gi�aritabl� Gatnbling .
_
LioerLSe. ` 'I�e �es�it3ns are h�.d � �v�ertir�gs be� the h�xxrs af 7:30,p.m. arid
lI i 30 g.m. at 1.494 NorE� Dale �treet. , go to help support Blessetl Sacram�t Gra�e
School.
; .rusnACn,�o�tco�ie.r�.iw.�ey.�ro�.�r. .. :, . _ . , ;>
All requi.red applicat3ans .and f�t�ave s�xni.�ted: Tf Caaicii appa.ro�val is granted:,
Blessed Sa�rac�t �iane & School As�ociati , which has beren iti eaci.st� far 33 Y�rs. �i.11
be al�cx�red fo oontinue thei.r sponsorship. _ _
�llNlrt.MMrn��nd Tb YV6ank .
If Cauncil appi.rova7.. is rx�t giv�en, Blessed a�,nt Hane & Schooi �soc�.aticin wili be r
farcaed to dis�antanue tt�eir spori.sarship.
w.,,�.u►m� _ �,s
�sroRr�raec�o.�rts: :
uau��:
. . � dl�--�°�
UIVISION OF LICENSE ANI) PERMIT ADMINI TRATION DATE 3 •.7'�7 / 3 ��"'��
INTERDF.PARTMFNTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant ��y�a,(� �'�h�� _ Home Address �q�q ��r-T Z c_.t
Rusiness Name Home Phone � �0'� ����
T7�hl�t ( � s
Bu�iness Address � �. � Type of License(s)
S'Sll7 A ^1
Business Phone - (p � C�4SS �'* ��1^'1b�i�'1 y �-!� h��'
Public Hearing Date 3 :2� � License I.D. 4� �S'1��
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� �1 ��
,
llate 1�TUtice l ,, - ' Dealer 4� N��
to Applican ` � � ' �j �
I'ederal Firearms 4� N��1
Public Hearing
DATE INSPE TION
REVIEW VERFIED (CO UTER) CUMMENTS
A roved No A roved
�
Bldg I & D �
N(A ,
,
Health Divn.
i N I� ,
�
Fire Dept. � �
� w �,4 i
�
Police Dept.
' Reco� e.�
9.en� I� �g�
License Divn. �
i
City Attorney �
�
Date Received:
Site Plan N��
To Council Research � �
Lease or Letter Date
f rom Landlord 3(3��
- ✓: /
.� - O� �, �Oi';
,
• :;�=�,.. Charitabie Gambling Control Board
Rm N-475 Griggs-Midway Bidg. For Board Use Onty
- �� 1821 University Ave. Paid Amt:
- `' St. Paul, MN 551043383 Check No.
f` ` (612) 642-0555
� �.....�•' Oate:
�`'� GAMBLING UCEN E RENEWAL APPLICATION
:i:.
y=
LICENSE NUMBER: A-OO�A'1�083 /EFF. DATE: 04116/$7 /AMOUNT OF FEE: f100.
� ,A,:: � 1.Applicant-Legal Name of Organization 2 Street Address '
BLESSED SACRAMaIT Hi�IE Ai+� SCl�OOI. f�50C ]800 R� pve
���4 3.City,State,Zip 4.County 5. Business Phone
:.i•-;;'. St Paul. MN 55119 CLASS 'A� LICEI� bi2 735-3676
' 6.Name of Chiet Executive Officer 7. Business Phone _
(7�ri a A��n��a �'
' 8. Name of Treasurer or Per n Who Acc nts for Revenues 9. Business Phone
• , � • �
10. Name of ambling Manager 11. Bond Number 12. Busi�ess Rhone �'
6erald D Jansen 51�08(►c�
13. Name of Establishment Where Gambling Will Take Place 14.County 15. No.of Active Members
Ideal Hall St Paul Ra�sev 2W
`� 16. Lessor Name 17. Monthty Rent:
Ideal �iail �7G(?
18. If Bingo will be conducted with this license, please specify days d times of Bingo.
Days Times Days Times Days Times
.
;;.;�: 19. Has license ever been: ❑ Revoked Date: Suspended Date: ❑ Denied Date: ~ :
,a�.
'-�"?'-. 20. Have internal controls been submitted.previously? �Yes ❑ No(If"No,"attach copy)
..�,�..,.,,..,ad.r:-a.
�:• 2t.Has current lease been filed with the board? � ` ❑Yes LgdVo(If"No,"attach copy) '
� �
� i':: 22. Has current sketch been filed with therboard? �Yes p No(If"No,".attach copy) �` " ..
�� � � � (3AMBLING ITEAUTHORIZATION ' - ,��, . • _ .
��.Y;.
� By my signature below, local Iaywenforcementofficers or agents of th Board aze hereby authorized to enter upon the site,at arry time, gambling is;. y
� being conducted,to observe the gambling and to enforce the law for ny unauthorized game or practice. - "
BANK•REC DS AUTHORIZATION
�`.' By my signature below,the Board is hereby authonzed to inspect the ank 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 Bo rd;
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 fuil responsibility for the fair and lawful operation of all a ivities to be conducted;
6. I will familiarize myself with the laws of the State of Minnesota res cting gambling and rules of the board and agree,if licensed,to abide by those
laws and rules,including amen,,,�nents thereto.
� 23.Official Legal Name of O�ization _,�� Signature(Chief ecutive Officer) Date Title
_ _ . . �a�/ g� '
: �� �, , . � _
+ ,,;e.hsy/ �,��.�tc . ACKNOWL GEMENTOF TICEBY CALGOVERNINCaBODY
"��,',: I hereby acknowledge receipt of a copy of this application. By ackno edging receipt,1 admit having been served with notice that this application will
+F,"� be reviewed by the Charitable Gambling Control Board and if approv by the Board,will become effective 30 days from the date of receipt(noted
- below), unless a resolution of the local goveming body is passed whi specifically disallows such activity and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the below n ed date.
24. City/County Name(Local Governing Body) Township: If site is located within a township,please complete items 24
� � �� �;;j � and 25:
Signature of rson Receiving Application: 25.Signature of Person Receiving Application
�^�' ' ' � � � �- ��
� �,_i
�� u ,�.,�
Title - Date Recei�ed(this date begins 30 day period Title:
q�%'A � ,--�.:3 a. 1-u�li � -� �•�
:��__.L-v
Name o Person DeliveringlApptication to Local Governing Body: Township Name
!� �
CG-00022-01 (5/8� , hite Copy-Board Canary-Applicant Pink-Local Governing Body
� City of Saint Paul
- Department of F nance and Management Services �
� • Licen a and Permit Division i �/�
203 City Hall l..Q � / "'
� St. Pau, Minnesota 55102-29&5056 �
APPLIC TION FOR LICENSE C����
CASH CHECK CIASS NO. New Renew
! (� I� --�-- 0 I� � ;�;{
! , Date �^'� tg" "
� Code No. Title of l.icense From � _ � 19'�'�To �% � 19(-� ~
i
' �� � �
; � � I
� 1� �l(��-�:Y:1 ��( �G s'�ti. :� l":(U�`:�
; � �� ("�L'�y� ��� �i.� .�y) v0�� �� � ApplicanUCompamr Name
; U �— 100 �2 n u ;:,C ;l C C.'I �_`..,�O C ,
; �k�/
; 100 Busfneas Name
,00 ' �-I 9 y ,�, '�.�r - -- ;
i � a �
i Busineas Address� Phone Na
� 100 � ��'' �lt ; /� /) � J// �
. 100 Mafl to Address Phone No.
C@I't�-t� I �^,'���; ..
: �oo �v—i�*c j �G i' j-�%� ..��<c%
Menaper/Owner•Name
,ao �9 �'�i � 1� , �-- C �
100 Atanager/Gwner-Home Addresa Phone No.
; 4098 Application Fee 2 5� 1 f� �
; Raceived the Sum of /1 100 '1 S� ;JG �c r :�/ �"1 � -: ��
{ V� • �V ManageNOwner-Ciry,State d Zfp Code
i
I 100 T tdl 100
i
I (/^ 7/ ( '` �_
, Ucense Inspector � � 8 ` /`� �
; Y� � Signature of Applicant
i
Bond-
Company Name Policy No. Expiration Oate
� insurance•
i Company Name Policy No. ExpiraUon Oate
i Minnesota State Identification No. Social Security No.
Vehicle Informatiort: aiaceNumuer
Serial Number
� Other.
. THIS IS A RE E1PT FOR APPLlCATION
i THIS IS NOT A LICENSE TO OPEAATE.Your application for li nse wiil either be granted or rejecied subject to the provisions of the zoning
; o�dinance and complatlon of the inspections by the Health, F re,Zoning and/or License Inspectora.
i
�
i
$15.00 CHARGE FO ALL RETURNED CHECKS
��
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� � —�,Cz.t...�-,— �/�� �g
��:� 3I�r� �� G�
� ' City f Saint Paul
� � Deparcment of Fina ce and Management Services ���'—!��
-;, . . _ Division of Licen e and Permit Registration
INFORMATION RE UIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHAR.ITABLE GAMBLING GAME IN
SAIiVT PAUL
1. Full and complete name of organizati which is applying for license
BLESSED SACRAMENT HOM N
2. Address where games will be held 14 4 N. DALE ST. ST. PAUL MN 55117
Number Streec City Zip
3. Name of manager signing this application who will conduct, operate and manage
Gamisling Games GERALD D. JANSEN Date of Birth 5-14-42
(a) Length of time manager has been m mber oi applicant organization 8 YEARS
4. Address of Manager 1949 EBERTZ COU T ST. PAUL MN 55119
Number Screet City Zip
5. Day, dates, and hours chis applicatio is for 7:30-11:30 p.m., WEDNESDAYS
6. Is the applicant or organization orga ized under the laws o� the State ot �T? NO �
7. Date of incorporation
8. Date when zegistered with the State o Minnesota
9. How long has organization been ia exi tence? 33 YEARS
10. How long has organization heen in esi tence in St. Paul? ' 33 YFARS
11. What is the purpose of the organizatf n? THIS OBGANIZATION WAS FORMED TO ASSIST
13LESSED SACRAMENT GRADE SCHO L.
12. Officers of applicant organizatfon
Name Cindy Langewisch V�e Virginia Lockman
Address 1567 Beech Address 1258 Etna
Title Presfdent DOB Tit1e Treasurer DOB 2-17-49
Name Name
Address Address
Title DOB Title DOB
13. Give names of officers, or any ot:�er ersons aho paid tor serrices to the organi�ation.
Name None Vame
Address �.ddress
Title ?'i�le
(Attach separace snee� =�r acdi=_or.s_ ::�_as. '
14. Actached hereto is a, list of names and addresses of all members of the organiz��ion ,
15. In whose custody will organization's records be kept?
Name �F$gL .raNS�t Address 1949 EB�T2_ �rn�RT_ ST. PAUL
16. Persons who will be conducting, assisting in conducting, or opera[ing the games:
Name GERALD JAN�EDI Da[e of Birth 5-14-42
Address 1949 EBERTZ COl}RT. ST. PAUL
Name of Spouse JACQUELINE L. JANSEN Date of Birth 1-4-47
Dates when such person will conduct, assist, or operate _Every Wednesday Night
Name Date of Bi:th
Address
Name of Spouse • • • � Date of Birth
Dates when such person wi1? concuct, ass�st, or operate
17. Have you read and do pou thoroughly unde:stand the provisfons of all laws, ordinances,
and regulations governing the operat:on oL Charitab?e Gambiing games? Yes
18. Attached hereto on t�e form fur�ished bv the City o� St. Paul is a Financial Report
which itsmiaes a11 rece�pts, expenses, and d±sbursemeats of the applicaat organization
as well as ali organ=zatjons who nave :eceit�ed `unds ror t:�e preceding calendar year
whfch has been s�gned, prepared, and ve:ii��d by GERALD JANSEN
Name
1949 EiiERT2 C011BT
�adress
who is the �A�Eg � oE the applicant Organization.
Vame oc Off=ce
19. Operator of premises where games .ril� be held:
Name JOSEPH PERKOVICH
B�rsiness Address 1494 N. DALE
Home Address 297 MARIA
20. Amount of rent paid by anpl�csnc Organi�acion tor re�c of the hall; specify amount
paid per 4-hour se�ston $175.00
� . . __ _ ��'���'.
��2�:: 'Ttie� proceeds ot the games will be di bursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
ALL PROCEEDS ARE GIVEN DIREC LY TO THE HQrlE � SCHOOL ASSOCiATION TO BE
USED FOR SCHOOL EXPENSES.
22. Has the premises where the games are to be held been certified for occupancy by the
City oE Saint Paul? YES
23. Has your organization riled rederal f rm 990-T? N� If answer is yes, please attach
a copy with this application. If ans ar is no, explain why:
TO BE FILED BY 5-1-88.
Any changes desired by the apol�canc �ssoc acion may be made only with the consent of the
City Council.
BLESSED SACAAMENT H(ME � SCHOOL ASSOC.
Organization
Date ,,�-.3��� By: P �
� Manage in charge of game
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, , Department o Finance and Managemenc Ser•rlces �5��� ���
, Divislon oE icense and Permit Administ;acion C�
� UNIFORH CHARI ABLE GAMBLINC FINANCIAL REPORT
Dace ����
1. Name of Orgartization r � ��-` / AS.SsG.
�
Z. Addresa vhere Charitable Gambli g is conducted /������ ,
3. Report Eor period covaring - t9 through /1- / __�g��
4. Total number of da�s played
5. Cross reeeipts for above pariod ; �y/ ��y
6. Grou prize payoucs Eor above pe lod ; / �.l� ��{�
��
7. Nec receipts - line 5 minua line 6 �
s L , � d
8. Expenses incurred in conducting nd operating game:
A. Crosa �ages paid. At[ach vo ker liat vith
names, address a�d groas vag s, ; �re � T� _
H. Renc far week, $ ,�
C. License fea stI!►LtE �- G' E� i �_i �
D. Insurance ; � �
.,
E. Bond ; 9 y
F. Dishonored checks not recover d ; �/�
C. Employers F.I.C.A. ; � �.
H. Salss Tax ; � ��,�
I. Hinn. U.C. Tax , ; �
J. Federal U.C. Tax ;
K. Niseellaneous EYpenaes. Idaac fy the amount
and to vhos paid.
�. 3.��►o�t Cd.a�o• s ��19. 3d
2. /�'Ji s� � - -
(S.;� �'�'A�b.��� � , n s -.t�
3. ; '
4. ;
9. Tocal Expens�s r�TAL ; ��G�
10. Nec Income - liae 7 minus line 9 ; ���r�
11. Checkbook balance beginning of peri d S S3�
12. Tocal of lin� 10 and 11 S _ �e��L
1J. Total contribucions froa lia� 17 S ���.T.�
14. Cheekbook balanea end of reporting eriod - �
line 12 less line 13 = ),a y`
15. Spaeify use sads of aaount on line 3;
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c'OMP1.1:1'1: IN: REVERSE SIf:E
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Name (fr.�i'i/.vii� Cel��a,� �� Name , ° '
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Addrean /„7,5� �j"�'q Address
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�/ i-,$�/7�.% .
/�-- Purpase Purpose
�sboc • �' �'Ssi6t Signacure Signacure
�� ���� �,�t-� of Recipienc of Recipienc
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Name �
Name A��
Address Addrasa
Data Rac'd �T��7�77 Daca Rec'd � �2� //�-,,?�j
Purposs Purpoae
Signacure Signacure
of Rcclpienc of Recipienc
.�
• Amoun[ /�-�d "'v "�
Amount E �rr�..r' ��.
Name � Name ��A�JC
Addresa Addreaa
Dace Rec'a �a y Date Rec'd ,�-��_ Q
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Purposa Purpose
Signacur• Signature
of Recipi�ne of Reeipient
.�d �
Amount �]� ' Amount • 9 �-�sr� `�
�a�
Nam� Name e.�'„yyn�;
Address ���m� Addr�ss •
Date Rac'd S-/9 Date Rec'd �— �f
� Purpose Purpo�e
Signature Signature
of Reeipienc of Recipient
Amouac � "~
°� � Amcunt d7a'
17. Total Disbursem�ncs
THIS REPORT HUST BE FILLID•Ill COl�LETEi,y Tp QUAI,IFy pppLICATI�N FOR CHARITABLE CA2�LING
LICENSE.
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__ ��,*•o, 1 C1TY OF SAINT PAUL
`' ' DEPAR MENT OF FINANCE AND MANAGEMENT SERVICES
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,, „ DIVISION OF LICENSE AND PERMIT ADMINISTRATION
°a ,��� Room 203, City Hall
Saint Paul,Min nesota 55102
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3/7/88
To: Virginia Baisley
From: Chri sti ne Rozelc C1e„
Re: Record Check
In connection with an applicat'on for a State Class A Gambling
License at 1494 N. Dale Stree , a record check is requested on the
following:
Gerald D. Jansen Cindy Langewisch
1949 Ebertz Court 1567 Beech
St. Paul St. Paul
Birthdate: 5/14/42 Birthdate:
Virginia Lockman
1258 Etna
St. Paul
Birthdate: 2/17/49 �
CR/car
. , . � ��'��o�'
" __ ,��_=a, C1TY OF SAINT PAUL
;'' '� DEPA TMENT OF FiNANCE AND MANAGEMENT SERVICES
: � � :
' : ,.• DIVISION OF UCENSE AND PERMIT ADMINISTRATION
' ,... Room 203. Ciry Hall
Sainc Paul,Minnesota 55102
Geo�e Lacimer
Mayor
March 8, 1988
Gerald Jansea (Blessed Sacr ent Home b School Association)
1949 Ebertz Court
St.. Paul, 1�IN 55117
Dear Mr. Jansen:
Your application for a State Charitable Gambl.ing License has been
received in this office.
A hearing on your applicatio for Cla.ss A Gambling� ID �(s) 65416 will be
held before the St. Paul Cit Couacil on March 22, 1988 at 9:00 A.M. ,
Third Floor of the City aad ountp Court House. This date may be
changed without the License Pex�i.t Division's consent and/or
knowledge. Therefore, it is suggested that you call the City Clerk's
Office at 298-4231 to confi this hearing date.
You are hereby notified that our attendaace is required at this
, meeting. Failure to appear y result in denial of your application.
Ve ruly yours;.. ,
. , � �
. � � , , .
_, . ,., .:. � .•;
� ' � , ' � � ,�'� �.
Joseph F. Carchedi
License Inspector
JFC/Ik