88-409 WHITE - C�TV CLERK
PINK - FINANCE COIIjICll ��'� �
CANARV - OEPAR7MENT G I TY O SA I NT PAU L O
BLUE - MAVOR , File NO•
Cou c l l 'on
,j � �.�1
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. 62564) for the renewal of a State Class A
Gambling License applie for by the Arlington Booster Club at
1079 Rice Street be and the same is hereby approved/��.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays
-�fIR1Rd
�� [n Fav r
.C.eowiiz
Rettman
�— �__ Agains BY
Sonnen
Wilson
Form Ap ov by City At y
Adopted by Council: Date
Ceriified Pas e ���oe�l,Sec ry BY
By.
-�V
A►ppr by 1Aavor: Date t-'� 2 '� _ Appro y Mayor for Submission to Council
_ By
PUBIISHE� �������� '�: 198$
mn a►� a�eoar�.� �lA'-'�Q�._ T"'�
_;� F. c��a�. Q1��� ��� ;�. 0 00 J 9$ � `
_ �� �,w„�,�� �„���,�,
c�ristine A�lc _ -- �a��� 3«r,�� .
� —
� Firianoe'& �t: 298-505� �. �,�,� ? C�c3.l. �i�ch .
OROER
: .. • : . - -- �
R�. applicatic� for a S"tatie. of ' ��:asts � C��ritab�ie �� L�.oense.
� ��I�fi�ATIQ�i D�Y'I'Es 3/8/88 LIATEz 3/22f 8$
�
�OA1111aoV17�oN8:(Ap�ow"!R)a. ' . (Rl) COUNCI� ,
vu�n�q� crvn.ae�� w� on� ,vwYsr �►�owe r+o. '
. � . DOMNO o0M�881oN -. 18D 026 8CFi0oL BCARD . . �" �.' . � .� .'.� . . �.� �.. . . � � .. -
. . �TAIiF . - . .� � . dMRTEA COMMIS810N � � - AS 1.4 -AOOi ri^D.ADUEQR � _�A DL R�F'C� � _FE£DlIIpC A00�• . .
01$TWLTCOUNCL . !.� . - . , . . . . . . .
� � �OR78 M�I,COtNiCp.OBJECIIVE? . . . . . . . ' �� ... �
_ Council Research �ente� `
:
MA� 151988
..nm.io.�o.t�r.wu��n twno.w�me.vw,a,.w�+ers.wtir�:
Ms. M�xy A. F�er, � behalf of the Ar BoQSte� Clvb,` x�aests Oo�u�ezl �aI of
-.-
t�heir -� app�iicati+� for a �tate o� Mixu�eaota C'��ar�.tabl.e G�bl' L�.c�. �e ;
�
sessi� ate he�l Fric�ay aftern�oons ` ' the ha�rs .of l�s Q0 p.m. and-5:00 p.Yn..at .
1099 Ri�e Str�e�t. ,. Pr+ooeeds are u,ged to c�e :
�u�.Prnxit and progra�ns for youth. - .
�nar�.,�dv.�.�.�.e�r�r. � .
A11 requi,red appli�atians and fees hav�e st�Umitt�d. If C7rnu�cil app�+ova1 is g�artt�d,
the �Arling�an Bc�te�' Club. t�.i.ch has in existenoe for 52 years► will be ail�w�ed ta
�iae their ��.p: _ _ _ ,
,:
' : 'COq�11B1!'�i'fNIInR whr�.end To Whan): '- , _ : . . ,
If QO�1Ci1 a�r-dl �s I10t giVe:lr the Ar' BooBt�ex' Club w3.11 be �t�rced bo di�tintie
thei.r spaa�orshi.p.
a��s: �. . � � _ � . �
w�iro�nr�,rs:
' �i�:
1,,� ��-s��9
DIVISION OF LICENSE AND PERMIT ADMINI TRATION DATE ��� / � � F'7 �� u
INTERDF.PARTMF.NTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
� I- ^
Applicant _�,Y �• '��Y� Home Address G 7�~ �. jt'�0�j� �IV�
Business Name ✓� t '�„�p rC'4,�Iome Phone �gg �� Q��
Business Address !b ? � , � Type of License(s)
Business Phone ` JTA� (.,'�S5 /'T �. ^ (�L5'f"� �CC,.,�
Public Hearing Date � License I.D. �6 �a 5��f
at 9:00 a.m. in the Council Chambers, /�
3rd floor City Hall and Courthouse State Tax I.D. 4� N T
� h �
llate Notice Sent �� � ��` Dealer 4l I���'
to Applicant � '� ����
rederal Fi.reartns 4� u JQ'
Public Hearing
DATE INSP 'CTION
REVIEW VERFIED (C MPUTER) CUNIl�IENTS
A proved N t A roved
�
Bldg I & D +
�,�
Health Divn. !v 'R '
i
�
� i
Fire Dept. j " �� �
I IV
j I
Police Dept.
� sl r1''� i ��'`�
�
License Divn. �
i
City Attorney �
i
Date Received:
Site Plan �
To Council Research �� �c��(��
eas or Letter Date
from Landlord a. ��
. - _ (�'d�.-f�9
.�_��.... Charitable Gambling Control Board For Board Use Only
, , Rm N-475 Griggs-Midway Bldg.
1821 Universiry Ave. Paid Amt:
St. Paul, MN 551043383 Check No.
':����:'� (612)642-0555 Date:
GAMBLING UC SE RENEWA�APPLICATION
UCENSE NUMBER: i+-i'7018�:i-i)4)i /EFF. DAT : f}Yi'U2l3i /AMOUNT OF FEE: i1Q6.OfJ
1.Applicant-Legal Name of Organization 2.Street Address
8005Tes� �l.UB r�RLIt�GTO�I i�9 'cdcerton �t
3.Ciry,State,Zip 4.County 5. Business Phone
St P�ui. �i wSiul �amsev 6i2 rr4-bi0s .: .
6. Name of Chief Executive Officer 7. Business PRpne uow��
�eboie �orm -
-,
8. Name of Treasurer or Person Who Accounts for Revenues 9. Business Phone �
. ( ) _. � .
10. Name of Gambling Manager 11. Bond Number 12. Business one�o,N�
�aiw A i-aser �s�O.i�J�h�i4
13.Name of Establishment Where Gambling Will Take Place 14.County 15. No.of Active Members
;Vorth Ena ?�arove!�ent Si s�aul a�2a �t0
16. Lessor Name 17. Monthly Rent:
;�arth tnd :�Dt�ve+�t aSoO
18. If Bingo will be conducted with this license, please specify days nd times of Bingo.
Days Times Days Times Days Times
x
}�' 19.Has license ever been: " ❑ Revoked Date: ���� ❑ Suspended Oate:� � 0 Denied Date: ,rJ,1%^�_
k 20. Have internal controls been submitted previously? �Yes ❑ No(If"No,"attach copy)
ha"
;e� 21. Has current lease been filed with the board? §�Yes ❑ No(If"No,"attach copy) ,
� 22. Has current sketch been filed'with`the board? , �1'es ❑ No(If"No,"attacti copy) .,:.,_ '
•�r• _,� _ . - . ._ ... _ - _ �-._ -::<�...y.
. . '":. � ., ' ' . GAMBLIN SITE�'AUTHORIZATION ~ ' ,,�...._,. ,,.,�,_.. •
�. By my signature below, local law.enforcemen�officers or agents of t e Board are hereby suthorized to enter upon the site,af any time, gambling is �
being conducted,to observe the gambling and to enforce the law fo any unauthorized game or practice.
�v' • BANK REC RDS AUTHORIZATION -
By my signature below,the Board is hereby authorized to inspect th bank records of the General Gambling Bank Account whenever necessary to
'"� fulfill requirements of current gambling rules and law. ,� .
� i OATH
I hereby declare that:
1. I have read this application and all information submitted to the rd;
2. All information submitted is true, accurate and complete;
3. All other required information has been fully disclosed;
4. 1 am the chief executive officer of the organization;
5. I assume full responsibitity for the fair and lawful operatiort of all ivities to be conducted;
� 6. 1 will familiarize myself with the Iaws of the State of Minnesota re pecting gambling and rules of the board and agree, if ticensed,to abide by those
laws and rules, including amendments thereto.
: 23.Official Legal Name of Organization Signature(Chief Executive O�cer) Date Title
��, . . _ , . • .
ACKNOWLEDGEMENT OF OTICE BY LOCAL GOVERNING BODY
I herel�y acknqwledge 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,wiN become effective 30 days from the date of receipt(noted
below), unless a resolution of the local governing body is passed wh h specifically disallows such activiry and a copy of that resolution is received by
the Charitable Gambling Control Board within 30 days of the below ted date.
24.City/Counry Name(Local Governing Body) Township: If site is located within a township, please complete items 24
- -�-- w„ , •.._�-� and 25:
Signature ot P�erso�i Receiving Application: 25.Signature of Person Receiving Application
1
Title Date Rec�ived(this date begins 30 day perio ) Title:
' _ :� �
Name of Person Delivering Application to Local Governing Body: Township Name
F CG-00022-01 (5/8'n White Copy-Board Canary-Applicant Pink-Local Governing Body
- City of Saint Paul �
-- Department of F nance and Management Services � �j
Licen e and Permit Division f � � S
, , 203 City Hall �j �n-�O
St. Pau, Minnesota 55102•298•5056 /�.� g
APPLlC T10N FOR UCENSE U`� �� �
� CASH CHECK CLASS NO. New Renew
caa � a � , _
�': oace � - " ,s�-�.
. ^
�� . Code No. Title of Llcense `,� - �: " � � _ � ":��
From 19"_To '` 19
.--
' o��� J-}-(��l :. `� I !! � � .� - _
�oo '
� _ r=� � � � ,ir� -�� � . �"�:u:-!F.- � 1 :. I
, _
�i i �.i l.: I� ., c. �� ��,t' r'�c_ � `! i, .r C: ApplicanUCompury Nams
� 100 , � _
1 � c, = , ;-
� � ) . �, � _. t. � .
100 euafness Name
, 100 i -�c7 , � : .. < < /
` Busineas Addreas Phoo�Na
�{ 100
100 Mail to Addreaa Phone No.
i _
100 '✓'„ ,.,� �� ;'"�l ?r—
ManapsrlOwner•�Name i.�` ! C -
1� �G 1 '> �.:_ �"'``�-.'j' � _ ' j �"'"�
� 100 AfanaqenGwnx-Nome Address Phons No.
` 4098 Appiicatlon Fee
� 2, 50 —_ �
Fieceived the Sum of 100 S 1 �C' «t ,''' •� �) � ��I �
� �. :�' J� ManageNOwnx-City.State d IIp Code
i . 1U0 tal 100 --
� , ';� � ��7`
` �:.. ,-
� �. � � �� -�`". ,., ,f % f' ����;� � -
. Ucense InspeCtor �� �-- By: � i" Signature o(Applicant
Bond•
� . Company Name Policy No. Expiratfon Date
' Insurance:
' Company Name Poliey No. Expiration Date
Minnesota State identification No. Sociai Security No.
Vehicte Information:
' Ser1a1 Number late Nwnber
Other.
; THIS IS A R CEIPT FOR APPUCATION
THIS IS NOT A UCEtJSE TO OPERATE Your application for 1 cense will either be granted or rejected subject to tAe provisions of the zoning
; ordinanCe and completlon o(the inapections by the Health, ire,Zoning and/or�icense Inspectors.
; r 9..- $15.00 CHARGE F R ALL RETURNED CHECKS
, d�
� ��
�a
3�Y��
� �
3 � �� � �
� City f Saint Paul ��" O �_�/D !�
; Departmecit of Fina ce and Management Services T �
� ,• • Division of Licen e and E'ermit Registration
INFORMATION RE UIRED WITH APPLICATION FOR PERMIT TO CONDUCT CHA.R.ITABLE GAMBLING GAME IN
SaiNT �PAUL
-
1. Full and complete name of orRanizati which is ap lying for license
,` �' �� r
2. Address whe games will be held s � ��f �S S� �
Number Screec City Zip
3. Name of manager signing this applica io vho will conduct, operate and manage
Gambling Games / �' Date of Birth �- / - � 3
(a) Length of time manager has been mber of appiicant organization •
4. Address of Manager f�j� � ) ��5� /
Number eet City Zip
�� � ,^
5. Day, dates, and hours this applicatio is ior - � �- � �Q�j
U
6. Is the applicant or organization org ized under the 1 w o= e State or 1�1?
7. Date of incorporation ,t L. ,
8. Date when registered with the State o Minnesota
9. How long has organization been ia ex tence? --
10. How long has organization been in e:ci tence in St. Paul?
,�-
11. What is the purpose of the organizati n? ,� ���p u��/L C�j��,�t.4,v�/� _
`' %C , D 0���-rH
12. Officers of applicant organizatiorc
Name *�ame �
/ ' � �' �"
Address �OG� � 'v Addr s
Title � ` �DOB �oC�/ si� Tit?e �Ji'z:���J DOB — --,'�C�
��
Nam� C'��✓ Name l � �
Address (�' � G (� � � � ��/ :�ddress �
/ � }/ C� �
Title DOB — Title �� DaB if —�='�'��,�—
13. Give names of officers, or any ot:�er ersons who paid ror servi.ces to tae organization.
Name vame
Address Address
Title :icie
(Attach separace snee� .°^r add.t'_or.__ ::��es. �
>
_ 4
14. Actached hereto is a list of names and addresses of all members of che organization. '
15. In whose custody wi11 organization's records be kept?
Name ��l��t /�'1'�/I��L� Address /�F�' � l��%/���:/V��/�/���
S'r �%��-/
16. Persons who will be conducting, assisting in conducting, or operating the games:
Name � Date of Birth �-- � '��
r
Address - � /
Name of Spouse ' ; � '',� Date o irth ��- ���pZ
c.... : A
/�
Dates when such pers�n will conduct, assist, or operate j�, �.�
� ��
, -
Na Date of Birth
Address
Name of Spouse Date of Birth
Dates when such person wi11 concuct, ass;st, or ope-ate
17. Have you read and do you thoroughly unde:staad che provisions of alI laws, ordinances,
and regulatior,s governing the operat�on ot Charitable Gambiing games? �/e 5
18. Attached hereto on �he for� furnished bv the C:ty o� Sc. Paul fs a Finaricia? Report
which itemizes a11 rece=pts, e�penses, ar.d disbursemeacs o= che applicant organization
as well as ail organ:za:fons who nave received `unds tor the oreceding calendar year
which `�as been si�ned, prepared, and verii�ed by ���y�S- �_ �,q.SG�
vame
/�<59 ���r�-��o,;: � � �-�Ki 5'��—�ci �r�c;
,
" �ddress -
who is che ���?'�/�y� �'�1,��i�?�3�.� of the appiicant Organization.
vame or Office
19. Operator of premises where Aames :�il: be held:
Name �-� � � _ _.. :
B�rsiness Address �4 9 �/�� �j^ '�����a2.� s�/�� _ .
� � � ����� �
Home Address � G� � .,u-�.= � //�'
20. Amount of rertt paid by aupl'_csnc Or3ani�acion tor rea[ oi the hall; specify amount
paid per 4—haur se�sion ����D, �a
- �'� ��-���
21 . Tne proceeds oi the games will be di bursed after deducting prize layout costs and
operacing expenses for the following purposes and uses:
i
�P��rs �';�lL�i � � ri�s � ° ,v�����,� ,v�u����
� J
22. Has the premises where the games are to be held been certified for occupancy by the
City of Sainc Paul? C 5
23. Has your organization riled tederaL orm 990-T? �L�S If answer is yes, please atcach
a copy with this applicacion. If an wzr is no, ekplain why:
Any changes desired 5v the appl=cant �,sso iation may be made only with the consent of the
City Cc�uncil.
' (/.tJ�cl O c/ /��S�G='C'S
� Organizacion
Ci
- ,-, .__._
Date �j-1-�� By: �-- '�
Mana r in charge of game
d .7 n £ � z tn rr + n .� cT [� cn
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Deparcmenc oE Finance and Managemenc Ser•�ic_s O v 7 J
, Division oE L cense and Permit Administration
UNLFORH CHARI BLE CAMBLINC FINANCIAL REPORY
� Date �'^ �—V o
1. Name of Orga�ization p •��
2. Address vhere Charicable Camblin is conducted �� � ,°
3. Report Eor period covering Cj 19�through ��r , �q���
�- '�-t-
4. Total numbe� of days played
5. Croas raceipta for above period ; '1��__� �C)t 7�
.a�
6. Croa� prize payouta for above pe iod S j'.'��j. 6 a �, pV
7. Nec receipts - llne 5 vinus 11ne 6 � ��L�, � 3S� ` j•�
!�
8. Expenses lncurrecl in conducting nd operating game:
A. Cross vages paid. Attach vo ker liat with �
n�men, address and groas wag s. ; �L�� � �
B. Rent for � weeks �—' �
s _. I� ,6S'�S.,Sr�
C. Lieenae Eee $ /OrD.�v
l�
D. Insurance � --
E. Bond ; � ,D/
F. Diahonored checks noc reeover d
s � .vv
G. Employ�rs F.I.C.A. ( 4�� a�� ; / :� y�
_d,a. _�L
H. Salea Tax ; —d-r�� f �r�
�� s.:,+T ��
I. Ninn. U.C. Tax ; O �
J. Federal U.C. Tax ; �
K. ltiscallaneous Expensea. Idan ify the a�ount
and co vhom paid.
�.qy�� �� � d �u s ��f '-��
�i�t,�-.. ��' Z. °���`"''� �'.,�:�. : Ls�'i
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3. Jr��, ��t�l���ti• �-Rx s SO�O.b7 �
AD ve►^-I rz•. J s'o,vv
4. ��trrEr�e4,� � qccT i 1.6�0. a�
�. P,�r�rk�.;,� s � 3Srl. 3
9. Total Expenaes P��� ��� � OTAL s �,�_7,� a.�
10. Net Income - line 7 minus line 9 t '�.����
---��-�
11. Cheekbook balance begiraing of per od = � � �-Q'�-�
1
12. Tocal oi liaa 10 and 11 f f,�,�. ��� /
�rL.__
13. Tou2 concribucions froa line 17 s ��y+ ��; ��
14. Cheekbook balanee end of reporting petiod -
line 12 less line 13 ; �'�� �/ .
�
15. Speeify usa made of amounc on line 13:
,� � ' _ ' � . Ev� i=cK �
/F�rt/
COMPiJ:1' TIIE ItEVERSE StU'E
.... ..�:.._.�c...�.._i .:,^,tit d�OU^� �:l i�;12 i2:
N Name 2�l,t�L 7—�1'� �ame
Address Address •
Dace Rec'd _��'G'lJ Dace Rec'd �
Purpose Purpose
Signacure Signacure
of Reeipient _ i of Recipienc , �
Amount �'T V� Amount ,Q�
Name Name
Address Addzesa
Da cs Rec'd ri� Dace Rec'd _,�(�(,�(��
Purpase Purpoae
Slgnacure Signacure �
of Recipien � oE Recipient w�--
Amounc GY � , ,QQ Amount -�, ���,�
Name N8�e
Address Addresa
Dace Rec'd �►"�Jg'Q,L('�' Date Rec'd ����
Purpaae Purpose
Signacur� � Signature
of Rscipient 4 of Recipient c ``--
Amount � d S Q� Amount 3 y��.fz
Name Name
Address Address •
� �Q� L
Datt Ree d Date Rec'd (
' Purpos�
Signature T� Purpoae
Signature
of Recipienc �`.---�.--� of Recipient � /�._
,�our�a ,��u�t o �
17. Total Diabursamanta ���„°�`���
THIS REPORT HUST BE FILLID•IN COl�LETELY TO QUALIFY APPLICATION FOR CHARITABLE CA?�LING
LICENSE.
7 � ii S O �-yl r �u �s S O �y-1 ry. fA+f S
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RV�IIOI�-02
Mmnesota Deputment ot A nue—Saies and Use Tax Division
Centennial 0lfite 8uiidi g—St. Paul, Minnesota 55145
(61 296-6181
CERTIFICATE OF EXEMPT ATUS—EXEMPT ORGANIZATION
Undrr the pn�vi�i��m ,d Sr���on :y7A__S. Suh�livi�iun 1 Ip) o(thr Minnrxuta Saica anJ Usc Tax L:tw,t!u organiution listed brlow is
�ettificd to he exempl Irc�m salrs and usY taxet en pur�hasex, ntsls and leases of tanybie personai property.The property must bt
useJ exclusively in the perfurmaner ot charitahlr, rcligious or educational functions or� in the case of seaior citizea
plu.wre�recreation or other nonprofit functians�of thr group. B�Ps,in the
Ariington Booster Club � Cenificate No.
3 03S�
2259 Edgerton Street E S
Date Issued
`St. Paul, Mfnnesoca 55101 April 4, 1986 .' •
� . •
Comm' 'ones of Revenu�
This�srtifiwtr is vaiid uatil revoked by thc By
�� ' �
MinnesoU Departmeat of Revenue. .
; P. R. BL.IISDELL, Acting'Director
Saks and Use Tax Division
The exemption does eot appiY to purchasrt of �neals or (odginq,
- -� �% �'�-s�� 9
__ ,�,_.o, C1TY OF SAINT PAUL
' '� � DEPA TMENT OF FINANCE AND MANAGEMENT SERVlCES
� �w
: '���� v DIVISION OF LICENSE AND PERMlT ADMtNISTRATION
• w
' ,��� Room 203. City Hall
Saint Paul,Minnesoa 55102
Geo�Latimer
Maqor
March 8, 1988
Marp A. Faser DBA Arli.ngton Booster Club
675 W. Hoyt Ave.
St. Paul, MN 55117
Dear Ms. Faser:
Your application for a Stat Charitable Gambling License has been
received in this office.
A hearing on your applicati n for Class A Gambliag Licease ID �(s) 62564
will be held before the St. Pau1. City Cauacil on March 22, 1988 at 9:00
A.M., Third Floor of the Ci y and County Court House. This date may 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 hearing date.
You are hereby notified tha your attendance is required at this
meeting. Failure to appear maq result i.n denial of your application.
Verq � ly your
,
. ' �'. .�'' a �.
����i.. .. ':J.i^��.i...+ � iv..v�►'yi'
// � f f
lf
Jaseph F. Carchedi �
License Inspector
JFC/lk
__ ��,*. ,, � C1TY OF SAINT PAUL
"' ' DEPA TMENT OF FINANCF AND MANAGEMENT SERVICES
A y�
� ' + '��� •� DIVISION OF LICENSE AND PERMIT AOMINISTRATION
�� ,��� - Room 203. City Hall
Saint Paul,-Minnesota 55102
George Latimer . l�' 0��< " /
_ Mayvr
3/7/88
To: Virginia Baisley
From: Chrlstine Rozek
Re: Record Che�k
In connection with an pplication for a State Class A Gambiing License
by the Arlington Boost rs at 1079 Rice Street, a record check is
requested on the foilo ing:
Mary A Faser Debbie Monn
675� W. Hoyt Ave. 1069 Greenbrier
St. Paul St. Paul
Birthdate: 8/1/13 Birthdate: 3/28/56
Va1 Fa1k Judy LaVagure
� 686 E. Arlington Ave. 690 E. Ariington
St. Paul St. Paul
Birthdate: 8/19/49 Birthdate: 7/20/50
Wally Knight
610 E. Iowa
St. Paul
Birthdate: 11/10/49
CR/car