88-518 N�HITE - CITY CLERK COI1�1C11
PINK - FINANCE G I TY OF SA I NT PA U L File NO. �� �� -
CANARV - DEPARTMENT
BLUE - MAVOR
� Co ci Resolution , ��
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,�__,,
Presented By
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That Application (I.D. # 1394) for a One Day City of St. Paul
Gambling Permit (Pulltab Only) applied for by St. Adalbert's
Church at 265 Charles St eet between the hours of 4:00 P.M. and
8:00 P.M. be and the sam is hereby approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays �
Dimond
�� [n Favo
Goswltz
Retbmaa �c
��;�� Against By
Sonnen
�VY'�Iseq.
APR 1 2 � Form Approv d by City Attorney
Adopted by Council: Date "
Certified Yas e uncil Secret By ' 3� �
gy ��✓�..
� � : ; � Approved by Mayor for Submission to Council
F�ppr by Mavor: Da e ',,-'�= k ,
g ' By
PUBIISHED �.��" �' � 9$8
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:� �.. c��. �,�..ry, �„�� �REEI� �H�ET � No.0 016 3 9 -
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Nu�ASER�R
. aHOnie No. �DaET oa�cton 2 QOII[1C�.a, �'�:�1,_,
Furv� & l�hgt�nnt. 298-5056 onoEr+: 1�,:,,,,�,, :
: � -
Councii Research Center
c3�e nay city o€ saint`Pau]. c�nb3.ing � 't tPul.ltab�s). APR 0 5 �$g
1�IFICATICIN: 3/28/88 I�R.tAiG : 4l'].2/88
IIHf�1�/1710N9:(MCr�t�)a ReJect(R)) COUMCIL REPORT:
bu�►o c�aw cron_sERVm�co�ussar, J;+� I a►�our�� u�vsr a►�a�rro.
ao�ia c�reea►+ �so szs scHOO�eonAO t � � �
� . � -. BTAFF , � � . . � CMAR7ER COMMI391�1 . � � AS.�3 �. -ADOL NrFO.AIDOED*' �_�ADD7.��MIFO�. _�ADOED .. �
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q8TR1CT OOUNCIL � . � � �
. •EMPLANA . . . . � � . .
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� �'�7�7."EYlIC�� `.C1CCl KEY71�Ily �1 �]�.� O� $tr ���.L"'t.�8 �� �8Q�1�t:8 L'O�l7IlCj.� �OR1c�, fQL'
his �ppl.icaticn for a (�e Day City af Paul GambLin� �xmit (Pu]:ltabe c�.y) . The
Pul:�.tabos� wili be:�old'in �j�ori with a Parish d�n�x °t�o be he7.d Agril 2i, Z988 at
265' C�arles Av�eait3e betr�en tY�e h�urs of 4 00 p.m. an�l 8:OD p.tn. Praoee�s wi1l go to the _
C�ia�rch.
;w�+c�rwM�:�.�r.o.a.�.►:.
If C�aycil app�raval is g�.vpxi, St. �,d�a '8. w1�i.ch has beP.n_an existe�ce 'for o�v�er`100 ye�s,
will be able �o sell p�ul.li:abs at their P sh diriner.
twhn.whw�.a�a rc w►wm): _ , : . . - , .. :` .
If C3cnu�cil app�roval is r�t giv�,.St. 's ��.11 r�ot be ab�e #o sell pulitabs at their
di.�tler.
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M�TOIIYMI�@1i8:
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DIVISION OF LICENSE ANI) P�RMIT ADMINIS RATION DATE 3 I �0 / � � S�
INTP,RDF.PARTMENTAL REVIEW CHECKLIST Appn rocessed/Received y
Lic Enf Aud
.�''
Applicant �GV• I 1 w1 KQ1r!'1Q t� Home Address p�� �Q N' I�..g
Business Name Q-� �. ���dtQe Phone s�a 8 ' �0D�
Business Address p��,Q� Yll Type of License(s) �.f'�"� �r1'1'1�•�
Business Phone o�g" �� cri L r�pt�'QW�1QZ�5 ! 1 ��j
) ' / c�. s �4
Public Hearing Date `"'1 (s7 g� License I.D. �{ Cp)_ q
at 9:00 a.m. in the Counci Chambers, A
3rd floor City Hall and Courthouse State Tax I.D. 4C � ��1
llate l�otice Sent; . � Dealer 4� � '/�'
to Applicant �
Federal Firearms �� � �}
Public Hearing --�
DATE II�`SP 'CTION
REVIEW VERFIED (C UTER) COMMENTS
A roved Not A roved
�
Bldg I & D , t I� �
IV
Health Divn. '
, � �� �
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Fire Dept. i x '�/� �
�\� �r�
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Police Dept. �� I �� o
�
License Divn. �K �
�►�Ig�
City Attorney �
Date Received:
Site Plan N Tl , ! � ��
To Council Research �f
Lease or ��er ,� L /'� Date
from Landlord �t,T'�� 1rY� l.i �/�
��� .-- - Gc ��-6/�
� ';' Minnesota Charitable Gambling Control oard LAWFUL GAMBLING EXEMPTION
:�;;-:°:' Room N475 Griggs-Midway Buiiding
�, 1821 University Avenue FOR BOARD USE ONLY
���• ` . � St.Paul,MN 55104-3383
�& :;. -
�,�Y:.. � ..�:: . (6121642-0555
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'a�INSTRUCTIONS: 1. Submit request for exemption at le st 30 days prior to the occasion.
n � '; 2. When completing form,do not co plete shaded areas until after the activity.
3. Give the gold copy to the City or C unty. Send the remaining copies to the Board.The copies will be
��-�:.� returned with an exemption numb r added to the form. When your activity is concluded; complete
�3R`;PLEASE TYPE the financial information, sign and ate the form, and retum to the Board within 30 days.
.?��«`.` Organization Name Number of Members License Number lif currently or previously
��? � Church pf �t'i. Adalbertts �,= "' 5� licensedland/orpermitnumber.
_�;
�.� 'Address City State Zip County
�+k., 26� Charles Ave. yt. �aul :'�inn• jJ�J� :La�.Se�
">�J:-', Chief Executive Officer's Name Phone Manager's Name Phone Number
` ji'2'• • el• �@r218� '; ,_. .. . � �612� 223:�'�'� ; >}"z'�,: ��.ti1,r;4'i�.'T?1aF1�.:a�r - i C��1� �i G'C+`,��QZ �'
,..,. . _
�+�.�y' . ... _ ._ ., . �_ _ _ .
,r, Type of Ofganization If Other Nonprofit Organization(Check One and attach proof of rwnprofit statusl.
;._�:�. ! ❑ Fratemal ❑ Veterans 0 IRS Designation
L3] Religion ❑ Other Nonprofit Organization 0 Incorporate with Secretary of State
.- -Attach proof of three years existence. ❑ Affiliate of Parent Nonprofit Organization
Name of Premises Where Activity Will Occur Datelsl of Activity,drawing�sl
� Church of St. AdaZbert�s
Premises Address City State Zip County
- 2b5 Charles Ave. St. Pa�l • '•tir.n. 5�i'� Ra^�se f-21—&�
- ��.������. ,�
;, �;� °xll[`aEket`fi/alne�,
� Game Yes No �" � ���`:``�w
Bingo
�"`�= Raffles
a
_"`',���Paddlewheels
�
�'` Tipboards
.s
y-� �` Pull-Tabs �
s
"�',^' Use of Profit
tr`r':
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,.. ..'. ..: ...: . , � .. _. . . . _ .
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� • •� I affirm all information submitted to the Board is true, acc r- �` �� "iit +� oard i .
�, �� ate, and complete.
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��:�Chief Executive Officer Signature Dat ��' x' ��`��>
" ACKNOWLEDGEMENT OF N TICE BY LOCAL GOVERNING BODY
I hereby acknowledge receipt of a copy of this application.By acknowledging receipt,I admit having been served with notice
'= that this application will be reviewed by the Charitable Ga bling Control Board and will become effective 30 days from the
w�.�; date of receipt(noted below)by the City or County, unles a resolution of the local governing body is passed which specifi-
- cally disallows such activity and a copy of that resolutio is received by the Cha�itable Gambling Control Board within 30
- days of the below noted date.
CITY OR COUNTY TOWNSHIP
Name of Local Governing Body(City or County) Township Name IMust be notified when County is the approving body)
r
� . -�t.l:L i i,�; �,.� � . . _ �.
Signature of PBrson Receiving Applicazion� Signature of Person Receiving Application
,;� . � ,.. � �- . ,�r,._
Title + '; _ �Date Recei d Title Date
-�: � .,r,a,:.J.�,s t,:y�:.i. , t Ur� �, - _
_ r
CG-00020-01 (6/87) White—Board Canary—Board retums to Organization to complete shaded areas.
Pink—Organization Gold—City or County
. . ,:�- cz�r o sa�.�rr PAUL ��6/�
� ' ' DEPART: .�Ti T �F FINAN E k� MANAGEiEVT SERVICES
l DIVISION OF LICEDISE A��'D PE:tI�IIT AD:iINISTRATION
INFORMATION REQUIRED WITH APPLICATION FOR PEItMIT TO CONDUCT GAI�LING SESSION IN SAINT PAUL
Four sessioas are allowed per year, with each session beiag a maximum of four consecutive
haurs. Tliis applicatioa aad a11 require attachments must be filed with the Licease
Inspector at I.east thirty days prior to he requested date of the gambling event.
1) Name of organization ._� /��L �
2) Address where orgaaizatioa's regul.ar meetings are he1.d ,,'1 1� C//���C.�'��
3) Day and time of inestings �
4) Address where gambling session will e held �2 G:� C:iCu� G�`���
5) Is appl.icant owaer of propertp where gambling sassion will be held? _�Yes No
6) If leased, who i.s the owner of pro�e ty w�ere g�tbliag session wi11 be ueld?
�'— _
7) Name of officer making application �
-T �
8) Address of officer� (, S— �.e r 57��,� � Date of birth �o,�CC.� .39
�
9) Name of manager who will conduct gamb ing sessiaa s�,,,,_,�
LO) Address of maaager
11) Ia coanection� with what event is thi gambling sessioa being held?
f ,L��-�''
12) Wliat type of gambling device(s) will e used? Paddlewheel Tipboard
_ . _____.. Raff e Pulltabs __`�_ Biago
13) Specify when gambling session(s) wilZ take place:
/ HOIIRS:
Day<s) �7�-��� Date(s) G -� -/1�5� From: � To: �
(Maximum of four hours)
14) Will prizes be paid in moaey or merch dise? ��c�v��
i �
15) Is the applicant association organize under the Iaws of the State of �Iinnesota? Yef
16) How long has the organi.zation been in existence? ��'�� . �
17) Wizat is the purpose of the organizati n? wb`Sh cfo D�Gb� �' Gr�„� ��or�s ��z ou.�-
18) Officer,�of-the organization: f Govx.�.����
lName Title Address Date of birth
�e�. T J/�'e.rnc�t. �G S` v/.e s �U 3
� ��-s��
19) . G�,ve names of ofi�cers or any other erson paid for services to the organization.
Nane-Tit1.e Address Date of Birth
, � . �
20) Ia whose custody wi.11 records of org ' ation's gambling sessions be kept?
Name S Gt-l►ti --Q� Address
21) Attach a cover Ietter defining the e ent for vhich you are requesting this license.
22) Attach a Ietter of permission to con uct the gambling session at the requested address.
23) Attach a copy of your orgaaization's membership roster and date each member joined.
24) Attach a copy of the Department of t e Treasury, Internal Revenue Service "Return of
Organization Exempt from Income Tax", Eorm 990. [Chapter 419.04 (I)]
25) Attach a copy of Department of the T easury, Internal Revenue Service, "Exenpt Orgaai-
zation Busi.ness Income Tax", Form 99 . [Chapter 419.04 (2) I
26) Attach the annual report required of charitable organizations by Minnesota Statutes,
Section 309.53. [Chapter 419.04 (3) j
27) Ha.ve you read and do you thoroughly derstand the. provisions of aIl laws, ordinances,
and regulations goveming the operati n of gambling sessions? y�s
28) Any changes desired by the applicant ssociation maq be made onlp with the consent of
the License Committee.
29) Has any person(s) participating in th operatioa of any of the gambling sessions
covered bq this Iicense ener been con icted of a felon in the State of Mianesota or
ia any other State or Federal. Court? Yes No �. If answer is "yes", provide
names, addresses, and bisth dates.
Organizati n: �I,LVG� 07 �1`,�F�Q (!�-e r �
.
By: (Officer-Ti le) �a--
and ��,�� �
State of Mianesota) (Manager in charge of gambliag session)
) ss
County of Ramsey ) t ,
�
-P_ti/ ✓ � . Cc_f/� �,*� � �-��,��
being duly swora say that they are the pet tioners ia tfie above appl.icat on; that they have
read the foregoing petition and know the c ntents thereof; that the same is tzue of their
own kaowledge.
�+*Me�ev�w+c,ra•��nr�o�,.����o�ss��.;>��
Subscrfbed and swora before me this �'' ��"`""'`�Y� �'� C_'_ _ � ^ ���i
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Notarq Pub ic, Couaty, Minneso
My Co�issioa Expires
Building Department Approved D approved by
Fire Department Approved D" approved by
Police Department Approved D approved by
City of Saint Paui ���j /�
Department of Fi ance and Management Services � ^ ��
Licen e and Permft Division � �
,. 203 City Hall�
, " St. Paul, Minnesota 55102-29&5056
APPUC TION FOR LICENSE
CASH CHECK CIASS NO. New Renew
� Q 0 _Z� x Q r•,
" Date �—/� �9�'
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�� Code No. Title of Licen§e From `��� �T�� `'� 19
o(o �.t t I ��s C� •:,'�5 -,
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ApplicenUCompany Name
100
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100 Buaineas Nam�
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100 `; i . �� t�-� �"� �."� �, ,�,/O•�
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Busineas Address Phone No.
100
100 Mail to AdCross Phone No.
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too T��t/• I ' !� P i • ��i , 1 ��.�i>.
ManapsNOwnar•Name
100 c�lD:� L �tQ,�' '�S
100 AtanapeqGwner-Home Address Pho�e No.
4098 Application Fee
Recelved the Sum of 2 150 �,J� ' � j �; , � �`;���,
09.. lt��` / .
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� 5 ManaysNOwner-Clty,Slate 6 21p Code
100 To al 100
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License Inspecior ��-- �
BY� Sig�aturQOf Applieant
Bond•
Company Name Policy No. Expiratio�Date
Insurance:
Compa�y Name Policy No. Expiration Date
Minnesota State Identification No. Social Security No
Vehicle Information:
Serfat Number late Number
Other.
THIS IS A RECEIPT FOR APPLICATION
THIS IS NOT A LICENSE TO OPERATE Your application for lic nse will either be granted or rejected sub�ect to the provisions of the zoning
ordlnance and complation o(tha inspections by the Health, Fi e,Zoning and/or license Inspectors.
$15.00 CHARGE FOR ALL RETURNED CHECKS
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� ��sr�
_ ��..•.. ' CITY OF SAINT PAUL
e~• �y r� DEPAR MENT OF FINANCE AND MANAGEMENT SERVICES �
� '��� a� DiVI510N OF LICENSE AND PERMIT ADMINISTRATION
'� Room 203. City Hall
....
Saint Paul,Minnesota 55102
George�latimer
Mayor
L•
3/22/88
To: Captain Steenberg
From: Christine Rozek G� •
Re: Record Check
In connection with an application for a one day ciy gambling permit (Pulltabs only)
at 265 Charles Avenue, a record c eck is requested on the following:
Tim Kernan
265 Charles
St. Paul
Birthdate: 8/20/39
CR/car
� ����
_4�,��*�e,� CITY OF SAINT PAUL
. ', DEPART ENT OF FINANCE AND MANAGEMENT SERVICES
�• = I we'
�� � DIVISION OF LICENSE AND PERMIT ADMINISTRATION
,.�. Room 203, City Hall
Saint Paul,Minnesota 55102
George latimer
Mayor
March 28, 1988
Reverend Tim Rernan (Church of St. Adalbert's)
265 Charles
St. Paul, MN 55103
Dear Reverend Kernan:
Your application for a City G bling Permit has been received in this
office.
A hearing on your application or Pulltabs ID �(s) 61394 will be held
before the St. Paul Citq Counc 1 on April 12, 1988 at 9:00 A.M., Third
Floor of the City aad Countp C urt House. This date may be changed
without the License & Permit D ision's consent and/or knowledge. _
Therefore, it is suggested tha you call the City Clerk's Office at
298-4231 to confirm this hear date.
You are hereby notified that y r attendance is required at this
meeting. Failure to appear ma result in denial of your application.
Very truly yours
� � � •
7`%
J eph F. Carchedi
License Inspector
JFC/lk