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88-498 WHITE - CITY CLERK PINK - FINANCE G I TY O SA I NT PAU L Council CANARV - DEPARTMENT �+ ) �. BLUE - MAVOR {'lle �0• ,Co nc "l Resolution n Presented By �`-� Referre o Committee: Date Out of Committee By Date RESOLVED: That Application (I.D. #67916) for a City of St. Paul Gambling Permit (Raffle Only) applied or by Jack �, Jill, Inc. at 270 North Kent �treet (Martin Luther ing Center) on April 8, 1988, between the hours of 8:00 P.M. and 10:00 P.M. be and the same is hereby approved. COUNCIL MEMBERS Requested by Department of: Yeas Nays Dimond Lo� In Fav r Goswitz Rettman B Sc6eibel A gai n s y Sonnen Wilson Adopted by Council: Date APR 7 �� Form Approved City Attorne Certified Pa s � ouncil Secre — By Bs. ��� J �R ' 7 Approv d ayor for Submission to Council /�ppr y 'Navor. at , B PUBl.ISHE� �P P. 1 198$ � o�►� reo_ ome oo.�e�o ��/�1��. M�.� �r�hed�� ���� ''�"� '`'� 1�. �}V���Q a��rr�r ar+ECroa ►Ya�ai�or+��►m Ch istine RoZ.ek � � aww+c�.Mw�sa�rr semncw or�ec,on 3 cnv c�nc ' . _ �,oc�r o.+�c,a� � Counc�i 1. Res$arch F. an t� 5 56 oAO : 1, «r��Y . . Applicatian for a one :day Cfty of �t. Pa 1 gambling .p�rmi,t (raffle only) Noxification Date:: Maxch 28, 1988 - He�.ring Date: Rp7�i..� 7, 1988 NEC611�t1DJlttlONii:(Mw'�(A)a RejeCt tF�) RESEARCe1 lI�OIM`: . ��ww�3 oowwreeioN om�sEavv�co�wnseioN o��m o�tE nwtivsr q��a. . 3 R � � � . . .. � IDIMIO OOMM8810N � 18D 625.SCHOOL 80AF� � . . � �. STAPF-� � � �. CHAR7FA COAMAIB9lOM. . . . � AS IS_ L N�IFO.ADDEDt . .HET9 TO�CWIT#�T � � . �CONB1R41@IT � . ' � � _ . . _FOW AD�L'MIFO. . _f�EDBliC7C -* .. �DIBTRK."f OOHI�ICIL . . .� . • TbN: "�°°"'°'"'�"°°°"�°�'�' Council Research Center. MAR 3 01988 �nr►�ra w�o�.�.�.aronn�srr�wna wr�.wn�,.w►»►..whr�: _ Ms. Janean Cloman, on behalf of Jack F; Ji 1 of America, Inc. , requests cou�cil apgroval of th��r City of St. Paul one day gambling p rmit (raffle only) . The raffle will be held at 270 Noith Kent (Marti.n Lu.ther King Center on` Apxil 8, .1988, between the hours of 8:00 F.M. �d 10:0U P,M. Proceeds wi2.1 be u�ed �for recreational, social, and.cultural�programs for - �hildren. �+I�►no�tc�ienw�..�cr.r,nu...-n.s�rro�: _ _ : . If cQUncil approval is granted, Jack and i11, Inc. , w�ic� has bee'n in existence Eor 6 ye�rs ` in 5t. Paul, will be able to sponsor this raffle. QOII�Y/N0�(VNM,1M�en.'arw Ta vVhoi�: ,. , Tf council approval is a�ot given, Jack an Jill, Inc. wi11_be unable to sponsor t�e raffie. � : �u.t�++►�rre�; � . �os - ca�s . ��awES: �����' UIVISION OF LICENSE AND P�:RMIT ADMIN STRATION DATE � °�S o� J °�S � � � INTERDF.PARTMF.NTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant JQ y�Q(�t 17 � I�VY1Q r1 Home Address �P 0 '�dl� _. Rusiness Iv'ame (;�L 4 J� (�._.l. h Home Phone ��� � � �- �� Business Address ��O �: � � Type of License(s) Business Phone a� - y�a 1 � �C1 f Q yy) b�!�1 P� ✓!"Y)L� ��C.,�i���� Public Hearing Date –i �� � �5 License I.D. 4F �� � ��� at 9:00 a.m. in the Counci Chambers, 3rd floor City Hall and Courthouse State Tax I.D. �� � f� llate l�otice Sent Dealer 4� � /�' to Applicant ��. � � I /� P'ederal Firearms 4� !" '1 I Public He�.iring DATE INSP 'CTIUN REVIEW VERFIED (C MPUTER) CUNIl�IENTS A roved N t A roved � Bldg I & D ��� ! Health Divn. ' � r�� � � Fire Dept. i � 1� I � I I ,� S I�� Police Dept. S� Y�-� f License Divn. �` '• � a�s � � � City Attorney � Date Received: Site Plan /� ,� o Council Research Lease � a� p —� Date from Landlord (� _. -: -- .. _ . ._ . _ _ - - � - - _ . . . _ , �... , . _ . . , ..,. . .__ ,. — --�,- , .. .. 1 �;�#�_ ,,'� . . � . �-.. . .. ��. .. �.. . � .�:::. ' �. . .. � _n..'�7�'1',�tCil:.�:'i h ' � .. "' - '� :..... . Minnesota Charitable Gambling Contr 1 Board < � :�LAWFUL GAMBLING EXEMPTfON j Room N475 Griggs-Midway Building � : . . , : �.. , : - = . , � �1821 University Avenue � F . FOR BOARD USE ONLY,, - � , 5 ^ - St.Paul,MN 551043383 ` ` " ��' � � (612)642-0555 .. . ._ . . . . . x�T� � ������� . � - � , • =� _ � • . • F � .. .:- '�-� - -' . . .,.� r ^ . s,�� �rr�'��5.:... �� ... .... . e.',r:l. ..' ' ` ''. .'.'- . :: . : �, :-� . `.� : ."'. ". ` t � " � ��� INSTRUCTIONS: �1. Submit request for exemption a�Ieast�30 days prior to the occasion `?,'� >� � � 2. When completing form,do not omplete shaded areas until after the activity. , �� , � . 3. Give the gold copy to the City o County. Send the remaining copies to the Board.The copies.will be, z :: retumed with an exemption nu ber added to the form. When your activity is concluded; complefe - . . , � PLEASE TYPE ' the financial information,sign a `d date the form, and retum to the Board within 30 days. -' `� =-' -- � ,' O�r anizatio�Nam —+�• �'"i<u�.-- �.ri n r i t�.. Nu cof Members License Number(if currently or p�eviously "� � , �,/t�ch,�� �i!l GF I�I`�Cr�t� J�,f , �� licensed)and/or permit number. ' _�`w� A��r�� ��C..��fV1l.J� ���°t��� itY . / !'t��j.. Statg r, Zi�1�.'+J��� Co�Y"T+ (��.�".s� �����r Chief Executive Of icer's Name P.hone Manager's Name � � Phone Number #��.,�� �• �rti��TF# ,�:��Z, e�`�tL:. �:�:� F�c�:��1 t�. �r��t`f N ��1Z� �.yG—}t,�`�� ; Type of Organization If Other Nonprofrt Organization ICheck Orre and attach proof of rwnprofit statusl. ' ❑ Fraternal �Veterans ' �`-- ❑ IRS Designation ' _ : � . � ❑ Religion Other Nonprofit Organization Incorporate with Secretary of State � Attach proof of three years existence. �Affiliate of Parent Nonprofit Organization Name of Premises Where Activity Will Occur Datels)ot Activiry,drawingls) _ j�`� 'r1�.11�' L.t_(i Nt;::. KIA,.'��{-U�il.Zl� � +v�G)��.' f��rrr��at��)!�� �t''�I�� � ' ��' �.• ��, _ Pre 'ses Address - Ci�y - S t Z'�� � Co�nty ���� '� ` ��"''� " ��j�% l��14�T �'#r fZ°�' .�T. #�`:�U�C.... /�� ..�. E_..y :�r�z�j/ ,. Game ` '� Yes No � `t . �. :.�.-. . �x e..BingQ�'; �. ; � } ,� ,,�, , ;; '- � Raffles . , � �` � r _ ;a Paddlewheels `�' � `'Tipboards Pull-Tabs . : Use of Profit � {, . � � , • . . , . ,3 �c�rj�r������r� ..�,��ic�} �,� �'��c��/��•���a�i��,�� 5� `�'a/ �'��`r�� :� �:�.I a irmI��all information submitted to the Board is true,a cor- at ,ayYd comple � ' -� - , �3-�3 g� � Chief Executive Officer Signature ate •y: - • ACKNOWLEDGEMENT OF OTIEE BY.LOCAL GOVERNING BODY � . =' " �' >. . - -, . � -t. : ��� I hereby acknowledge receipt of a copy of this applicatio .By acknowledging receipt,I admit having been served with notice '- ,� ;,,that this application will be reviewed by the Charitable ambling Control Board and will become effective 30 days from:ihe �.� date of receipt(noted below)by the City or County, unl ss a resolution of the local governing body is passed which specifi-�' ;� cally disallows such activity and a copy of that resoluti n is received by the Charitable Gambling Control Board within 30 days of the below noted date. � ` � - CITY OR COUNTY - TOWNSHIP ' ; : N e f Local Gove�ni�g Body�City or Gounty) Township Name(Must be notified when County is the approving body) - � �i y, ��t.(.�x../ _ : ; • Signatyre "f� /�son' Receivina Appli tioii j � Signamre of Person Receiving Application �,,i � vt,�rt C_.-}tJ G�iv � ., : ` . Title ..� Date R i� Title . ' Date �� ��,,ti , .,�-- �J��� _ - _ ���._d � � CG-0OD20-01 I6/87) hite—Board � Canary.-Board retums to Organization to complete shaded areas. _ , Pink—Organization Gold—City or County -1 � �*h . ��-�9� CITY F SAINT PAIII. , •;. � , DEPARTMENT OF FIN CE AND MANAGII�NNT SERVICES DIVISION OF LICENS AND PEBMZT ADMII�TISTRATION INFORMATION RE UIRED WITH APPLICATION FO PERMIT TO CONDUCT G�IDLING SESSION ZN SAINT PAUL : Four sessians are allowed per year, wit each session bei.ag a maximum of four consecutive hours.. This application and all requir d attacl3ments must be filed with the Licease Iaspector at I.east thirty daqs prior to the requested date of the gambling event.. • S�•�wl Ck � I)- Name of organization � A �,�,� ' 2) Address where orgaaization`s regula meetings are held Z 70 �� �.� 3) Day and time of ineetings �i� � � 4) Address where gambling session will be held �70 �Q�' ��,'�,"�" 5) Is applicant owner of propertp wher gambling session wi1l be held? Yes � No 6) If Zeased, who is the owner of prop rty where gambling session wil1. be held? �i(�G �rau� l�,�r j�l �•k� �in,� �.,►rat,�cn� (�e�e�- 7) Name of officer makiag application S� J r 8) Address of officer '� Date of birth 9) Name of manager who will conduct g ling sessioa SanedA ���On 10) Address of maaager � �• Date of birth �� �S sZ TT) rn connection with what event is th gambling sessioa being held? a � � 12) What type of gambl.iag device(s) wil be u e � Paddlewheel Tipboard � Raf le � Pulltabs Bingo 13) Specifq when gambling session(s) wil take place: Dap(s) y O �� HOURS: •O 'O Date(s) From: • To: , (Maxi an�m of f our hOUI ) 14) Will prizes be paid in money or merc andise? ��n,C� 15) Is the applicant association organiz d under the laws of the State of Minnesota? � 16) How long has the organization besn eaistence? � �" �� �. 17) Wizat is the purpose of the organizat on? �;�[�M .,�JOUa' r Q/� �ro�. e,a�,ldrer IS) For what wi Z the p oceeds from this eveat be used? � � S�e�V'1 Ct PVi d y3- L a�if 19) Give names of officers or any other erson paid for services t� the organization. Name—Title Address Date of Birth f�esa Sw�i�l�► - f�zoidt�� �[ ��43 M�or;� �1��0�. vP �3 'i C�o � �I�01'�1 2fl) Officers of the orgaaizatioa: ��7�� ' Name-Title Address Date of birth ` • n�t� R�cord� Srcy � C AV6 �o' � �7 Srt,.�dn 1'�, C�.��.�p se� Au�a► 14u� � ��/s�. Carolyn G/l a�,�, Treasure� � k.l�aw v�e. � 8 s� src�e ��. fi�e«I s� 68 Carr�I �4r� i�J����7 � 21) Ia whose eustodq will records of or anization's gambling sessions be kept? Name � C,Q � Address ��/� ZQ ���� I"'rV�r � 22) Attach a cover Ietter defining the vent for which you are requesting this license. 23) Attach a letter of permission to c duct the gambl.ing session at the requested address. 24) Attach a copy of your organization` membership roster and date each member joined. 25) Attach a copy of the Departmeat of e Treasurq, Internal Revenue Service "Return of Orgaaization Exempt from Income Taa", Fona 990. [Chapter 419.04 (1) ] -0 - 26) Attach a copy of Department of the easury, Internal Revenue Sernice, "Exempt Organi- zation Busiaess Income Tax", Form 99 T. [Chapter 419.04 (2) J -0 - 27) Attach the anaual report required of charitable organizations by Mi.nnesota Statutes, _ Section 309.53. [Chapter 419.04 (3) ] 28) Have pou read aad do you thoroughly nderstand the provisions of a11 laws, ordinaaces, aad regul.ations governing the operat on of gambling sessions? y�s —� 29) Any changes desired by the applicant association ma.p be made onlq with the consent of the License Co�ittee. 30) Has any person(s) participating in t e operation of any of the gambling sessions covered by this license ever been co victed of a felon in the State of :iinnesota or in anp other State or Federal Court? Yes No �. If answer is "yes", provide names, addresses, and birth dates. � Organizat on: a�k � ��11 � �����.�. ��G. By: (Officer-T tle) and ��r , ���L�C� State of Minnesota) i (Manager in charge of gamb ' g ession) • � ss �i����U�.(,�-P/l. � •� C nty of Ramsey ) � Q and b " dulp sworn say that they are the pe itioners in the above application; that they have a e foregoing petition and kaow the ontents thereof; that the same is true of their own kaowledge. Subs ibed and swo ore me his; +sy�'M��+ °�� � , n.�.a�*�,ac�;«-� .l�day � � L� 19 � • . _ � _ .. '; L .���� '� �- b i •_ .. ' ,. , ,il( ,,.1,1;_ -. ^��r � ,,r �:,'�Tr1 ,i ; � ; � Notarq Public, County, es ta ',,�,�,_ ,; : � ..... _ . . . ,�,_t,,� �.., My Commission Expires �- ` "